Recipient transplant coordinator has roles in involving in all transplant procedure as follows, to support for decision-making by patient and their family, to facilitate communication among the transplant team members, to educate recipients and living donors on the life after transplantation and to provide continual support for medical management. In 2011, certificated recipient transplant coordinator system started. The certificated recipient transplant coordinators are responsible for transplant relating medical care in their own institution. The certificated recipient transplant coordinator would be expected to play active roles which enrich the medical environment of continuing long-term support of recipients and living donors.

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By renewal of the Japanese Transplantation Act, organs can be donated after brain death(BD) with consent from their family, if he or she did not deny organ donation and organs of children younger that 15 years old can donate their organs under BD condition.Until the end of 2012 after renewal of the Act, 118organ donations were performed from BD donors and annual BD organ donation increased from 13 to 45 cases. However, the number was still extremely smaller than other developed countries. Finally a boy younger than 6 years old donated his organs and one girl underwent heart transplantation and two children underwent liver transplantation (split) on 15th of June, 2012. Although there have been several problems to be solved in transplant centers,procurement hospitals and Japan Organ Transplant Network, we hope a steady increase in BD organ donation and to save transplant candidates as many as possible.

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Platelets are the blood constituents which contain three types of granules, i. e., alpha granule, dense granule, and lysosomal granule. Each granule contains various biophysiological substances such as growth factors, cytokines, lipid mediators, etc. Platelets have been conventionally focused as trigger of inflammatory response and injury in the liver. However, in recent years, some studies uncovered that platelets have strong effects on promoting liver regeneration, anti-fibrosis, and antiapoptosis. This review presents experimental and clinical evidences of platelets in accelerating liver regeneration, anti-fibrosis, and anti-apoptosis and their mechanisms.

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Drug transporters possess the role of detoxification mediating membrane transport of drugs, toxins and waste products. Drug transporters are mainly categorized to 4 groups based on their driving force such as facilitated diffusion, primary active transporter, cotransporter and antiporter. Among them, ATP-driven efflux pump, P-glycoprotein (multidrug resistance-1) recognizes tacrolimus, cyclosporine, steroids, sirolimus and everolimus. In addition, the intestinal Pglycoprotein was well acknowledged as an absorptive barrier for its substrates. The bioavailability of orally administered tascrolimus was limited in the absorptive barrier at the intestinal epithelial cells. The blood concentration/oral dosage of tacrolimus was inversely correlated with the expression level of MDR1 mRNA in the intestinal epithelial cells of recipients. Several single nucleotide polymorphisms (SNP) were examined in the pharmacokinetics of tacrolimus and cyclosporine. However, there was no statistically significant difference in the tacrolimus pharmacokinetics based on MDR1 SNPs. On the other hand, biliary secretion of mycophenolate glucuronide is mediated by the multidrug resistance associated protein-2 (MRP2). Its biliary secretion is decreased in the presence of concomitant administration of cyclosporine. In addition, mycophenolate glucuronide rather than mycophenolate was recognized as the substrate for hOAT3. These results indicate that drug transporters play important role in posttransplant immunosuppressive therapy.

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The blood brain barrier has important roles for physiological and pathological state in the brain. The molecules involved in barrier function have been identified. Now we can analyze these molecules by genomics and proteomics methods. The blood brain barrier is also called neurovascular unit which is composed of brain capillary endothelial cells, astrocytes, pericytes, neurons and microglia. They closely interacted with each other for the development and maintenance of blood brain barrier functions. In this review I will summarize some basic concepts and recent new findings about blood brain barrier：structure and function, neurological diseases, proteomics method, in vitro experimental system, and enzyme replacement therapy for lysosomal storage diseases/mucopolysaccharidosis.

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Cyclosporine and tacrolimus are used to prevent acute rejection episode for renal transplant recipients. The lymphocyte immunosuppressant sensitivity test(LIST)can predict the therapeutic efficacy of these immunosuppressive agents in renal transplant recipients. We previously reported that there were correlations between cyclosporine and tacrolimus pharmacological efficacy evaluated by LIST with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide However, the correlation of pharmacological efficacies of calcineurin inhibitors has never been evaluated at early phase after operation. This study examined the relationship between cyclosporine and tacrolimus pharmacological efficacy by LIST with MTT assay procedure at before and at two,four and six weeks after transplantation in renal transplant recipients. The relationships between cyclosporine- and tacrolimus- pharmacological efficacies gave significant Kendall and Spearman coefficient correlation in these transplant recipients by the LIST with MTT assay procedure at just before, at four and six weeks after transplantation(P＜0.05). However, no statistically significant relationship was only observed between the pharmacological efficacies of the calcineurin inhibitors at two weeks after transplantation(P＞0.05). The correlation between cyclosporine and tacrolimus pharmacological efficacies may change due to either high dose immunosuppressive therapy or clinical events at two weeks after renal transplantation.

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