Before a state of national emergency was declared, The Japan Society for Transplantation (JST) formed task force committee against COVID-19 and published the first guidelines for general awareness and restriction of transplantation on March 6, 2020. JST published the second guidelines with Q&A for safe deceased organ donation on April 11, the third one with clinical questions on the treatment of the recipient with COVID-19 on May 8, and the fourth one with a check list for re-starting living renal transplantation on May 29. JST started the patient registry on COVID-19 recipients not only for epidemiologic data but also for providing treatment options to save them. JST had the webinar on COVID-19 prevention for donor coordinators who had little information on COVID-19 on May 2. JST is working very hard to keep transplantation active during the COVID-19 pandemic in Japan.
【Objective】 Biliary anastomotic strictures occur in 10-30% of liver transplant recipients, and such a complication affects not only the quality of life of the patient, but also the outcome. Biliary stenting may reduce the incidence of biliary stricture after duct-to-duct biliary anastomosis. We investigated the effectiveness of anchoring the biliary tube to the peritoneum for prevention of biliary stricture in living-donor liver transplantation.
【Method】 We analyzed 19 patients who underwent duct-to-duct biliary reconstruction in living-donor liver transplantation from February 2007 to October 2017 We did not anchor the biliary stent to the peritoneum until 2015, and tube dislodgement occurred frequently. Therefore, we started to anchor the stent to the peritoneum. We compared the rate of tube dislodgement, and biliary anastomotic strictures between the two groups.
【Result】 When the stent was not anchored to the peritoneum, 8 of 15 cases developed dislodgement of the biliary stent; biliary anastomotic strictures requiring endoscopic treatment occurred in 4 of the 8 cases. After the stent was anchored to the peritoneum, tube dislodgement did not occur in the following 4 cases.
【Conclusion】 Anchoring of the biliary catheter to the peritoneum seems important to avoid such a complication after living-donor liver transplantation.
Pericarditis is an uncommon complication following living-donor lung lobectomy surgeries. Here we report a case who developed pericarditis that showed constrictive patterns in echocardiography two months after a lung donation surgery. The patient was a male in his 30s who underwent a left lower lung lobectomy as a donation surgery in the setting of a living-related lung transplantation. Pericardium was incised then half-closed upon transecting the pulmonary vein. Five weeks after the surgery, the patient was readmitted due to having a moderate amount of pericardial effusion with an elevation of the serum CRP level. Pericarditis was diagnosed, and the patient was treated with colchicine. Although the CRP level normalized within several weeks, plasma BNP level rose up to 170 pg/mL. Echocardiography revealed an early diastolic notch of the ventricular septum and a reversal flow of the hepatic vein on inspiration, suggesting patterns of constrictive pericarditis. The patient was closely observed, after which the echocardiography findings and the BNP level normalized. Such a clinical course could be regarded as a postpericardiotomy syndrome and should be considered in the management of living-donor lung transplantations.
Few descriiptions of the treatment of postoperative bowel obstruction after living-donor liver transplantation (LDLT) have been published. We report on two patients who suffered postoperative bowel obstruction after LDLT and underwent laparoscopic adhesiolysis.
[Case 1] A man in his seventies who had underwent LDLT (right lobe graft) for liver cirrhosis with hepatocellular carcinoma. Seven years later, he was admitted to the hospital with abdominal pain and fever, and received the diagnosis of bowel obstruction with afferent loop syndrome. Laparoscopy revealed encapsulating bowel adhesion, and laparoscopic adhesiolysis was performed.
[Case 2] A female in her teens who had underwent LDLT (lateral segment graft) for congenital biliary atresia. Fourteen years later, she was admitted to the hospital with abdominal pain and vomiting, and received the diagnosis of bowel obstruction. Because the laparoscopy revealed internal herniation of the jejunum by a string-like adhesion, she underwent adhesiolysis. Postoperative courses were uneventful in both patients. The laparoscopic approach was safely performed for small bowel obstruction after living donor liver transplantation.
We experienced a case of living renal transplantation from a horseshoe kidney donor. The recipient was a 32-year-old man with end-stage renal failure. At 20 years old, he received a living renal transplantation from his mother. However, he received dialysis again for chronic rejection at the age of 31. The donor was his healthy 66-year-old father, who had a horseshoe kidney. Dynamic computed tomography (d-CT) showed two renal arteries and one renal vein on the left side, and the isthmus was supplied by several accessory arteries and veins. The donor surgery was performed through an abdominal midline incision. The accessory arteries were clamped to demarcate the boundary of the isthmus. After the isthmus parenchyma was clamped, the kidney was divided at the boundary by electric scalpel. Both cut ends of the isthmus were closed by sutures. The left kidney was transplanted into the left iliac fossa of the recipient. The donor was discharged on the 9th day after surgery without perioperative complications. Likewise, the recipient experienced no surgical complication or rejection. Kidney functions of donor and recipient have been stable for a 12-month follow-up period. We believe horseshoe kidneys may be used for living donor transplantation in selected cases after a detailed preoperative evaluation.
【Objective】 We aimed at obtaining suggestions to increase the number of organ donations by conducting a meta-analysis of studies on attitudes towards organ donation for undergraduate nurse students around the world.
【Data Sources】 We looked for documents published by April 2017 using CINAHL, MEDLINE, Japan Medical Abstract Society, CiNii, and PsycINFO. We searched for English and Japanese literature including all terms of “attitude”, “students”, “nursing”, “Tissue and Organ Procurement”, and “organ donation”. This study was carried out based on Prisma Statement 2010.
【Study Selection】 As a result of our search, we extracted six reports from CINAHL, 45 from MEDLINE, seven from Igaku Chuo Zasshi, 0 from CiNii, and 0 from PsycINFO databases. After exclusion criteria were applied, 21 reports were available for analysis.
【Data Extraction】 All reports involved studies with a cross-sectional research design. Self-administered questionnaires were used for data collection.
【Results】 Favorable family opinion toward donation significantly correlated with positive attitudes toward organ donation by the subjects.
【Conclusion】 This study outlined attitudes toward organ donation among nursing students worldwide. Positive attitudes of a person toward organ donation and transplantation demonstrated the influence of family members’ attitudes, suggesting that holding discussions with family members while the person is still alive could eliminate differences in opinions, thereby increasing opportunities for organ donation.
【Objective】 This study is an investigation of the In-House Transplant Coordinator (IHCO) position in Japanese hospitals.
【Methods】 In the spring of 2017, prefectural transplant coordinators were given a seven-item survey that focused on the following areas: number of IHCOs, variety of medical roles, license requirements, presence of an IHCO Committee, availability of training opportunities, and other topics of local interest.
【Results】 Surveys were obtained from 45 out of 47 Coordinators (95.7%). In 866 total hospitals, there were 2,690 IHCOs. From this number, 59.9% were nurses, 20.5% were doctors, and 16.9% came from other positions. Eighty-eight-point-six percent of the IHCOs were commissioned by either the prefectural government or a foundation. At most, specialized IHCO training was conducted twice per year in each prefecture.
【Conclusion】 In comparison with a similar survey conducted in 2008, the number of IHCO positions has increased. IHCOs play an important role in improving hospital administration, educating staff about organ procurement, and caring for donor candidates and their families. On the other hand, the IHCO role is an extra duty, not a primary job. If there are donor candidates to deal with, the position can become quite burdensome. These results suggest that improvements in education and qualification for the IHCO role are warranted. In addition, a system to better evaluate IHCO activities is needed to improve coverage by medical insurance.