移植
Online ISSN : 2188-0034
Print ISSN : 0578-7947
ISSN-L : 0578-7947
最新号
選択された号の論文の11件中1~11を表示しています
特集「日本移植学会 移植症例登録・統計報告(2023年)」
報告
  • 日本臨床腎移植学会, 日本移植学会
    2024 年 59 巻 3 号 p. 217-236
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    A total of 2,001 kidney transplants including 1,753 from living donors, 29 from non-heart-beating donors and 219 from heart-beating donors were performed in 2023 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.

  • 日本心臓移植研究会/日本心臓移植学会
    2024 年 59 巻 3 号 p. 237-241
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    Since the Organ Transplantation Act was passed in October 1997, a total of 819 heart transplantations (HTx) had been performed in Japan as of December, 2023. After the Revised Transplant Act came into effect in July 2010, the number of brain-dead organ donation increased and 84 HTx were performed in 2019. In 2020 and 2021, the number of HTx decreased due to the COVID-19 pandemic. However, as the severity and mortality of COVID-19 decreased in 2022, the number of HTx increased, with 115 HTx performed in 2023, the highest number to date. After approval of the use of an implantable continuous-flow ventricular assist device (iVAD) for bridge-to-transplant (BTT) in 2011, BTT cases using iVAD increased. Currently, most patients are waiting for transplantation with VAD implantation.

    Although the survival rate after HTx in Japan is favorable, the waiting period is extremely long. The relatively high rate of death while waiting for HTx is big problem, and revision of the allocation system is being considered so that patients with higher urgency can receive transplantation.

  • 日本肺および心肺移植研究会
    2024 年 59 巻 3 号 p. 243-249
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    【Objective】 This paper presents the 20th official registry report on lung transplantation in Japan, conducted by the Japanese Society of Lung and Heart-Lung Transplantation since 2005.

    【Design and Methods】 The study analyzed data from cadaveric lung transplantation, living-donor lung transplantation, and heart-lung transplantation performed until the end of 2023. The data included transplant numbers, recipient survival rates, functional and working statuses, and causes of death. Survival rates were calculated using the Kaplan-Meier method.

    【Results】 By the end of 2023, a total of 871 cadaveric lung transplantations (438 single, 433 bilateral), 293 living-donor lung transplantations, and 3 heart-lung transplantations were performed. The number of cadaveric lung transplants reached a record high of 128 in 2023. The 5-year and 10-year survival rates for cadaveric lung transplantations were 73.52% and 60.32%, respectively, surpassing international registry data. The survival rates for living-donor transplantations were similar to those of cadaveric lung transplantation, with 5-year and 10-year rates of 73.36% and 60.52%, respectively. All three heart-lung transplant recipients are alive. 75.9% of cadaveric lung transplant recipients achieved an mMRC scale grade of 0 or 1, as did 75.2% of living-donor lung transplant recipients. Infections were the leading cause of death after lung transplantation in both cadaveric and living-donor lung transplantation. Primary graft dysfunction, which used to be a serious problem after lung transplantation, has become less frequent.

    【Conclusion】 The outcomes of lung transplantation in Japan have been satisfactory. Although the number of transplants decreased in 2020 due to the COVID-19 pandemic, it recovered in 2021 and reached a record high in 2022 and again in 2023. The Japanese Society of Lung and Heart-Lung Transplantation will continue to provide annual reports on Japanese lung transplantations.

  • 日本膵・膵島移植学会膵臓移植班膵臓移植症例登録委員会事務局
    2024 年 59 巻 3 号 p. 251-257
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    A total of 555 cases of pancreas transplantation from deceased and living-related donors have been performed in 21 institutions in Japan between April 2000 and the end of 2023. The following donor- and recipient-related factors were analyzed in the 528 cases from deceased donors out of the total 555 cases: 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 posttransplant survival rates of patient and graft. Based on the analyses, the current status of pancreas transplantation in Japan was described. The patient survival after the transplantation was 95.9%, 94.3% and 92.2% at 1, 3, and 5 years, respectively. The pancreas graft survival in cases with simultaneous pancreas and kidney transplantation (SPK) was 87.6%, 84.5%, and 81.7% at 1, 3, and 5 years, respectively. The pancreas graft survival in cases with pancreas after kidney transplantation (PAK) (82.7%, 67.7%, and 57.7% at 1, 3, and 5 years, respectively) and pancreas transplantation alone (PTA) (68.8%, 34.4%, and 20.6% at 1, 3, and 5 years) was significantly poorer than SPK. 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 favorable, it is necessary to overcome graft thrombus in SPK cases and chronic rejection in PAK and PTA cases for improving the posttransplant outcomes.

  • 日本膵・膵島移植学会膵島移植班
    2024 年 59 巻 3 号 p. 259-261
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    In 2023, due to the temporary suspension of the supply of an islet-isolation enzyme, islet isolation could not be performed at islet transplant facilities for a period of time; clinical islet transplantation was performed in only one case in Japan.

    The annual number of islet isolation and transplantation performed from the resumption of islet transplantation in 2012 to 2023 was 1-6 cases, except 0 cases in 2020 due to the COVID-19 pandemic. Thirty-one islet isolations were performed in the 10 years to 2023, of which 26 resulted in sufficient islet yield for islet transplantation. The success rate of islet isolation is very high at 83.9%. In particular, when islet isolation is limited to brain-dead donors, 21 islet transplants were performed out of 24 isolation cases, resulting in an islet isolation success rate of 87.5%.

    Although the problem of shortage of donors for islet transplantation is now greatly improved due to the increase in the number of brain-dead organ donations, and the success rate in islet isolation is very high, the number of islet transplants performed has fluctuated from year to year and not has increased the number of islet transplants, greatly affected by factors such as the COVID-19 pandemic and the instability of the supply of islet-isolation enzyme.

  • 日本腸管リハビリテーション・小腸移植研究会
    2024 年 59 巻 3 号 p. 263-269
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    Thirty-two intestinal transplants for 41 patients were performed since 1996 in 6 institutions. There were 32 deceased donor and 13 living donor transplants. Primary causes of intestinal transplants were short gut syndrome (n = 21), intestinal mobility function disorder (n = 18), others (n = 2) and re- transplantation (n = 4). 1-year patient survival was 90%, and 10-year patient survival was 54%. They were excellent results for a standard therapeutic option for intestinal failure if patients fail to maintain total parenteral nutrition.

  • 日本造血細胞移植データセンター, 日本造血・免疫細胞療法学会
    2024 年 59 巻 3 号 p. 271-281
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    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 30 years; more than 5,500 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.

原著
  • 朝居 朋子, 佐藤 毅, 横田 裕行
    2024 年 59 巻 3 号 p. 283-289
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    【Objective】 Organ transplantation presents ethical issues and value conflicts, making it an ideal dilemma material for school education. It stimulates students to consider their opinions and exchange ideas. Therefore, we have developed ethical dilemma teaching materials.

    Design: Practical report

    【Methods】 For ethical dilemma discussions on organ transplantation, we selected five themes: (1) The anonymous principle; (2) Overseas transplant by charity; (3) Organ trafficking; (4) Opt-Out; and (5) Priority donation to relatives. Our standardized lesson format addresses: (i) The ethical dilemma theme; (ii) Class objectives; (iii) Key discussion points; and (iv) Class time schedule. The lessons fit within 50 minutes, the typical duration of junior and high school classes.

    【Results】 Using this protocol, we discussed “The anonymous principle” with 3rd grade students at a junior high school in Japan. From their feedback, we concluded that the students deeply engaged, and seriously gave their opinions on the ethical dilemmas. We were impressed by the depth of the students’ thinking, their willingness to listen to the opinions of others, and the transformation of their opinions.

    【Conclusion】 Teaching materials on ethical dilemmas can foster the students’ ability to grasp complex societal issues, consider how to solve them, make understanding-based choices, and verbalize their thoughts. We believe that such discussion on ethical dilemmas in organ transplantation will benefit the students intellectually and spiritually, and lead to a deeper awareness in society of organ transplantation issues.

症例報告
  • 田口 司, 富丸 慶人, 小林 省吾, 織田 典明, 林 智之, 伊藤 壽記, 佐々木 一樹, 長谷川 慎一郎, 岩上 佳史, 山田 大作, ...
    2024 年 59 巻 3 号 p. 291-295
    発行日: 2024年
    公開日: 2024/12/26
    ジャーナル フリー

    Graft duodenal bleeding is one of the complications after pancreas transplantation that may lead to graft loss. To date, few reports have described graft preservation with conservative treatment for graft duodenal bleeding. Herein, we described a case in which graft preservation was achieved after graft duodenal bleeding from graft gastroduodenal artery (GDA) treated with interventional radiology (IVR). The patient was a 48-year-old man who had undergone brain-dead pancreas-kidney transplantation for type 1 diabetes and renal failure at the age of 42 years. Three months ago, he visited a local physician for bloody stools. An upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, and his symptoms spontaneously resolved. One month later, he again experienced bloody stools. Abdominal contrast-enhanced CT revealed a hematoma in the graft duodenum, leading to emergency hospitalization. Double-balloon endoscopy via the anus was performed, but the bleeding source was not identified, and his symptoms resolved spontaneously again, leading to discharge. Three weeks after the discharge, he presented with bloody stools and abdominal pain and was transferred to our hospital for further evaluation and treatment. At that time, his pancreas and kidney grafts functioned well. He was diagnosed graft duodenal bleeding by abdominal CT. We performed angiography via the graft celiac artery and identified bleeding from a branch of the graft GDA, anterior superior pancreaticoduodenal artery (ASPDA). Although a possibility was considered that embolization of this branch might cause ischemia of the graft duodenum, we planned to treat the bleeding with embolization by IVR because the branch was relatively peripheral, we performed coil embolization by IVR and achieved hemostasis of the graft GDA. At 1 year and 3 months after the treatment, the patient remained alive without graft duodenal rebleeding and his pancreas graft functions were maintained. This case suggested that embolization by IVR may be an effective treatment for such bleeding from the graft.

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