Current status of organ transplantation in Japan and worldwide |
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Authors: | Norio Yoshimura Hideaki Okajima Hidetaka Ushigome Seisuke Sakamoto Masato Fujiki Masahiko Okamoto |
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Institution: | (1) Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; |
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Abstract: | Recent advances in immunosuppressant therapy have dramatically reduced the frequency of acute rejection of organ transplants.
Subsequently, the short-term graft survival rate has been improved, and ABO blood type-incompatible and existing anti-HLA
antibody-positive kidney transplantation has been enabled, which has increased the availability of living kidney donors. Japan
has a unique history and strategies of liver transplantation (LT) for various liver diseases. The outcomes of living donor
liver transplantation (LDLT) in Japan is comparable to that of deceased donor liver transplantation (DDLT) in Western countries
despite the relatively short history of LT. The main disadvantage of LT in Japan is donor shortage mainly due to the small
number of available deceased donors. There are some disadvantages with LDLT in autoimmune liver diseases because of the dependence
on blood relative donors. The first brain-dead pancreas transplantation (PTx) was performed in 2000. Since that time, 42 brain-dead
PTx, 2 non-heart beating PTx, and 14 living donor PTx had been performed by the end of 2007. One of the 44 recipients of deceased
donor PTx died of unknown causes 11 months after transplantation. Although most of the deceased donors in Japan were marginal
and their condition was not favorable, the results of these cases were comparable to those of Western countries. Fourteen
intestinal transplantations (ITx) had been performed by the end of 2007 in four transplant centers. There were 3 deceased
donor and 11 live donor transplants. The original diseases included short bowel syndrome (n = 6), intestinal function disorder (n = 6), and retransplantation (n = 2). The graft and patient survival rate are 60% and 69%, respectively. Eight recipients survived and stopped parenteral
nutrition with full-functioning grafts. Amendment of the Japanese law for the utilization of deceased donors should increase
the number available donors in the future. |
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