The task force committee against COVID-19 of the Japanese Society for Transplantation has registered all cases of COVID-19 among organ transplantation recipients in Japan. Details of the survey up to November 2, 2020, were reported.

A total of 35 recipients were registered, 14 by the end of May and 21 after June. The ratio of the recipients to the number of new infections in general has decreased to one-third since June. The infection route, age distribution, period from transplantation to infection, symptoms at onset, and prognosis were reported.

On the other hand, according to the report of the Japan Organ Transplant Network, deceased organ donation decreased from March to June 2020, but returned to the same level as usual in September. The mutual aid system was introduced to reduce the risk of medical staff against COVID-19 for organ donation.

This report presents Japanese status of organ procurement from deceased donors for organ transplantation in 2019, just before the COVID-19 pandemic in Japan.

The Act on Organ Transplantation was established in July, 1997, and amended in June, 2009. After the enforcement of the amended Act on Organ Transplantation in July, 2010, the number of brain-dead donors vastly increased. But the total numbers of deceased donors for organ transplantation, which were almost the same in 2010, 2011, and 2012, decreased in 2013 and 2014 and slightly increased in 2015, 2016 and 2017. But in 2018, incredibly, the total number of deceased donors decreased to 95. In 2019 the total number increased again to 125. Only in Japan among developed countries, are the numbers of the deceased donors limited. The lives, which are cured by the organ transplantation around the world, cannot be cured only in Japan.

The organ procurement for transplantation from deceased donors is supported by the efforts of procurement teams.

A total of 2,057 kidney transplants including 1,827 from living donors, 54 from non-heart-beating donors and 176 from heart-beating donors were performed in 2019 in Japan.

The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, status of viral antigens and antibodies, pretransplant complications, causes of death of deceased donors, ischemic time and histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed.

We also report the results of follow-up survey for recipients and living donors.

As of December 31, 2019, a total of 10,038 liver transplants had been performed in 69 institutions in Japan. There were 595 deceased donor transplants (592 from heart-beating donors and 3 from non-heart-beating donors) and 9,443 living-donor transplants. The annual total of liver transplants in 2019 was 395 (88 deceased donor transplants and 307 living-donor transplants). The most frequent indication was cholestatic disease, followed by hepatocellular disease and neoplastic disease. As for hepatocellular disease in 2019, alcoholic cirrhosis and non-alcoholic steatohepatitis were the most common. Patient survival following transplantation from heart-beating donors (592 transplants: 1-year 89.6%, 3-year 86.1%, 5-year 82.9%, 10-year 74.9%, 15-year 64.4%, 20-year 49.5%) was similar to that from living-donors (9,443 transplants: 1-year 85.4%, 3-year 81.5%, 5-year 79.0%, 10-year 73.9%, 15-year 69.3%, 20-year 65.8%, 25-year 63.1%, 30-year 58.2%). Graft survival was very much the same as patient survival (heart-beating donor: 1-year 89.1%, 3-year 86.1%, 5-year 82.8%, 10-year 74.8%, 15-year 64.3%, 20-year 49.5%; living-donor: 1-year 84.7%, 3-year 80.5%, 5-year 77.9%, 10-year 72.3%, 15-year 67.2%, 20-year 63.4%, 25-year 60.4%, 30-year 55.1%). Survival data are reported according to age and sex of recipient, indication, graft type, age and sex of donor, ABO-compatibility, and other factors.

Since the Organ Transplantation Law was passed in October 1997, a total of 512 heart transplantations (HTx) had been performed in Japan as of December, 2019. Of those, 443 HTx were performed after activation of a revised Transplant Act, and 84 were performed in 2019. Most recipients had dilated cardiomyopathy; and the waiting condition of all patients was status 1 at HTx. The mean waiting time as status 1 continuously increased to 1502 days in 2018 from 892 days in 2014 in adults. After approval of the use of the implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) in 2011, BTT, especially using cf-LVAD, increased. In 2019, 63 of 67 adult cases were supported by several types of cf-LVADs. Mean support duration also continuously increased to 1531 days in 2019 from 876 days in 2014. Fifty children underwent HTx and 38 (76%) of them were BTT cases (8 in Nipro VAD, 13 in EXCOR VAD, 9 in Jarvik 2000 and 8 in other cf-VADs). Most of the patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with calcineurin inhibitor (cyclosporine or tacrolimus), mycophenolate mofetil, and steroid as an initial immunosuppressive regimen. Patient survival at 10 and 15 years was 89.4% and 79.1%, respectively, which is superior to that of the international registry. This survey documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.

【Objective】 To scrutinize the status of lung transplantation in Japan, the Japanese Society of Lung and Heart-Lung Transplantation started to collect and present registry data from 2005. This is the 16th official registry report of Japanese lung transplantation.

【Design and Methods】 The data for cadaveric lung transplantation and living-donor lobar lung transplantation performed by the end of 2019 were registered in the database and analyzed with respect to the number of transplants, recipient survival rates, recipient functional and working statuses, and causes of death after transplantations. Survival rates were calculated by the Kaplan-Meier method.

【Results】 A total of 526 cadaveric lung transplantation (276 single, 250 bilateral), 234 living-donor lobar lung transplantation and 3 heart-lung transplantation procedures were performed by the end of 2019. Five-year and 10-year survival rates of cadaveric lung transplantations were 71.2% and 58.9 %, which were superior to those in the international registry. Five-year and 10-year survival rates of living-donor lobar transplantations were similar to those of cadaveric lung transplantation, with 73.6% and 61.9%. The recipients of 3 heart-lung transplantations are alive. The functional status of more than 80% of recipients was restored to a mMRC scale grade of 0 or 1 after transplantations. Infection has been the leading cause of death after lung transplantation. The number of deaths from chronic lung allograft dysfunction, malignancy and post-transplantation lymphoproliferative disease have been increasing in recent years.

【Conclusion】 The outcomes of Japanese lung transplantation are so far satisfactory. The modified Japanese transplantation law has been enforced since July 2010, and an increase in the number of cadaveric organ transplantations was achieved thereafter. The Japanese Society of Lung and Heart-Lung Transplantation will continue to present annual reports of Japanese lung transplantations.

A total of 437 cases of pancreas transplantation from deceased and living-related donors have been performed in 18 institutions in Japan between April, 2000, and the end of 2019. The following donor- and recipient-related factors were analyzed: age and gender of donor and recipient, cause of death, history of diabetes and hemodialysis, waiting period, total cold ischemic time, operative procedure, immunosuppression and survival rates of patient and graft. Based on the analyses, the current status of pancreas transplantation in Japan was demonstrated. Although the donor conditions have improved every year, they were still mostly marginal. The patient survival after the transplantation was 95.8%, 95.8% and 94.2% at 1, 3, and 5 years, respectively. The pancreas graft survival in SPK cases was 87.3%, 85.4%, and 83.2% at 1, 3, and 5 years, respectively. The pancreas graft survival in PAK (85.4%, 67.6%, and 52.3% at 1, 3, and 5 years, respectively) and PTA cases (66.7%, 41.6%, and 31.2% at 1, 3, and 5 years, respectively) was significantly poorer than in SPK. The main cause of pancreas graft loss was graft thrombus in SPK cases, while it was chronic rejection in PAK and PTA cases. In conclusion, we demonstrated the current status of pancreas transplantation in Japan. While the posttransplant outcome was comparable to that in the United States and Europe, it is necessary to overcome graft thrombus in SPK cases and chronic rejection in PAK and PTA cases for improving the posttransplant outcomes.

In April 2020, islet transplantation was covered by health insurance in Japan. Clinical islet transplantation has been suspended temporarily since July 2019; currently, each facility is in the process of preparing for clinical islet transplantation coverage by health insurance and clinical islet transplantation will be restarted the summer of 2020. Islet transplantation performed using the Edmonton protocol as a clinical trial at each institution that has performed it from 2004 to 2007 and islet transplantation performed as a multi-center clinical trial based on the CIT protocol performed from 2012 are introduced in this report. In addition, the new criteria for the approval of an islet transplant facility and recipient criteria for islet transplantation are introduced as well.

Thirty intestinal transplants have been performed since 1996 in 6 institutions. There were 19 deceased-donor and 13 living-donor transplants. Primary causes of intestinal transplants were short gut syndrome (n = 13), intestinal mobility function disorder (n = 14), others (n = 1) and re- transplantation (n = 4). One-year patient survival was 89%, and 10-year patient survival was 53%. They were excellent results for a standard therapeutic option for intestinal failure if patients fail to maintain total parental nutrition.

Hematopoietic stem cell transplantation (HSCT) offers potentially curative treatment for a wide range of otherwise fatal hematologic disorders, and the number of HSCTs has continued to increase over the last 20 years; more than 5,000 allogeneic and autologous HSCTs have been performed annually in recent years. A constant increase of allogeneic HSCTs for older (aged over 50) patients, and an increase in the variety of donor/stem cell sources such as cord blood from unrelated donors have led to this constant increase of HSCT in Japan. The transplant survival outcome also continues to improve and the assets for the improvement include better supportive care, innovative transplant approaches, and the considerable contribution of a well-established transplant outcome registry to a variety of clinical studies.

【Objective】 Patient decision-making in relation to maintaining a high quality of life and sustaining self-management behaviors are predicted to be imperative for long-term graft survival in kidney transplants. The purpose of this study is to elucidate the relationship between decision-making for kidney transplant and self-management behavior, and post-transplant satisfaction, and factors related to self-management behavior and post-transplant satisfaction.

【Design】 A cross-sectional and descriptive survey.

【Methods】 Self-administered questionnaires were conducted among 202 kidney transplant recipients of A hospital in 2017.

【Results】 A total of 158 completed the questionnaires. The relationship between decision-making for spontaneous transplantation and self-management behavior was not confirmed, but post-transplant satisfaction was higher when transplant professionals affected decision-making. Self-management behavior was higher in women and unemployed persons, and decreased with increasing years after transplantation, showing a positive correlation with satisfaction after transplantation. Factors that increased satisfaction after transplantation were no comorbidities or readmissions, serum creatinine levels of less than 2 mg/dL, and employment.

【Conclusion】 Appropriate provision of information by transplant professionals at the time of decision-making will improve post-transplant satisfaction and self-management ability. In addition, patient-tailored guidance by professionals is necessary for self-management support.

【Objective】 The purpose of this study is to identify the factors involved in low back pain (LBP) that interfere with rehabilitation after living donor liver transplantation (LDLT).

【Design】 Retrospective study.

【Methods】 We recruited 34 patients who underwent LDLT between January 2016 and March 2018, at The University of Tokyo Hospital. From postoperative Intensive Care Unit (ICU) stay to 1 month after release from the hospital, we examined the presence or absence of LBP, investigated its relationship with the patients’ backgrounds and postoperative factors, and studied the cause of LBP by postoperative period.

【Results】 Thirteen patients (38.2% of the whole) developed LBP. They had higher weight gain rates and maximum Body Mass Indexes (BMI). The mechanical ventilator extubation date and the starting point of postoperative mobility were also longer in these patients. During the postoperative ICU stay, these patients had difficulty in changing their posture on the bed and struggled with the softness of the mattress, lending to the development of LBP. Furthermore, motions and postures that strained the lower back were linked to higher risk of LBP during the post ICU period.

【Conclusion】 In LDLT, it is necessary to take appropriate management for LBP from the early postoperative stage to after discharge.

A woman underwent ABO-incompatible living kidney transplantation in her fifties. She was taking three immunosuppressants, tacrolimus, everolimus and methylprednisolone. Three years and eleven months after the transplantation, her blood test showed pancytopenia and liver dysfunction (AST: 136 IU/L, ALT: 91 U/L). As a result of scrutiny, we diagnosed PVB19 infection and treated it with a dose reduction of immunosuppressant and blood transfusion. The treatment was successful without IVIG administration, and there has been no recurrence.