【Objective】 Advances in liver transplantation (LT) have shifted treatment goals from merely saving lives to improving post-transplant quality of life (QOL). Return to work is one of the key indicators of social reintegration and QOL after transplantation. This study aimed to evaluate the employment status of adult liver transplant recipients before and after transplantation at a single institution.

【Methods】 Adult patients who underwent either living-donor or deceased-donor LT at our institution between 1997 and 2023 were included. A self-administered questionnaire was used to assess employment status, employment type, and barriers to returning to work during the five years before and after LT. The study was approved by the institutional ethics committee (approval number: 022-0285).

【Results】 A total of 117 out of 126 eligible patients responded (response rate: 92.9%). The median age at the time of LT was 52.7 years (range: 19.2-70.0). Employment rates decreased gradually before LT (from 72.6% three years prior to 65.0% one year prior) and increased steadily after LT (from 46.2% at one year post-LT to 65.7% at five years post-LT). Patients who were employed one year before LT (n = 76) had significantly higher employment rates five years after LT (89.1%) compared to those who were unemployed at that time (n = 20, 44.4%). Of those who returned to work, 48.8% resumed employment at their pre-transplant workplace, and 47.9% were employed full-time. The main barriers to re-employment included physical limitations and insufficient understanding or support in the workplace.

【Conclusion】 The employment rate five years after LT (65.7%) was comparable to that of the general population in Japan. Pre-transplant employment status was significantly associated with post-transplant work outcomes. Tailored support by transplant coordinators, considering individual physical conditions, workplace environments, and employer support may promote successful return-to-work among LT recipients.

【Objective】 To conduct a multi-institutional survey regarding the current attitudes and challenges associated with donation after circulatory death (DCD) in Japan.

【Methods】 The survey was developed by the Committee for DCD of the Japan Society for Transplantation through a series of conference calls. It was distributed via email invitations containing a link to an online questionnaire (Google Forms, CA). Following an initial round of solicitations, reminder emails were sent, and individual follow-ups were conducted to clarify ambiguous responses.

【Results】 Among all respondents, 82% indicated that organ transplantation from DCD donors is necessary, although 34% believed that implementation would be difficult. Approximately 52% of respondents expressed a willingness to perform organ transplantation from DCD donors. The main barriers cited were the absence of established guidelines, insufficient hospital infrastructure, and limited manpower. Notably, 68% reported that they would be willing to proceed with DCD organ transplantation if these issues were addressed.

【Conclusion】 This survey highlights strong support for DCD as a potential solution to the current organ donor shortage in Japan. However, several challenges must be addressed, including ethical considerations and the establishment of standardized guidelines—particularly those related to organ preservation. These findings may serve as a foundation for the development of clinical protocols and institutional systems to facilitate the safe and effective implementation of DCD in Japan.

【Objective】 To evaluate the safety, effectiveness, and dose administration of basiliximab in suppressing acute rejection in organ transplants other than kidney transplants in Japan.

【Design】 A retrospective, multi-center, non-interventional chart review study.

【Methods】 Data were collected from patients who received basiliximab as induction therapy during organ transplantation (liver, heart, lung, small intestine, pancreas, and islet) between January 1, 2016, and December 31, 2020 (patients before 2016 were included for small intestine). The primary endpoint was the incidence of adverse events within six months post-transplant. Secondary endpoints included the evaluation of effectiveness over six months post-transplant for each organ transplant and administered dose of basiliximab.

【Results】 A total of 320 patients were included across organ transplant indications. The incidence of adverse events was 77.2%, with common events being anemia, increased AST/ALT/CRP, and CMV viremia. The incidence of adverse drug reactions was 30.6%, with severe reactions (Grade 3 or 4) reported in 10.9% and 4.7%, respectively. Acute rejection occurred in 23.1% of liver transplants and 50% of small intestine transplants, and with lower rates in other organ transplants. Basiliximab was administered at a total dose of 40 mg (or 20 mg in pediatric) in two divided doses of 20 mg (or 10 mg in pediatric) each, on the day of transplant and four days post-transplant.

【Conclusion】 Induction therapy using basiliximab could be considered applicable as the treatment option for organ transplants other than kidney transplants, with an acceptable safety and effectiveness profile.

【Background】 Preformed donor-specific anti-HLA antibodies (DSA) are associated with antibody-mediated rejection and graft loss in kidney transplantation. To identify immunological risk pre-operatively, our institution has implemented routine anti-HLA antibody screening using LABScreen^® Mixed (LSM) for all patients awaiting deceased donor kidney transplantation, regardless of sensitization history. This study aimed to evaluate the prevalence of LSM positivity and its associated risk factors.

【Methods】 Among 203 patients evaluated between January 2019 and December 2023, 168 underwent at least one LSM screening. Patients were categorized into sensitized (history of blood transfusion, pregnancy, or transplantation) and non-sensitized groups. Normalized background (NBG) ratios and LSM positivity rates were compared between groups. Logistic regression was used to identify independent risk factors for LSM positivity. Changes in positivity rates with varying NBG cut-off values (2.5, 3.5, 4.5) were also assessed.

【Results】 Sensitized patients showed significantly higher NBG ratios and LSM positivity rates for both HLA Class I and II. Transfusion and pregnancy were independent predictors for Class I positivity, while pregnancy and prior transplantation were predictors for Class II. Increasing the NBG cut-off from 2.5 to 4.5 resulted in a 6.0-11.2% decrease in positivity rates across all subgroups.

【Conclusions】 Sensitized patients demonstrated higher rates of LSM positivity; however, a notable proportion of non-sensitized patients also tested positive. These findings underscore the clinical importance of universal LSM screening, irrespective of sensitization history, and highlight the need for cautious interpretation of results, particularly in patients without known sensitizing events.

【Background】 Post-transplant lymphoproliferative disorder (PTLD) is a lymphoid or plasmacytic proliferation that occurs in association with immunosuppression and is recognized as a relatively rare but serious complication following solid organ transplantation.

【Case Presentation】 A woman in her 50 s developed type 1 diabetes in her teens and underwent living-donor kidney transplantation followed by deceased-donor pancreas transplantation. Due to recurrent type 1 diabetes in the transplanted pancreas, she received three islet transplantations. Five years after the last transplantation, she presented with persistent fever. PET-CT revealed lymphadenopathy in the mesentery and axilla, and biopsy confirmed a diagnosis of diffuse large B-cell lymphoma (DLBCL) -type PTLD.

【Treatment and Outcome】 Immunosuppressive therapy was adjusted without complete discontinuation. Four cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy against PTLD resulted in partial remission, so subsequent four cycles of DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, hydroxydaunorubicin, and rituximab) therapy led the PTLD to complete remission. Throughout the treatment, islet graft function was preserved. Therefore, no evidence of PTLD recurrence was observed during follow-up.

【Conclusion】 This is the first reported case of PTLD after islet transplantation in Japan. Careful adjustment of immunosuppressive therapy enabled disease remission while preserving islet graft function. This case provides important insights into the management of PTLD following islet transplantation.