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The purpose of this study was to investigate the wear behavior of pure titanium when opposed to six different crown restorative materials. Abrader specimens were prepared by casting pure titanium and these were paired with substrates including pure titanium, resin composite, lithium disilicate, zirconia, silver-palladium-copper (Ag-Pd-Cu) alloy, and bovine enamel. The wear volume of each abrader and substrate specimen was measured using the two-body wear test, and factors affecting wear behavior, such as microstructures and hardness, were evaluated. Results indicated that titanium-to-titanium abrasion caused significant wear in both the abrader and the substrate. In contrast, no significant wear was observed for the zirconia and Ag-Pd-Cu alloy against titanium. SEM images showed linear wear marks in most specimens other than zirconia and resin composite, microcracks in enamel, and filler fall in resin composite. A strong correlation between the wear volume and Vickers hardness was found for ceramics, resin composites, and enamel. However, due to the small slope of the approximate straight line in this correlation suggests that the wear behavior of materials when abraded by titanium is only partially influenced by the microstructure and hardness of the material.

For ruptured cerebral aneurysms over 90 years of age, the outcome and the safety after endovascular treatment are not well-known. This multicenter retrospective registry enrolled patients with ruptured cerebral aneurysms after endovascular treatment from January 2015 to December 2019 in Japan. We investigated differences between the patients over 90 years (age ≥ 90) and those under 90 years of age (age <90). The primary outcome was defined as a modified Rankin scale 0-2 at 30 days. Secondary outcomes were all-cause death and returned to premorbid modified Rankin scale at 30 days. Safety outcomes were the incidence of ischemic stroke and technical complications. Among 8,024 patients with aneurysm, 204 were aged ≥ 90 years and 7,820 were <90 years, those of median age were 92 and 65 years. The proportion of females and premorbid modified Rankin scale was higher in the age ≥ 90 group (n [%]; 191 [93.6] vs. 5,395 [69.0], median [interquartile range]; 1 [0-2] vs. 0 [0-0]). The modified Rankin scale 0-2 at 30 days was lower in age ≥ 90 patients than in age <90 patients (13.2% vs. 56.2%, adjusted odds ratio [95% confidence intervals]; 0.13 [0.08-0.21]). In age ≥ 90 patients, all-cause death was significantly higher (adjusted odds ratio [95% confidence intervals]; 1.85 [1.19-2.86]) and returned to premorbid modified Rankin scale was significantly lower (adjusted odds ratio [95% confidence intervals]; 0.26 [0.17-0.39]). However, safety outcomes were not significantly different between both groups. In this population undergoing endovascular treatment for ruptured cerebral aneurysms, patients older than 90 years had a poor prognosis but no difference in having perioperative complications.

Background: Liver transplantation has improved survival rates in pediatric patients with end-stage liver failure. However, post-liver transplant infection remains a threat to patient recovery. This study reported the frequency and patterns of infections after liver transplantation and identified factors related to the accuracy of fever source investigation., Method: This is a single-center descriptive and retrospective study in the quaternary Pediatric Intensive Care Unit (PICU) in Japan. All pediatric patients who underwent liver transplantation from 2019 to 2021 were eligible. The patients were divided into two groups based on culture positivity: the positive culture group and the negative culture group., Results: A total of 152 pediatric patients were included in the study. The median age was 11 months, and 86% of cases underwent living donor liver transplantation. Among the 152 cases, 18% showed positive bacterial culture results. The timing of positive culture varied bimodally, with 34% occurring after postoperative day 15. Among the positive cultures, 84% were bacterial, and 20% were fungal. Factors associated with positive culture were analyzed, and as a result, re-laparotomy and a higher graft recipient weight ratio (GRWR) were identified as factors associated with infection., Conclusions: We reported the frequency and patterns of infections in pediatric patients undergoing living donor liver transplantation and demonstrated that factors associated with positive culture were re-laparotomy and GRWR. This study provides important clinical data for infection management after liver transplantation., (© 2025 Wiley Periodicals LLC.)

This study aimed to investigate the release of metallic ions from cobalt-chromium (Co-Cr) alloys fabricated by additive manufacturing (AM) for comparison with dental casting. Co-Cr alloys were fabricated via AM using selective laser melting (SLM) and electron beam melting (EBM) in powder-bed fusion. Polished and mechanically ground specimens were prepared. Each specimen was analyzed using an electron probe microanalyzer (EPMA). Each specimen was immersed in an acidic saline solution for 7 days in accordance with ISO 10271: 2020. The EPMA indicated the segregation of some elements in the as-prepared SLM and EBM specimens, whereas the polished and ground specimens exhibited a homogenous elemental distribution. The total amount of ion release from the SLM and EBM specimens was confirmed to be less than 7 μg/cm 2 , which was less than 42 μg/cm 2 for the cast specimen. The polished and ground specimens exhibited an even lower ion release than the as-prepared specimens. The amount of ions released from the Co-Cr alloy was less than the 200 μg/cm² requirement of ISO 22674: 2022. Co-Cr alloys fabricated by SLM and EBM could provide superior corrosion resistance to cast specimens. AM could be a valuable method for fabricating appliances and denture frameworks in dentistry.

Hypophosphatasia (HPP) is a congenital bone disease caused by tissue-nonspecific mutations in the alkaline phosphatase gene. It is classified into six types: severe perinatal, benign prenatal, infantile, pediatric, adult, and odonto. HPP with femoral hypoplasia on fetal ultrasonography, seizures, or early loss of primary teeth can be easily diagnosed. In contrast, pediatric, adult, and odonto types of HPP over 4 years of age are less likely to be diagnosed because they do not have typical symptoms. Consequently, it may be misdiagnosed as common osteoporosis, and treatments incompatible with HPP may be implemented. The purpose of this study was to analyze the effects of bisphosphonate preparations administration on the femur of Akp2 +/- mice, a mild-type HPP mice model. Zoledronic acid (Zol) was subcutaneously administered to 4-week-old Akp2 +/- mice at 1 mg/kg (volume: 200 μL) once a week for a total of 5 times. Afterward, spontaneous locomotor activity analysis was performed, and serum and femur bones were collected at 9 weeks of age. Additionally, micro-computed tomography (CT) analysis, histological analysis, and analysis of the expression levels of various marker proteins and genes were performed. Age-matched Akp2 +/+ mice served as controls. The results demonstrated that the administration of Zol to Akp2 +/- mice, compared to Akp2 +/+ mice, insufficiently promotive bone formation, torn femoral head cartilage, and decreased spontaneous locomotor activity. Therefore, it is important to accurately diagnose patients with mild-type HPP., Competing Interests: Conflict of Interest: All authors have no conflicts of interest with respect to this study other than those stated in the Funding section. Human and Animal Rights and Informed Consent: This study was approved by the Tokyo Dental College Animal Experimentation Committee and the Recombinant DNA Experiment Safety Committee (approval numbers: 300706, DNA2101). The study protocol also complied with the ARRIVE guidelines., (© 2025. The Author(s).)

In 2022-23, several European countries reported paediatric acute liver failure (ALF) with enterovirus infection. In August-November 2024, three neonatal cases of ALF with echovirus 11 (E11) were reported in Tokyo, Japan. All neonates developed irreversible multiple-organ failure and died. The E11 strain belonged to the new lineage 1, which was the same as strains isolated from neonatal ALF cases in Europe in 2022-23.

Introduction: Information on the clinical utility of daptomycin in patients with persistent bacteremia and daptomycin's pharmacokinetic data in pediatric patients has been sparse. In addition, reports on the experience of using daptomycin in children undergoing solid organ transplantation have been extremely limited. The authors describe a pediatric case of persistent bacteremia after solid organ transplantation successfully treated by daptomycin. Blood daptomycin concentrations were measured by liquid chromatography-mass spectrometry and pharmacokinetic analysis was performed. We also conducted a literature review on the use of daptomycin in children with persistent bacteremia., Case Report: An eight-year-old girl who underwent small bowel and liver transplantation experienced persistent bacteremia due to Staphylococcus epidermidis. The bacteremia persisted despite standard therapy; however, it finally resolved with the addition of daptomycin. The patient had renal dysfunction and the initial dosing resulted in excessive drug exposure. The dosage was adjusted based on the pharmacokinetic analysis. The dosage of administrated teicoplanin was also adjusted according to trough concentration values. In the literature review, we identified 12 cases of neonates and 24 cases of post-neonatal children with the experience of using daptomycin for persistent bacteremia; however, no solid organ transplant recipient was identified. Similar trends in blood concentrations and dose ratios of teicoplanin and daptomycin were observed over time., Discussion: More information is required regarding the clinical utility and pharmacokinetics of daptomycin in pediatric patients with persistent bacteremia. Referring to the exposure to renally excreted drugs that are routinely measured and pharmacokinetic analysis of daptomycin may be useful in optimizing the dose of daptomycin in special patient populations, including those with renal impairment., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Background: Obesity indices reflect not only fat mass but also muscle mass and nutritional status in older people. Therefore, they may not accurately reflect prognosis. This study aimed to investigate associations between a body shape index (ABSI), body mass index (BMI), and mortality in the general older population., Methods: This nationwide observational longitudinal study included individuals aged between 65 and 74 years who underwent annual health checkups between 2008 and 2014. Exposures of interest were ABSI and BMI, and the primary outcome was all-cause mortality. Association between the ABSI and BMI quartile (Q1-4) and mortality was assessed using Cox regression analysis. A restricted cubic spline was also used to investigate nonlinear associations. The missing values were imputed using multiple imputation by chained equations., Results: Among 315,215 participants, 5074 died during a median follow-up period of 42.5 (interquartile range: 26.2-59.3) months. Compared with ABSI Q1, ABSI Q3 and Q4 were associated with increased risk of mortality, with the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.13 (1.05-1.22) and 1.23 (1.13-1.35), respectively. Compared with BMI Q3, BMI Q1 and Q2 were associated with an increased risk of mortality, with aHRs and 95% CIs of 1.51 (1.39-1.65) and 1.12 (1.03-1.22), respectively. The impacts of these indices were greater in male than in female. The heatmap of the aHR for mortality by continuous ABSI and BMI showed that higher ABSI was consistently associated with higher mortality risk regardless of BMI, and that the combination of low BMI and high ABSI was strongly associated with increased mortality risk., Conclusions: High ABSI and low BMI are additively associated with the risk of all-cause mortality in the general older population in Japan. Combination of ABSI and BMI is useful for evaluating mortality risk in older people., (© 2024 The American Geriatrics Society.)

Anemia and chronic kidney disease (CKD), which worsen bidirectionally, are associated with mortality in older adults. This study aimed to examine the association between CKD and the type of anemia and its impact on mortality in the general population. Data from a nationwide database of 203,280 individuals who participated in the annual "Specific Health Check and Guidance in Japan" evaluation between 2008 and 2011 were used. Over a follow-up period of 4 years, 2,819 all-cause, 1,595 cancer-related, 523 cardiovascular, and 128 infectious disease deaths were recorded. Macrocytic anemia was detected in 2.3% of participants. The prevalence of normocytic and macrocytic anemia increased with advancing CKD stage. Multivariate Cox proportional hazards regression analysis revealed significant associations between macrocytic anemia and the all-cause, cancer, and cardiovascular mortality rates. Including the anemia type improved the prediction accuracy for all-cause deaths. The participants were divided into eight groups based on the anemia type and CKD. Macrocytic anemia of CKD had the highest hazard ratio for all-cause mortality in the general population. A correlation was observed between macrocytic anemia and CKD. Macrocytic anemia predicted mortality in the general population, suggesting that it could serve as an early indicator of premature death in high-risk individuals., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Mild hypophosphatasia (HPP) can be difficult to distinguish from other bone disorders in the absence of typical symptoms such as the premature loss of primary teeth. Therefore, this study aimed to analyze the crystallinity of hydroxyapatite (HAp) and the three-dimensional structure of collagen in HPP teeth at the molecular level and to search for new biomarkers of HPP. Raman spectroscopy was used to investigate the molecular structure, composition, and mechanical properties of primary teeth from healthy individuals and patients with HPP. The results showed that the crystallinity of HAp decreased and the carbonate apatite content increased in the region near the dentin-enamel junction (DEJ) of HPP primary teeth. X-ray diffraction (XRD) analyses confirmed a decrease in HAp crystallinity near the DEJ, and micro-computed tomography (CT) scanning revealed a decrease in mineral density in this region. These results suggest incomplete calcification in HPP primary dentin and may contribute to the development of diagnostic and therapeutic agents.

Background: Neuromuscular scoliosis is associated with cerebral palsy caused by metabolic diseases. Patients with scoliosis require meticulous consideration in abdominal surgery, as scoliosis can reduce the abdominal cavity volume, compress abdominal organs, and cause abdominal complications. Special attention should be paid to the graft position, especially in the setting of liver transplantation (LT). We herein describe a pediatric case of LT for carbamoyl phosphate synthetase I (CPS1) deficiency with severe scoliosis., Case Presentation: A 13-year-old girl with CPS1 deficiency was transferred to our department as a candidate for liver transplantation. She underwent living donor liver transplantation with a left lobe from her mother. Following LT, portal vein (PV) complications occurred due to the kinking anastomosis, requiring several rounds of graft repositioning, PV reconstruction, thrombectomy, and finally stent placement due to severe scoliosis. Technical efforts were made to ensure PV blood flow with stent placement via the umbilical vein. Three months after LT, she was discharged from our hospital with sufficient PV flow., Conclusions: This report suggests the need for a careful surgical approach in patients with skeletal abnormalities, such as the management of complications arising from anatomical abnormalities and selection of the appropriate graft size. Preoperative assessment and surgical planning of both donors and recipients according to patient characteristics should be carefully conducted., (© 2024 Wiley Periodicals LLC.)

Natural killer (NK) cells are a promising cellular therapy for T cell-refractory cancers but are frequently deficient or dysfunctional in patients with hepatocellular carcinoma (HCC). In the present study, we explored a novel therapy for HCC using NK cells derived from donor liver graft perfusate. These liver-derived NK cells, named LMNC-NK cells, are more abundant in liver mononuclear cells (LMNCs) than in peripheral blood mononuclear cells (PBMCs) from the same donor. We developed a method to expand LMNC-NK cells by 33.8±54.4-fold, enhancing their cytotoxic properties and cytokine production, including granzyme B, CD107a, TNF-α, and IFN-γ. These cells also showed an increased expression of cytotoxicity receptors. An RNA-seq analysis revealed considerable differences in gene expression between LMNC-NK and PBMC-NK cells, with 453 genes upregulated and 449 downregulated in LMNC-NK cells. These genes are involved in the mitogen-activated protein kinase cascade and cell differentiation, explaining the increased activity of LMNC-NK cells. Quantitative reverse transcription polymerase chain reaction confirmed the significant upregulation of TLR6, KIT, MMP14, IRF8, TCF7, FCERIG, LEF1, NLRp3, and IL16 in LMNC-NK cells. LMNC-NK cells effectively eliminated HepG-2-Luc cells in vitro, and in an orthotopic murine model of HCC, they exhibited a potent anti-tumor effect, outperforming PBMC-NK cells. The expression of the activation marker CD69 + in LMNC-NK cells was also significantly higher among tumor-infiltrating lymphocytes compared to PBMC-NK cells. Our research suggests that the adoptive transfer of LMNC-NK cells could be a promising treatment for HCC, offering a novel and effective source of NK cells with superior cytotoxic functions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Decreasing the graft size in living donor liver transplantation (LDLT) increases the risk of early allograft dysfunction. Graft-to-recipient weight ratio (GRWR) of 0.8 is considered the threshold. There is evidence that smaller volume grafts may also provide equally good outcomes, the cut-off of which remains unknown. In this retrospective multicenter study, 92 adult LDLTs with a final GRWR ≤0.6 performed at 12 international liver transplant centers over a 3-year period were included. Perioperative data including preoperative status, portal flow hemodynamics (PFH) and portal flow modulation, development of small for size syndrome (SFSS), morbidity, and mortality was collated and analyzed. Thirty-two (36.7%) patients developed SFSS and this was associated with increased 30-day, 90-day, and 1-year mortality. The preoperative model for end-stage liver disease and inpatient status were independent predictors for SFSS (P < .05). Pre-liver transplant renal dysfunction was an independent predictor of survival (hazard ratio 3.1; 95% confidence intervals 1.1, 8.9, P = .035). PFH or portal flow modulation were not predictive of SFSS or survival. We report the largest ever multicenter study of LDLT outcomes using ultralow GRWR grafts and for the first time validate the International Liver Transplantation Society-International Living donor liver transplantation study group-Liver Transplantation Society of India consensus definition and grading of SFSS. Preoperative recipient condition rather than GRWR and PFH were independent predictors of SFSS. Algorithms to predict SFSS and LT outcomes should incorporate recipient factors along with GRWR., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Liver transplantation has been indicated for propionic acidemia (PA) patients with frequent metabolic decompensation and performed as an enzyme replacement therapy. We retrospectively evaluated the outcomes of patients with PA and analyze the appropriate timing of living donor liver transplantation (LDLT)., Methods: We reviewed 12 children with PA who underwent LDLT, who were divided into early (period from the first episode of metabolic decompensation to LDLT < 1 year; n = 6) and late (> 1 year; n = 6) indication groups depending on the timing of LDLT., Results: The patient and graft survival rates were 100% in 12 children with PA, and the median observation period was 61 months (5-193 months). None of the patients experienced any episodes of metabolic decompensation after LDLT. The timing of LDLT did not influence the incidence of surgical complications. Two patients in the late indication group had episodes of cardiac arrest and long QT syndrome before LDLT, and one patient showed prolongation of QT interval after LDLT. Two of the six patients in the late indication group had findings of metabolic stroke of the brain on MRI before LDLT. Although LDLT improved the findings of metabolic stroke, a decrease in development quotient score was shown in the post-LDLT course., Conclusions: LDLT may be an effective therapeutic option for improving metabolic control. Early LDLT might be help prevent cardiomyopathy and neurological impairment., (© 2024 Wiley Periodicals LLC.)

Objective: Placental abruption is associated with adverse perinatal outcomes including intrauterine fetal demise, which subsequently results in stillbirth. However, few studies have demonstrated the preventability of stillbirth due to placental abruption. Therefore, we evaluated the possibility of preventing stillbirth caused by placental abruption by reviewing all stillbirths in our region., Methods: This study reviewed all stillbirths after 22 weeks of gestation in Shiga Prefecture, Japan from 2010 to 2019, excluding lethal disorders. We evaluated 350 stillbirth cases, with and without placental abruption., Results: There were 32 stillbirths with PA and 318 without placental abruption. The probability of preventing stillbirth was significantly higher in patients with placental abruption than in those without (30% vs. 8%, p  < 0.001). We also determined the recommendations for preventing stillbirths with placental abruption., Conclusion: Some stillbirths caused by placental abruption can be prevented. We recommend improvements to perinatal maternal-fetal care and perinatal emergency transport systems.

Oxidative stress caused by reactive oxygen species (ROS) is involved in the pathogenesis of renal ischemia-reperfusion injury (I/R injury), a major cause of acute kidney injury and delayed graft function (DGF). DGF is an early transplant complication that worsens graft prognosis and patient survival, but the underlying molecular changes are unclear. The proteasome is a multicatalytic enzyme complex that degrades both normal and damaged proteins, and recent studies have revealed that the immunoproteasome, a specific proteasome isoform whose proteolytic activity enhances the generation of antigenic peptides, plays critical roles in the cellular response against oxidative stress. In this study, we demonstrate the impact of the immunoproteasome in human DGF and in a mouse model of I/R injury. In patients with DGF, the expression of β5i, a specific immunoproteasome subunit, was decreased in vascular endothelial cells. In a mouse model, β5i knockout (KO) exacerbated renal I/R injury. KO mice showed greater inflammation, oxidative stress, and endothelial damage compared with wild-type mice. Impaired immunoproteasomal activity also caused increased cell death, ROS production, and expression of inflammatory factors in mouse renal vascular endothelial cells under conditions of hypoxia and reoxygenation. In conclusion, reduced expression of the immunoproteasomal catalytic subunit β5i exacerbates renal I/R injury in vivo, potentially increasing the risk of DGF. Further research targeting β5i expression in DGF could lead to the development of novel therapeutic strategies and biomarkers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Zonisamide is a medication developed in Japan that is effective for motor symptoms and wearing off in Parkinson's disease (PD). Zonisamide has properties that may improve sleep disorders. The aim of this study is to verify the safety and efficacy of zonisamide for sleep disorders and rapid eye movement (REM) sleep behavioral disorders (RBD) using a mobile two-channel electroencephalography /electrooculography recording system in patients with PD., Methods: The present study is a single-blind randomized placebo-controlled trial. The subjects in the treatment group took zonisamide (25 mg per day) before bedtime. The primary outcome was sleep efficiency. The secondary endpoints were assessed as followed; objective outcomes of TST , WASO, SOL, REM sleep/non-REM sleep ratio, deep sleep (N3) time, ratio of RWA to total REM sleep epochs, and subjective outcomes of the PDSS-2, Pittsburgh sleep questionnaire, and RBDSQ., Results: Between the zonisamide and placebo groups, no significant differences were found in the primary outcome and secondary outcomes., Conclusions: The objective and subjective sleep metrics in this clinical trial did not significantly demonstrate zonisamide efficacy for sleep disorder in patients with PD. Although not significant, improvement in WASO and SOL was observed when zonisamide was compared with the placebo., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: The Japanese cedar (Cryptomeria japonica D. Don) is one of the most important Japanese forest trees, occupying approximately 44% of artificial forests and planted in East Asia, the Azores Archipelago, and certain islands in the Indian Ocean. Although the huge genome of the species (ca. 9 Gbp) with abundant repeat elements may have represented an obstacle for genetic analysis, this species is easily propagated by cutting, flowered by gibberellic acid, transformed by Agrobacterium, and edited by CRISPR/Cas9. These characteristics of C. japonica recommend it as a model conifer species for which reference genome sequences are necessary., Results: Herein, we report the first chromosome-level assembly of C. japonica (2n = 22) using third-generation selfed progeny (estimated homozygosity rate = 0.96). Young leaf tissue was used to extract high molecular weight DNA (> 50 kb) for HiFi PacBio long-read sequencing and to construct an Hi-C/Omni-C library for Illumina short-read sequencing. The 29× and 26× genome coverage of HiFi and Illumina reads, respectively, for de novo assembly yielded 2,651 contigs (9.1 Gbp, N50 contig size 12.0 Mbp). Hi-C analysis mapped 97% of the nucleotides on 11 chromosomes. The assembly was verified through comparison with a consensus linkage map comprising 7,781 markers. BUSCO analysis identified ∼ 91% conserved genes., Conclusions: Annotations of genes and comparisons of repeat elements with other Cupressaceae and Pinaceae species provide a fundamental resource for conifer research., (© 2024. The Author(s).)

Liver transplantation is the only life-saving procedure for children with end-stage liver disease. The field is however heterogenic with various graft types, recipient age, weight, and underlying diseases. Despite recently improved overall outcomes and the expanded use of living donors, waiting list mortality remains unacceptable, particularly in small children and infants. Based on the known negative effects of elevated donor age, higher body mass index, and prolonged cold ischemia time, the number of available donors for pediatric recipients is limited. Machine perfusion has regained significant interest in the adult liver transplant population during the last decade. Ten randomized controlled trials are published with an overall advantage of machine perfusion techniques over cold storage regarding postoperative outcomes, including graft survival. The concept of hypothermic oxygenated perfusion (HOPE) was the first and only perfusion technique used for pediatric liver transplantation today. In 2018 the first pediatric candidate received a full-size graft donated after circulatory death with cold storage and HOPE, followed by a few split liver transplants after HOPE with an overall limited case number until today. One series of split procedures during HOPE was recently presented by colleagues from France with excellent results, reduced complications, and better graft survival. Such early experience paves the way for more systematic use of machine perfusion techniques for different graft types for pediatric recipients. Clinical reports of pediatric liver transplants with other perfusion techniques are awaited. Strong collaborative efforts are needed to explore the effect of perfusion techniques in this vulnerable population impacting not only the immediate posttransplant outcome but the development and success of an entire life., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: In Japan, there has never been a national analysis of pediatric deceased donor liver transplantation (pDDLT) based on donor and recipient factors. We constructed a Japanese nationwide database and assessed outcomes of pDDLT focusing on the pediatric prioritization system introduced in 2018., Methods: We collected data on pDDLTs (<18 years) performed between 1999 and 2021 from the Japan Organ Transplant Network and Japanese Liver Transplantation Society, identified risk factors for graft survival and compared the characteristics and graft survival in pDDLTs conducted before and after the introduction of the pediatric prioritization system., Results: Overall, 112 cases of pDDLT were included, with a 1-year graft survival rate of 86.6%. Four poor prognostic factors were identified: recipient intensive care unit stay, model for end-stage liver disease/pediatric end-stage liver disease score, donor cause of death, and donor total bilirubin. After the introduction of the system, allografts from pediatric donors were more reliably allocated to pediatric recipients and the annual number of pDDLTs increased. The 1-year graft survival rate improved significantly as did pDDLT conditions indicated by the risk factors., Conclusions: Under the revised allocation system, opportunities for pDDLT increased, resulting in favorable recipient and donor conditions and improved survival., (© 2024 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)