Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), which was declared a pandemic in March 2020, has since caused a serious global health crisis. COVID-19 has spread to more than 200 countries and millions have fallen ill. Patients who have undergone an organ transplant are at increased risk of complications from COVID-19 due to conditions such as hypertension, diabetes, cardiovascular disease, chronic lung disease, and obesity, as well as chronic immunosuppression. We measured antibodies to the five SARS-CoV-2 proteins in kidney transplant patients who received two approved and available BNT162B2 (mRNA) vaccinations. It is possible to simultaneously identify antibody reactions to the extracellular domain (ECD), the three individual domains of the spike protein (S1, S2, and the receptor-binding domain (RBD)), and the five proteins of the nucleocapsid. The serological response following BNT162B2 COVID-19 mRNA vaccination was investigated using possible receptors. The subjects were 111 patients one month after receiving two coronavirus vaccines following kidney transplantation. Antibodies were found in 41% (46 cases). The positive rate of antibody formation tended to be low in transplant patients, whereas in the control group of healthy subjects it was 100%. The positive rate indicated by immunosuppressant was 36% (37/100) in the cases using tacrolimus at the time of vaccination and 90% (9/10) in the cases using cyclosporine. The intensity of each fragment in antibody-positive cases showed the normalized mean fluorescence intensity (nMFI), which indicated the highest ECD levels in the transplant patients and healthy control groups, followed by RBD, S1, and S2. In the reactivity pattern of the fragments of the positive cases, the control group had an nMFI of 110,000 to 140,000, while the transplant patients had an nMFI of 6,900 to 25,000, showing a difference in cumulative nMFI. The proportion of fragments also varied greatly among transplant patients, and no uniformity was observed. By contrast, in the healthy control group, the nMFI value tended to be constant for each fragment. The results suggest that performing antibody monitoring during the Coronavirus crisis may be useful for the protection against and treatment of infection as well as in determining the individual vaccination interval, vaccination amount, and number of vaccinations required.

【Objective】 The purpose of this study was to find strategies to increase the intention rate of organ donation. We investigated the current status and characteristics of organ donation intention and their relation to health consciousness.

【Design and Methods】 We conducted a cross-sectional survey of 660 patients visiting a university hospital in the metropolitan area. We determined their background, presence or absence of organ donation intention, and health consciousness (health literacy and subjective well-being). For statistical analysis, we used a stepwise method of variable selection, adjusted the confounding factors using propensity scores, and used logistic regression analysis to clarify the relation between organ donation intention and health consciousness.

【Results】 Two hundred sixty-three questionnaires were returned (recovery rate 39.8%), of which 248 were used. The intention rate of organ donation was 22.6%. It was higher for non-elderly people (p=0.0002) and those with a medical history (p=0.0132). It was related to health literacy (p=0.0373) and critical health literacy (p=0.0049), which was a sub-item of health literacy.

【Conclusion】 It is thought that high critical health literacy may have led to the skill to understand the social and economic significance of organ transplantation. Health literacy and critical health literacy must be increased to increase the intention rate of organ donation. It is important to make a visit to a university hospital a valuable opportunity. It is necessary for medical professionals to confirm the organ donation intention to give meaning to the social significance of organ donation, and to provide support to increase empowerment.

【Background】 The shortage of organ donors has been critical in Japan both in donation after brain death and conventional donation after cardiac death (DCD). As one of the international trends towards expanding the donor pool, Maastricht Category III controlled DCD (cDCD) has been recognized as a promising strategy.

【Objective】 In order to understand the current status of cDCD organ transplantation, particularly of hearts and lungs, recent world reports are reviewed.

【Results】 In Europe, a significant expansion of the donor pool has been demonstrated by introducing cDCD. Heart as well as lung transplantation from cDCD donors has been developed as a reliable option using ex-vivo machine perfusion in Australia, the UK and other countries.

【Conclusion】 Under the critical shortage of organ donors in Japan, the role of cDCD should be discussed cross-sectionally among transplantation organs taking into consideration ethical and legal issues.

【Objective】 The present study involved the conduct of a simulation of lending surgical equipment for organ recovery to help optimize the provision of transplant medical care without regional disparities during the COVID-19 pandemic and reduce the burden on transplant surgeons, not only during the COVID-19 pandemic but also after the pandemic.

【Methods】 We lent out surgical equipment for organ recovery owned by Fujita Medical University for use in organ recovery in Aichi and Shizuoka Prefectures. The transportation, cleaning, sterilization, and packaging of the equipment to be rented out was outsourced to Nippon Steri Co., Ltd. After recovering the organs, each organ recovery team was asked to respond to a questionnaire.

【Results】 Surgical equipment for organ recovery was rented to 10 organ transplant teams (heart: 3, lung: 1, liver: 2, pancreas: 3, kidney: 1) in 6 cases of brain death donation. All teams participating in the simulation completed organ recovery without any problems, and organ transplantation was performed at each facility. All of the teams participating in the simulation responded positively to this simulation. As their reasoning, 60% answered that “the number of staff was reduced,” and all teams answered that “it led to a reduction in the burden.”

【Conclusions】 This simulation of surgical equipment rental for organ recovery demonstrated the potential utility of providing transplant medical care without regional disparities during the COVID-19 pandemic and reducing the burden on transplant surgeons.

In recent reports, graft survival was decreased after renal transplantation in transplant recipients due to their sarcopenia and frailty. In the present study, we experienced a case of obese sarcopenia, which showed conflicting results of renal biopsy and estimated effect by low trough concentration of tacrolimus, an immunosuppressive drug. The recipient was an obese male in his 30s with cytochrome p450 3A5 (CYP3A5)^*1/^*3 and ^*1 allele who was on hemodialysis. He received a renal transplant from a healthy female donor in her 60s, and was on tacrolimus to prevent rejection. The trough value of tacrolimus did not exceed 10 ng/mL; therefore, we suspected possible chronic antibody-related rejection based on serum creatinine and other factors. We performed a renal biopsy and measured the area under the concentration-time curve (AUC) of tacrolimus. As a result, tacrolimus-induced nephrotoxicity was suspected. In this case, the trough value of tacrolimus was low, but the AUC was high enough for renal toxicity. This high AUC could be caused by obese sarcopenia and the CYP3A5 wild type ^*1 allele. In the case of suspected obese sarcopenia, it would be preferable to measure body composition and to evaluate CYP3A5 gene polymorphism; if the trough level of tacrolimus is low in obese sarcopenic patients, addition of another alternative immunosuppressive drug may prevent post-transplant rejection without nephrotoxicity.

A 58-year-old man diagnosed with non-alcoholic liver cirrhosis and hepatocellular carcinoma (HCC) was referred to our hospital. The Child-Pugh score and the Model for End-stage Liver Disease score were both 8 points. The patient required liver transplantation (LT) to treat his liver cirrhosis and HCC. His son volunteered to be the partial liver donor and living donor (LD). LT using the right lobe graft without the middle hepatic vein (MHV) from the patient’s son was planned. Securing adequate graft-to-recipient body weight ratio and maximizing functional graft volume are important considerations for successful LDLT. The estimated graft volume was 994 cm³, and the congestion area without reconstructing V5 and V8 was 208 cm³ (20.9%) Therefore, it was necessary to create a new MHV to reconstruct the branch of V5 and V8 and connect this to the recipient’s hepatic vein. The distance between V5 and V8 of the graft was estimated as 8.6 cm. The patient had a large shunt vessel from the umbilical vein to the left external iliac vein that was considered suitable for the new MHV. LDLT was performed, and the patency of the new MHV, V5, and V8 was excellent in the early period. The post-operative clinical course was uneventful, and the recipient was discharged on the 28th post-operative day. Seven months after LT, Doppler echography and enhanced CT scan confirmed good patency of the vein graft. Here, we reported a case of LDLT, in which MHV was reconstructed with a large shunt vessel.