The incidence of de novo malignancy after heart transplantation is increasing due to the need for immunosuppressive therapy for life. Development of malignancy is one of the severe problems which affects transplant outcome and in fact, previous studies reported the marked decrease in survival rates. Skin, prostate, lung or breast cancers are reported to increase in adult recipients and post-transplant lymphoproliferative disorder is increasing in pediatric recipients. Not only male or older recipients, but also recipient with a history of malignancy or Epstein-Barr virus status are reported to face risk of de novo malignancies after heart transplantation. As a result, we need to plan systematically for recipients before transplantation. Further study on specific screening and treatment methods for early detection and treatment of malignancies after heart transplantation is needed.

After lung transplantation, patients are at risk for postoperative malignancy due to immunosuppression and the high risk of oncogenic virus infection. Concerning the indication for deceased-donor lung transplantation (DDLT) in patients with a history of malignancy, a disease-free interval (DFI) of more than 5 years is required; however, in cases of low risk for recurrence, such as skin cancer and certain types of hematological malignancy, 2 years of DFI is accepted. On the other hand, the indication for living-donor lobar lung transplantation (LDLLT) is discussed on a patient-by-patient basis, and when the estimation of recurrence is considered to be less than 30%, LDLLT is performed. About de novo malignancy after lung transplantation, we retrospectively reviewed the records of 343 (LDLLT: 124, DDLT: 219) patients undergoing lung transplantation between April 2002 and December 2023. Thirty-six patients (10.5%) developed de novo malignancies after lung transplantation. Fifteen patients developed post-transplant lymphoproliferative disorders (PTLD) and 23 developed solid organ malignancies. The 5-year overall survival (OS) rate after lung transplantation in patients diagnosed with de novo malignancies was 70.4%, while it was 81.1% (p＝0.13) in patients without malignancies. The 2-year OS rates after diagnosis in patients with PTLD and solid organ malignancies were 60.0% and 57.3%, respectively (p＝0.58). In patients with solid organ malignancies, the 2-year OS rate in those who received radical treatment was 83.9%; however, it was 12.5% in those who received chemotherapy only or palliative care (p<0.01). Malignancies after lung transplantation may have a significant impact on long-term survival after lung transplantation. Physicians who follow up with lung transplant recipients should be careful about the development of malignancy because radial treatment can provide a better prognosis.

The increase in liver transplant (LT) recipients’ age and improved survival rates have led to more patients with pre-transplant malignancies (PTMs). Common risk factors, like obesity and alcohol use, often link nonhepatic cancer with chronic liver diseases. Immunosuppressive therapy in LT recipients raises the risk of post-transplant cancer recurrence, affecting survival rates. Although PTM’s impact is well-studied in kidney transplants, data for LT is limited. Patients with cirrhosis and cancer have outcomes influenced by cirrhosis severity and chemotherapy’s impact on liver function. This study examines LT eligibility and required waiting period for PTM patients, focusing on cancer type and treatment history. Comprehensive cancer history is essential for evaluating LT eligibility. Future research should gather extensive data on PTM’s effect on post-LT outcomes, identifying recurrence risk factors to improve management and survival.

De novo malignancies after liver transplantation are the leading cause of patient and graft loss over the long term. In comparison with a normal population, increased standardized incidence ratios have been universally reported as for various neoplasms among liver transplant recipients. Factors associated with de novo malignancy include smoking, alcohol use, alcoholic and fatty liver disease, and some disease specific risks such as inflammatory bowel disease in primary sclerosing cholangitis; however, immunosuppression is the strongest factor predisposing liver transplant recipients to developing de novo malignancies. At present, no immunosuppressive modulation can be recommended to avoid them; however, mTOR inhibitors seem favorable for those developing malignancies. Immune check-point inhibitors are considered as contraindicated for liver transplant recipients in fear of graft loss; however, recent reports have confirmed their efficacy in some cases.

What is transplant oncology? It is an emerging concept to bring cancer care and research to the next level by integrating transplantation medicine and oncology proposed from Japan in 2014. It is defined as “any application of transplant medicine and surgery to the treatment of cancer aimed at improving patients' survival and quality of life” and is composed of four pillars (4 E's): i) Evolution of multidisciplinary cancer management, ii) Extension of the limits of conventional cancer surgery, iii) Elucidation of self- and non-self recognition by linking tumor and transplant immunology, and iv) Exploration of molecular mechanisms of carcinogenesis, invasion, and metastasis by immunogenomic approaches.

In this review, we will primarily focus on how transplant oncology will unlock the future of patients suffering from intractable cancers by incorporating liver transplantation and its operative techniques into the management of hepatobiliary malignancies.

Candidates with a history of pretransplant malignancy (PTM) face increased risks of cancer recurrence and impact on survival rates due to the immunosuppression required after kidney transplantation. From the perspective of optimal utilization and fair allocation of organs donated after brain death or circulatory death, it is crucial to establish an appropriate waiting period following cancer treatment. This waiting period should decided based on the primary lesion, histology, stage of the PTM, and the latest treatment outcomes. This paper examines the changes in waiting periods and eligibility criteria for kidney transplantation in candidates with a history of PTM, as informed by guidelines from the 2000s and 2010s, and recommendations from the 2019 Consensus Workshop by the American Society of Transplantation.

When determining transplant eligibility and appropriate waiting periods for candidates with a history of PTM, decisions should not be based solely on traditional guidelines. Instead, they need to consider the latest cancer treatment outcomes, the risk of cancer recurrence under immunosuppression, and the most current knowledge about treating recurrent cancer. This decision-making process should involve not only transplant physicians but also specialists from the relevant oncology departments, oncologists, and the patients and their families.

Kidney transplantation is improving quality of life as well as life expectancy. However, immunosuppressive drugs after kidney transplantation are increasing the standardized incidence ratio and cumulative incidence of malignant tumors. Malignancies have also recently become the leading cause of death among kidney transplant recipients. In recent years, the frequency of malignancy is increasing due to the long-term viability and survival of kidney transplant recipients and the increasing potency of immunosuppressive drugs. Malignancy control is needed to further improve the outcome of kidney transplantation. In this article, we would like to clarify the characteristics, screenings and managements of de novo malignancy after kidney transplantation.

In Japan, 555 pancreatic transplants were performed between 2004 and 2023. Although the transplant outcomes were good, 29 patients (32 cases) developed de novo malignancy after transplantation. The most common was PTLD, accounting for approximately 30% of the total. Although the occurrence of malignant tumors does not significantly decrease patient survival rates or graft survival rates, it may affect patient survival and graft survival 5 years or more after transplantation. In addition, 72 deaths were recorded out of 555 cases, and malignant tumors were the third most common cause of death after infections and heart disease. At Fujita Health University Hospital, 7 out of 119 cases developed de novo malignancy after pancreatic transplantation, and one patient died. It is important to avoid over immunosuppression after transplantation, and regular screening for de novo malignancy is essential for improving the outcome of pancreatic transplantation.

In kidney transplantation, antibody-mediated rejection (AMR) and the development of donor-specific anti-HLA antibodies (HLA-DSA) can lead to graft failure. However, despite the histological features of AMR and the characteristic lesions of AMR/CAMR as defined by the Banff criteria, there are cases where DSA is not present. In these instances, it is believed that non-HLA antibodies may be involved. In this study, we retrospectively analyzed cases where DSA was not detected in the histopathological manifestation of CAMR after kidney transplantation to investigate which antibodies are involved. In antibody tests conducted at the time of biopsy, eplets associated with DSA were detected in 6 out of 13 cases (46.2%). Among the 34 types of non-HLA antibodies, anti-AT1R antibodies were detected in 2 cases (15.4%), anti-MICA antibodies in 2 cases (15.4%), and protein kinase C eta (PRKCH) in 1 case (7.7%). In 2 cases (15.4%), no antibodies were detected. The necessity of searching for non-HLA antibodies is suggested when CAMR is observed. It is considered that performing eplet analysis and non-HLA antibody tests in cases where rejection is suspected but HLA-DSA is not detected could potentially identify antibodies that may cause CAMR.

【Background】 A patient smartphone application (hereafter referred to as “the app”) is implemented for kidney transplant recipients (KTRs) at Mie University Hospital. The app features include notifications, medication records, and health records. This study aimed to analyze the use of these app features and identify methods that can improve adherence among KTRs.

【Methods】 The participants were 100 KTRs who consented to participate in the study out of the 135 who used the app at our hospital between April 2022 and December 2022. The survey items included a questionnaire on app usage, feature-specific app usage rates, and usage rates by the period from transplantation to app introduction.

【Results】 According to the questionnaire on app usage, the helpful app features were notifications (84.2%), medication records (63.2%), and health records (24.6%). The percentages of KTRs with >50% usage rates for these features were 92.0%, 58.7%, and 28.8% for read notifications, medication record entries, and health record entries, respectively. The rates of reading notifications, medication record entries, and health record entries were significantly lower in patients who had the app introduced >5 years, 5-10 years, and >2 years post-transplantation, respectively.

【Conclusions】 To promote self-management using the app, it should be introduced during the early post-transplant period since motivation is high, as it may contribute to the maintenance and improvement of adherence.

[Introduction] We report our experience in the rehabilitation of a pediatric patient who underwent brain-dead double lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation.

[Patient] A teenaged boy had developed B-progenitor cell acute lymphoblastic leukemia X−7 years before. Although he achieved remission with multidrug chemotherapy, it relapsed in X−6 years, and he underwent bone marrow transplantation and was in remission. The patient developed obstructive bronchiolitis in X−3 years, was listed for lung transplantation in X−2 years, underwent brain-dead bilateral lung transplantation, and underwent tracheostomy on the 12th postoperative day (POD12).

[Results] When rehabilitation was started on POD6, we observed severe limitations of range of motion in the extremities and thorax, as well as significant muscle weakness (manual muscle strength test (MMT) 2). During intubation, the patient was encouraged to sit on the edge (POD7), stand (POD11), sit in a wheelchair (POD13), and get out of bed; however, it was difficult to perform rehabilitation due to breathing difficulties and decreased motivation. We shared information across multiple professions and considered a program that would motivate the child to have fun and implemented a program that included hiding his favorite action figures in the hospital ward and making the child move around using lower-limb wheelchairs to search for the action figures. After he was transferred to the general floor on POD48, his muscle strength and physical strength improved, and his general condition including breathing improved, so that he was able to work cooperatively on rehabilitation. When he was transferred to a previous hospital for rehabilitation on POD98, his muscle strength had improved to MMT 3-4, and he was able to walk 60 m in a walker and drive a lower-limb wheelchair 120 m.

[Conclusion] Postoperative rehabilitation of patients who were in poor general condition before transplantation is often difficult to implement. Rehabilitation of pediatric patients requires the introduction of programs that include play that children can enjoy and the setting of goals, and it is important to continue rehabilitation patiently.

Surgical treatment such as pancreatectomy is used for painful and refractory chronic pancreatitis. However, pancreatectomy, especially total pancreatectomy, is highly invasive because it involves loss of pancreatic endocrine function. Therefore, an islet autotransplantation has been developed to maintain endogenous islet function by transplanting islets isolated from the excised pancreas into the patient’s own liver. Total pancreatectomy with islet autotransplantation (TPIAT) is indicated in cases of chronic pancreatitis with non-dilated pancreatic ducts, hereditary pancreatitis, or in cases where previous treatment is ineffective. In Europe and the United States, TPIAT has become a treatment option and a standard of care in the United States. However, the number of TPIATs is limited in Asia, including Japan, and autologous islet transplantation is not covered by public insurance in Japan. Therefore, the authors have initiated a multi-institutional clinical trial for advanced medical care with the aim of making this treatment covered by public insurance in Japan.