【Objective】 The purpose of this study was to examine the relationship between the type of information the parents received from high school students and the parents’ interest in organ transplants and the presence of family dialogue.

【Design】 Cross-sectional study.

【Methods】 The transplant medical education was carried out at three Ibaraki prefectural high schools, and the lecturer urged the students who attended to tell their parents what they learned in the class. We conducted a cross-sectional survey of high school parents by anonymous self-administered questionnaires. Question items were 10 items concerning organ transplantation and donation. The analysis was performed by chi-square test.

【Results】 Questionnaires were distributed to 464 persons, and 255 valid responses were received. When the subjects answered that they read the handouts, the percentage that answered that they interacted with family for the first time was high. When the subjects answered that they heard the story from the child, the percentage that answered that they interacted with family for the first time was high. When the respondents answered that they read the handouts, a high percentage answered that they were interested before. It was not related to whether the subjects heard from the children and their interest in organ transplantation.

【Conclusion】 It was suggested that parents may receive interest in organ transplantation by receiving information on organ transplantation from children. It was suggested that parents who are not interested in organ transplants cannot receive information on organ transplants simply through utterances and handouts from their children.

【Objective】 We surveyed the opinions and concerns of medical consultants (MCs) regarding organ-donor evaluation and management in Japan.

【Design】 Cross-sectional questionnaire survey.

【Methods】 We used a questionnaire regarding the opinions and concerns of MCs regarding organ-donor evaluation and management.

【Results】 Responses were received from 100 of 169 MCs (59.2%). Of the responding MCs, 69% supported organ-donor evaluation and management by emergency physicians or intensive care physicians, and 20% supported the former Japanese system of visits by MCs.

【Conclusion】 Many of the MCs were in support of organ-donor evaluation and management by emergency physicians or intensive care physicians. The responses clarified the appropriate medical care, and the preparation of an instruction manual and a clinical trial were suggested. There was also concern over extended criteria donors and transplant organ variation, injuries, and dysfunction. Appropriate procedures for such cases should be considered.

【Background】 Liver transplant recipients occasionally need long-term hospitalization due to liver dysfunction from chronic rejection, recurrence of primary diseases, or other illnesses such as malignant tumors. On such occasions, however, it is not always possible for transplant centers to satisfy the recipients’ and their families’ requests due to limited capacity. Here, we report a case who needed long-term hospitalization due to liver failure from chronic rejection and wished for home care- based follow-up. Further, the role of recipient transplant coordinators in its implementation is discussed.

【Design】 Case report.

【Managements and Results】 The patient is a 60-year old female who had undergone a living donor liver transplantation for fulminant hepatic failure. Fifteen years after the operation, she developed liver failure due to chronic rejection, characterized mainly by repeated hepatic encephalopathy. The patient and her family rejected the treatment option of re-transplantation, and hoped for home care-based follow-up instead. To establish the follow-up system, the recipient transplant coordinators first managed the conferences with medical doctors, nurses, pharmacists, and nutritionists. As a result, the problems of the patient and her family could be shared, and all medical professionals could work as a team to achieve the treatment goal. Second, the coordinators organized a support system with the regional medical facilities including visiting nurses and a nearby hospital. Eventually, her home care-based treatments were successfully established.

【Conclusion】 As the age of recipients increases and as the number of long-term survivors grows, cooperation with multifactorial medical professionals and collaboration with community resources become crucial and indispensable. Early action is necessary and would contribute to sustainable care in patients’ residential areas. Recipient transplant coordinators play an important role for its implementation.

A retrospective survey was conducted to assess the status of organ transplantation in patients with pre-formed donor-specific anti-HLA antibodies and the implementation of desensitization with rituximab in Japan. We obtained the data from 227 institutions for procedures performed between 2013 and 2016 for kidney transplantation and between 2001 and 2016 for transplantation of other organs, including the liver, pancreas, heart, lung, and intestine.

Results showed pre-formed donor-specific antibodies (DSA) in recipients of 529 transplanted kidneys; rituximab was used in 462 of those transplantations. Rituximab was used in 48 of 135 liver transplantations in recipients with pre-formed DSA and in 1 of 1 small intestine transplantation involving pre-formed DSA. Such DSA was also reported in 5 heart transplants and 4 lung transplants. However, rituximab was not used for desensitization in any of those procedures.

We also report on detection and assay of anti-HLA antibodies and DSA, criteria for transplantation, dosage of rituximab, and concomitant immunosuppressive drugs used at the institutions.

We retrospectively surveyed the status of rituximab use in treatment for antibody-mediated rejection (AMR) in Japan between 2013 and 2016 for kidney transplantation and between 2001 and 2016 for transplantation of other organs, including the liver, pancreas, heart, lung, and intestine.

Two hundred twenty-seven institutions responded. AMR developed in 493 patients who underwent kidney transplantation; 288 of those patients were treated with rituximab. AMR developed in 81 patients for liver transplantation, 4 patients for pancreas transplantation, 16 patients for heart transplantation, 22 patients for lung transplantation, and 2 patients for small intestine transplantation; rituximab was used in 18, 4, 4, 14, and 1 of those patients, respectively.

We also report on treatment details and rituximab dosage.