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Purpose: This study aimed to elucidate the difficulties faced by adult native liver survivors with biliary atresia (BA) in Japan. Methods: A single-center, retrospective, observational study of 57 adult patients with BA was conducted. The clinical course of BA was compared between native liver survivors and non-survivors who reached adulthood. Indications and outcomes of liver transplantation (LT) among non-survivors were assessed. Results: A significantly larger portion of non-survivors (n = 10) met the criteria for LT (p < 0.001) and received treatment for portal hypertension after reaching 20 years of age (p < 0.01) compared with the survivors. Causes of death included liver cirrhosis (n = 8), graft failure of living donor liver transplantation (LDLT) (n = 1), and hepatocarcinoma (n = 1). Two of the non-survivors who died of liver cirrhosis had no indication for LT because of alcohol dependence and uncontrolled infection. An appropriate donor candidate could not be found for the five patients who opted for LDLT. All six patients waitlisted for deceased donor liver transplantation (DDLT) died after a median waiting period of 17 months. Conclusion: Adult BA patients in Japan have limited options for LT, mainly owing to low donor candidate availability for LDLT and a low prevalence of DDLT. [ABSTRACT FROM AUTHOR]

Aim: Liver allografts from brain‐dead donors, which were declined and were eventually not transplanted due to accompanying marginal factors, have never been surveyed in Japan. We surveyed the declined allografts and discussed the graft potential focusing on various marginal factors. Methods: We collected data on brain‐dead donors between 1999 and 2019 from the Japan Organ Transplant Network. We divided their liver allografts into declined (nontransplanted) and transplanted ones, and then characterized declined ones focusing on their timepoints of decline and accompanying marginal factors. For each marginal factor, we calculated the decline rate from the number of declined and transplanted allografts, and assessed the 1‐year graft survival rate from transplanted allografts. Results: A total of 571 liver allografts were divided into 84 (14.7%) declined and 487 (85.3%) transplanted ones. In the declined allografts, a majority was declined after laparotomy (n = 55, 65.5%), most of which had steatosis and/or fibrosis (n = 52). Out of the moderate steatotic (without F ≥ 2 fibrosis) allografts (n = 33), 21 were declined and 12 were transplanted, leading to a 63.6% decline rate. The latter 12 achieved a 92.9% 1‐year graft survival rate after transplantation. Comparison of donor background showed no significant difference between the declined and transplanted allografts. Conclusion: Pathological abnormalities of steatosis/fibrosis seem to be the most common donor factor leading to graft decline in Japan. Allografts with moderate steatosis were highly declined; however, transplanted ones achieved promising outcomes. This national survey highlights the potential utility of liver allografts with moderate steatosis. [ABSTRACT FROM AUTHOR]

Introduction: Living‐donor lobar lung transplantation is an alternative procedure to deceased donation lung transplantation. It involves graft donation from healthy donors; however, only a few reports have discussed its long‐term prognosis in living lung donors and their associated health‐related quality of life. This study aimed to examine living lung donors' health‐related quality of life. Methods: In our cross‐sectional survey of living lung donors, we assessed health‐related quality of life‐based on three key aspects (physical, mental, and social health) using the 36‐Item Short Form Health Survey. We also evaluated chronic postoperative pain and postoperative breathlessness using the numeric rating scale and the modified Medical Research Council Dyspnea scale, respectively. Results: We obtained consent from 117 of 174 living lung donors. The average scores of the living lung donors on the 36‐Item Short Form Health Survey were higher than the national average. However, some donors had poorer physical, mental, and social health, with lower summary scores than the national averages. Low mental component summary predictors included donor age (<40 years; odds ratio = 10.2; p <.001) and recipient age (<18 years; odds ratio = 2.73; p <.032). Low role‐social component summary predictors included high lung allocation score (≥50; odds ratio = 3.94, p <.002) and recipient death (odds ratio = 3.64; p =.005). There were no predictors for a physical component summary. Additionally, many donors did not complain of pain or dyspnea. Conclusions: Living lung donors maintained an acceptable long‐term health‐related quality of life after surgery. Potential donors should be informed of relevant risk factors, and high‐risk donors should receive appropriate support. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare the post-transplant survival of untwinned single lung transplantation (SLT) to twinned SLT. In untwinned SLT, the contralateral lung is judged unsuitable for transplantation and might affect the lung graft within the donor body and recipient survival after SLT., Methods: A retrospective analysis was conducted on 84 SLT recipients at our center, divided into untwinned SLT and twinned SLT groups. The demographics of donors and recipients, surgical characteristics, complications, mortality, and survival rates were compared., Results: There were no significant differences in recipient and donor demographics between the two groups. Surgical characteristics showed no significant differences. Microbiological findings of the transplanted lungs indicated a low incidence of positive cultures in both groups. 3-month to 1-year mortality and overall survival rates were comparable between the two groups., Conclusion: At our institution, both untwinned and twinned SLT procedures exhibited excellent survival rates without significant differences between the two procedures. The favorable outcomes observed may be associated with the strategic advantages of Japan's MC system and the diligent management of marginal donor lungs although this requires further investigation to elucidate the specific contributory factors., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Background: More than 45 cases of transfusion-transmitted hepatitis E virus infection (TT-HEV) have been reported in Japan. Therefore, in 2020, universal individual donation nucleic acid amplification testing (ID-NAT) was implemented for HEV., Study Design and Methods: We characterized HEV NAT-positive blood donors. The number of new HEV infections and the asymptomatic infection rate were estimated using the HEV NAT-positive rate. HEV RNA quantitation, phylogenetic analysis, and antibody tests were performed, and the residual risk of TT-HEV was assessed based on the lookback study results., Results: A total of 5,075,100 blood donations were screened with ID-NAT during the first year of implementation, among which 2804 (0.055%; males: 0.060%, females: 0.043%) were NAT-positive with regional differences. Approximately 270,000 new HEV infection cases were estimated to occur annually in Japan, with an asymptomatic infection rate of 99.9%. The median HEV RNA concentration, excluding cases below the limit of quantification, was 205 IU/mL. Among the 1113 cases where the genotype could be determined, HEV-3 and HEV-4 accounted for 98.8% (1100) and 1.2% (13), respectively. The maximum duration of HEV viremia, including the pre- and post-ID-NAT window periods, was estimated to be 88.2 days. Within the 3 years since ID-NAT implementation, no confirmed cases of breakthrough TT-HEV were observed., Discussion: Multiple indigenous HEV strains are prevalent in Japan, infecting a significant number of individuals. However, since the implementation of ID-NAT, TT-HEV has been prevented due to the test's high sensitivity., (© 2023 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)

Background: During these 2 decades (1999-2019), many therapeutic strategies have been developed in the field of heart transplant (HTx) to improve post-HTx outcomes. In the present study, 116 consecutive HTx adults between 1999 and 2019 were retrospectively reviewed to evaluate the influences of a therapeutic modification on post HTx outcomes., Methods and results: Patient survival, functional status and hemodynamics after HTx and modification of therapeutic strategies were reviewed. The overall cumulative survival rate at 10 and 20 years post-HTx was 96.4 and 76.7%, respectively. There were no significant differences in survival rate or exercise tolerance after HTx between extracorporeal and implantable continuous flow-LVAD. Post-HTx patient survival in patients, irrespective of the donor risk factors such as donor age, low LVEF, history of cardiac arrest, was equivalent across cohorts, while longer TIT and higher inotrope dosage prior to procurement surgery were significant risk factors for survival. In 21 patients given everolimus (EVL) due to renal dysfunction, serum creatinine significantly decreased 1 year after initiation. In 22 patients given EVL due to transplant coronary vasculopathy (TCAV), maximum intimal thickness significantly decreased 3 years after initiation., Conclusions: The analysis of a 20-year single-center experience with HTx in Japan shows encouraging improved results when several therapeutic modifications were made; for example, proactive use of donor hearts declined by other centers and the use of EVL in patients with renal dysfunction and TCAV.

Background: Liver transplantation is the most suitable treatment option available for end-stage liver disease. However, some patients require retransplantation, despite medical advances that have led to improved survival. We aimed to compile a definitive, nationwide resource of liver retransplantation data in Japan, seeking to identify the predictors of patient survival posttransplantation., Methods: Questionnaires were sent to 32 institutions that had conducted 281 retransplantations before 2015., Results: Among the 265 patients included in this study (142 pediatric cases), the average age at primary transplantation was 23 years, and retransplantation was performed after an average of 1468 days. The main indication for retransplantation was graft rejection (95 patients). Living-donor liver transplantation accounted for 94.7% of primary transplantations and 73.2% of retransplantations. Patient survival at 1, 3, or 5 years did not differ by type of transplantation but was better for pediatric (70.8%, 68.3%, and 60.1%, respectively) than for adult (57.2%, 50.4%, and 45.2%, respectively) recipients (P = 0.0003). Small-for-size syndrome, retransplantation within 365 days, and inpatient status at retransplantation were significant predictors of poor survival in pediatric cases. Retransplantation within 365 days and conditions warranting retransplantation were significant predictors of poor survival in adult patients., Conclusions: In Japan, where >70% of retransplantations are performed using living donors, the indications and timing are different from those in previous reports from other countries, while maintaining comparable survival rates. Considering technical challenges, graft failure within 365 days should be thoroughly restricted to justify the use of living donor.

To investigate optimal unit selection for umbilical cord blood transplantation (UCBT), we conducted a registry-based study of 1355 adults with acute myeloid leukemia in first or second complete remission who underwent single-unit UCBT. To be eligible for analysis, UCB units had to contain a total nucleated cell (TNC) dose of 2.0 × 10 7 /kg or higher and present at least a 4/6-match for HLA-A, -B, and -DR antigens in line with clinical practice in Japan, both of which are less stringent criteria than those used in Western countries. Neither TNC dose nor the degree of HLA matching affected survival (P = 0.138 and P = 0.696, respectively). As for HLA-A, -B antigens and -DRB1 allele, better HLA matching was associated with lower non-relapse mortality (P = 0.011) but higher relapse (P = 0.046), resulting in no improvement in survival (P = 0.680). Taking the allele level for each HLA-A, -B, and -DRB1 into consideration was less useful for predicting non-relapse mortality (P = 0.198). These findings suggest that the less stringent criteria for UCB unit selection are acceptable for Japanese patient population and perhaps even more beneficial in terms of providing a better chance to find a suitable UCB unit.

Background: The classification of many new cases of hepatitis virus infection as overt hepatitis does not reflect the true incidence of infection because the disease takes an asymptomatic course in some cases. In this retrospective cohort study, we aimed to estimate the incidence rates of new hepatitis C virus (HCV) infections among the blood donors., Study Design and Method: A 5-year retrospective cohort study was conducted to estimate the incidence rates by using the medical records of the blood donors between 2008 and 2013 for HCV infection. HCV seroconversions were investigated using a chemiluminescent enzyme immunoassay and then confirmed by nucleic acid amplification tests., Results: The incidence rate of HCV infection was 0.40 per 100,000 person-years (95% confidence interval, 0.27-0.57) for HCV RNA seroconversion only and 7.32 per 100,000 person-years (95% confidence interval, 6.73-7.95) if either HCV RNA or anti-HCV seroconversion were taken into consideration. No significant difference of new HCV infections was found between the sexes., Conclusion: The incidence rate of HCV infection of this study was lower than that detected in a previous 1994-2004 study in which HCV incidence was 1.86 per 100,000 person-year, which reflects the presence of an effective blood screening system and health strategies targeting hepatitis control and prevention., (© 2018 AABB.)

The Japan Marrow Donor Program (JMDP), established in 1991, has continued to grow in its capacity to facilitate unrelated bone marrow (BMT) and peripheral blood stem cell transplantation (PBSCT) for the past 25 years in Japan. The current donor pool is 463,465 (as of 31 December 2016) and 20,237 transplants were performed with the help of the Japanese Red Cross, government, and supporters. As JMDP introduced PBSCT in 2010, the vast majority of transplants are BMT. All donors are fully typed for HLA-A, B, C, and DR. The peak age of registered donors is around 40 years. The 8/8 HLA-matched donors are found in our registry for 96% of the patients and 54% of the patients receive a transplant. The median time between the initiation of donor search and the transplantation is approximately 122 days. The median interval between the initiation of donor search and identification of the first potential donor is 40 days. The most common diseases for which unrelated BMT/PBSCT is indicated are acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndrome (MDS), and malignant lymphoma. In recent years we have seen a marked increase in elderly patients who received BMT.

The relative desirability of an unrelated donor with a bidirectional 1-locus mismatch (1MM-Bi), a 1-locus mismatch only in the graft-versus-host direction (1MM-GVH), or a 1-locus mismatch only in the host-versus-graft direction (1MM-HVG) is not yet clear. We analyzed adult patients with leukemia or myelodysplastic syndrome who received a first allogeneic stem cell transplant from an HLA-A, -B, -C, and -DRB1 matched or 1-allele mismatched unrelated donor in Japan. The effects of 1MM-Bi (n = 1020), 1MM-GVH (n = 83), and 1MM-HVG (n = 83) compared with a zero mismatch (0MM) (n = 2570) were analyzed after adjusting for other significant variables. The risk of grades III to IV acute graft-versus-host disease (GVHD) was higher with marginal significance in the 1MM-GVH group than in the 0MM group (hazard ratio, 1.85; P = .014). However, there was no significant difference in overall or nonrelapse mortality between the 1MM-GVH and 0MM groups. There was no significant difference in acute GVHD or overall or nonrelapse mortality between the 1MM-HVG and 0MM groups. The risks of acute GVHD and overall mortality were significantly higher in the 1MM-Bi group than in the 0MM group. These findings indicate that unrelated donors with 1MM-GVH and 1MM-HVG are both good candidates for patients without an HLA-matched unrelated donor in a Japanese cohort., (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

The shortage of available organs for transplantation is a worldwide issue. To maximize the number of transplantations, increasing the number of organs transplanted per donor (OTPD) is widely recognized as an important factor for improving the shortage. In Japan, we have had 211 donors, 1112 organs transplanted, and 924 recipients receiving the transplants, resulting in 4.4 ± 1.4 recipients receiving transplants per donor and 5.3 ± 1.6 OTPD as of February 2013. Because donor age is a well-recognized factor of donor suitability, we analyzed the correlation between donor age group and OTPD. Only the age group 60 to 69 years and the age group 70 to 79 years were significantly different (P < .05) from adjacent age groups. We estimate that a donor under age 70 years has the potential to donate 4.6 to 6.7 organs., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: High-normal albuminuria (HNA) is an independent predictor of cardiovascular risk in the general population. Although hypertensive donor (HTD) candidates with HNA were considered acceptable donors by the Amsterdam Forum 2004, the transplant prognosis of HTDs with HNA has not been determined. Therefore, we investigated the transplant prognosis of HTDs with HNA., Methods: We retrospectively analyzed 52 adult living-donor kidney transplants performed at Kagawa University Hospital. HNA was defined as albuminuria of 15 to 30 mg/g Cr. Changes in kidney function of donors and recipients were assessed up to 2 years after transplantation., Results: Overall, 38 donors were normotensive and 14 were hypertensive. Nine of 14 HTDs exhibited HNA before donation. More HTDs with HNA had arteriosclerotic vasculopathy or glomerulosclerosis than did normotensive donors (NTDs). Hypertension and the degree of albuminuria did not affect the donors' posttransplantation kidney function. The risk of discompensatory changes in kidney function after donation was significantly higher in HTDs with HNA than in NTDs (odds ratio, 10.5; 95% confidence interval, 1.51-72.9; P=0.02). In multivariate analysis, the coexistence of hypertension and HNA was not significantly associated with discompensatory changes after donation (adjusted odds ratio, 6.04; 95% confidence interval, 0.19-192; P=0.31). Recipients of HTDs with HNA had similar allograft survival rates but lower allograft function compared with recipients of NTDs., Conclusions: Although further studies are needed to confirm our results, the short-term prognosis of living-donor kidney transplantation was similar between HTDs with HNA and NTDs.

Because of the serious organ shortage in Japan, the use of extended criteria (EC) donors is inevitable to increase the number of deceased donors. However, the influence of this practice on recipient outcomes has not been clarified yet. We analyzed donor and recipient factors to determine whether those factors, especially from EC donors impacted early recipient outcomes. From February 1999 to January 2011, 100 deceased liver transplantations were performed in Japan, including 85 consecutive adult cases (age≥18 years) who were studied to evaluate whether 6 recipient and 16 donor factors affected 3-month (90-day) recipient survival. Upon univariate analysis, Model for End-stage Liver Disease (MELD) score≥25 (P=.018), donor age≥55 years (P=.040), and cold ischemia time (CIT)≥10 hours (P=.00013) significantly reduced 3-month survival. Multivariate analysis confirmed the independent contributions of, three adverse factors including MELD score≥25 (P=.0133, odds ratio [OR]=12.3, 95% confidence interval [CI]=1.7-90.3), donor age≥55 years (P=.013, OR=14.0, 95% CI=1.6-119.5), and CIT≥10 hours (P=.0024, OR=67.6, 95% CI=4.5-1024.9). Three-month recipient survivals with 0, 1, 2, and 3 positive factors were 100% (n=34), 94.4% (n=36), 53.8% (n=13), and 0% (n=2), respectively (P<.0001). In conclusion, to improve recipient short-term survivals, minimizing CIT is the first priority. In the long-term, we must promote deceased donation to reduce recipient MELD scores by shortening the waiting time, and revise the allocation system to minimize CIT by giving priority to the local area., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background and Objectives:   In previous studies, we reported the transmission of hepatitis E virus (HEV) by transfusion, and the frequent detection of HEV markers in Japanese blood donors with elevated ALT levels. For the current study, we carried out a nationwide survey of the prevalence of IgG anti-HEV in qualified blood donors throughout Japan., Materials and Methods: The 12,600 samples from qualified blood donors were collected from seven blood centres (1800 per centre) representing nearly all regions of Japan. Samples were from age- and sex-matched blood donors who tested negative for all the current blood screening tests. The samples were screened using the in-house IgG anti-HEV ELISA. Sequentially, the positive samples were tested by the commercial IgG anti-HEV ELISA., Results: Of 12,600 samples, 431 (3·4%) were regarded as positive for IgG anti-HEV. The prevalence of IgG anti-HEV was higher in eastern Japan (5·6%) than in western Japan (1·8%) (P<0·001), and was also age-dependent and higher in men (3·9%) than in women (2·9%) (P=0·002)., Conclusion: The spread of the domestic infection of HEV was observed in qualified blood donors in Japan. A higher prevalence of IgG anti-HEV was observed in male donors, older donors and in donors residing in eastern Japan. Further studies are necessary to clarify the potential risk of transfusion-transmission of HEV in Japan., (© 2010 The Author(s). Vox Sanguinis © 2010 International Society of Blood Transfusion.)

Background: Screening blood donors for hepatitis C virus (HCV) antibody has effectively mitigated transfusion transmission of HCV. We conducted a post hoc analysis to clarify the impact of donor screening on a general population of reproductive-age females and their offspring., Study Design and Methods: Anti-HCV screening in Japan started in late-1989. In a cohort studied between May 1990 and November 2004, a total of 22,664 consecutive serum samples from pregnant women were screened for anti-HCV. Reactive samples were further tested for HCV RNA. Linear structural regression was applied to identify causal relationships., Results: Anti-HCV-reactive rates declined significantly by two measures. First, among women known to have been transfused, rates fell from 14.8% to 3.1% with the implementation of anti-HCV screening (p < 0.01). Nevertheless, this is 10 times higher than the 0.3% reactive rate seen in a similar cohort of nontransfused women. Second, rates fell from 1.8% among women born in 1955 or before to 0.3% for women born in 1966 or later (p < 0.01). Among 103 anti-HCV-reactive women, 31 (30%) had been transfused and another 17 (17%) had other identifiable risk factors. The remaining 55 (53%) had no clear risk factor. Blood transfusion accounted for 19% of anti-HCV acquisition, by path analysis. Only one infant in this cohort was vertically infected with HCV., Conclusion: Anti-HCV screening of donated blood and hygienic improvements have markedly decreased HCV infection of pregnant women with a transfusion history; however, 70% of anti-HCV-reactive women were deemed to be infected via routes other than transfusion.

Because of a small number of patients, only a few studies have addressed the outcome of bone marrow transplantation (BMT) in children with Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia (CML), who receive graft from a volunteer-unrelated donor (VUD), especially after practical application of imatinib mesylate. The outcomes of BMT from a VUD in 125 children with Ph+ CML were retrospectively reviewed. Patients were identified through the Japan Marrow Donor Program as having undergone BMT between 1993 and 2005 and were aged 1-19 years at the time of transplant (median age, 14 years). The probabilities of 5-year overall survival (OS) and leukemia-free survival (LFS) were 59.3% and 55.5%, respectively. Multivariate analysis identified the following unfavorable survival factors: infused total nucleated cell dose<314 x 10(6) /kg (relative risk [RR]=2.43; 95% confidence interval [CI]=1.33-4.44; P=.004), advanced phase (RR=2.43; 95% CI=1.37-4.31; P=.004), and no major cytogenetic response (MCyR) at the time of BMT (RR=6.55; 95% CI=1.98-21.6; P=.002). Of the 17 patients treated with imatinib, 15 (88%) achieved MCyR at the time of BMT, and this group had an excellent 5-year OS of 81.9%. Disease phase, infused total nucleated cell dose, and cytogenetic response were independent risk factors for survival of unrelated BMT. These findings provide important information for assessing the indications for and improving outcome in unrelated BMT for the treatment of pediatric CML., (Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

This study indexed the mental status in six living donor liver transplantations (LDLT) performed at the Juntendo University Hospital between 2005 and 2007. The donors' preoperative and postoperative psychiatric and psychological status was assessed using the Profile of Mood States (POMS) and the State-Trait Anxiety Inventory (STAI). The present study found that the donors' POMS anger/hostile score decreased significantly following transplantation. In addition, the STAI score suggested that donors had little anxiety or depression following the operation. Although the present study was limited due to the small number of donors, the findings suggest that a successful operation stabilizes donor mentality. The studied donors will be reassessed for their mental and physical condition in the future.

Objective: To investigate the knowledge, attitudes and practice of Japanese students regarding brain death and organ transplantation., Methods: A 22-item questionnaire was handed out among 383 Japanese students during the 2002 academic year. The data was finally analyzed using a statistical package for social sciences, SPSS., Results: Most students knew that organ transplantation can save a life 97%, while only 38% of the students were aware that there is no treatment for brain dead patients. Overall, 60% of the respondents believed brain death is equal to human death and 63% believed that organ removal from brain dead donors is mutilation of the body. There was a negative association between the students who reported positive attitudes toward the idea that removing an organ is mutilation of the body with their willingness to be a donor. Of the students 27% were opposed to the necessity of family agreement for organ donation. Although 66% expressed their wish to be a donor, less than half of them, 31% had a donor card; and 40% did not even know how to get a donor card., Conclusion: Granting a veto power to the family as well as the mistaken idea that there is recovery from brain death, can be considered as obstacles to organ procurement from the brain dead in Japan. The high value of life among Japanese society and the willingness to be a donor, bring hope that giving correct medical information and proper public education can increase social acceptance of organ transplantation from the brain dead in Japan.