Japan Organ Transplant Network Research Articles

The Start of an Islet Transplantation Program in Japan

In Japan, pancreas donation had become possible from cadaveric donor sources, both heart-beating or non–heart-beating (NHB). Pancreas allografts have been distributed in the organ allocation system of the Japan Organ Transplant Network. Meanwhile, islet transplantation has been categorized as a tissue transplantation; it is free from legal restraints. Thus, pancreata for islet isolation must be obtained from NHB donors. Herein we report the starting program and preliminary results of islet transplantation in Japan. Selection and listing criteria for transplantation include regional priority, ABO blood type, previous islet transplant status with insulin independence, and a longer waiting time. Five institutes in Japan (Fukushima, Chiba, Kyoto, Kobe, and Fukuoka) are prepared to start programs. A two-layer cold storage method using perfluorocarbons and UW solution is recommended for pancreas preservation. Islet isolation and purification procedures are performed according to institute-specific protocol. Immunosuppression is based on sirolimus/tacrolimus combined with basiliximab induction. Two or three consecutive infusions of >5000 IE/kg are planned for each recipient until achieving insulin independence. Twenty-seven isolations and 14 transplants were performed in eight non–insulin-dependent diabetes mellitus (IDDM) recipients. Almost all (26 of 27) were NHB donors. All recipients are free from hypoglycemic episode after transplantation. One of these recipients is insulin independent; the others are currently on minimal doses of exogenous insulin. The feasibility of islet transplantation using NHB donors was confirmed using a two-layer cold storage method and a steroid-free immunosuppressive protocol, with a high rate of graft function.

総説 腎移植シリーズ: 日本臓器移植ネットワークの現況と腎移植

総説 腎移植シリーズ: 日本臓器移植ネットワークの現況と腎移植

Simultaneous hepatic artery and portal vein thrombosis after living donor liver transplantation

Simultaneous hepatic artery and portal vein thrombosis rarely occurs after liver transplantation. The etiology is unknown. Of 213 patients (72 children and 141 adults) that underwent living donor liver transplantation (LDLT) from January 1996 to March 2003, 4 (2%) developed simultaneous thrombosis at 3 hours to 7 days (median, 4 days) after the operation. Emergent thrombectomy was performed in three patients; the remaining patient was registered in the Japan organ transplant network. All of the patients died due to hepatic failure (range, 18 hours to 6 days after the diagnosis; median, 2 days). Portal vein, hepatic artery, and hepatic vein velocity in the liver graft were measured every 12 hours by Doppler ultrasonography for 2 weeks after liver transplantation. These parameters were stable until just before the simultaneous thrombosis. These findings indicate that protocol Doppler ultrasonography can diagnose, but not predict, this fatal complication.

Transplantation of pediatric cadaveric kidneys into adult or pediatric recipients

In Japan, nationwide cadaveric organ sharing for kidney transplantation by the Japan Organ Transplant Network (JOTN) has operated since April 1995. This study retrospectively analyzed the long-term results of single pediatric donor kidneys transplanted into adult or pediatric recipients at a single center. From March 1983 to December 2002, 281 cadaveric renal allografts were transplanted at our center, including, 17 recipients of cadaveric kidneys from donors aged less than 16 years. We divided these 17 recipients into two groups: 10 adult recipients (group 1; G1) and seven pediatric recipients (group 2; G2). HLA-AB, -DR mismatches were 1.3 ± 1.3, 0.7 ± 0.5 in G1 and 2.6 ± 1.3, 1.4 ± 0.8 in G2, respectively ( P < .05 for both). The end of the observation of this study was March 2003. Among G1, two recipients died with functioning grafts and one died after graft loss. Among G2, no recipients died. Patient survival rates at 1 and 5 years were 90% and 80% in G1 and 100% and 100% in G2, respectively. At the end of the observation in this study, five recipients among G1 and six recipients among G2 had functioning grafts. Graft survival rates at 1 and 5 years were 90% and 80% in G1 and 85.7% and 85.7% in G2, respectively. Our results demonstrate that transplantation of pediatric cadaveric kidneys into pediatric recipients was excellent compared to adult recipients in terms of survival. Priority to pediatric patients should be given especially in cases of pediatric donors.

ANALYSES OF CONTRIBUTING FACTORS TO EARLY GRAFT FUNCTION IN 1279 KIDNEY TRANSPLANTS FROM NON-HEART-BEATING DECEASED DONORS.

O394* Aims: Kidney transplant (KTx) from non-heart-beating donors (NHBD) would be one of the countermeasures dealing with organ shortage. In the present study, the contributing factors to influence early graft function after KTx from NHBD were investigated. Methods: Since April 1995, 1279 cases of deceased donor KTx were done from NHBD in Japan. In 876 cases among them, triple-lumen/double-balloon catheter (TR/DBC) for in situ perfusion (ISP) was inserted into abdominal aorta via femoral vessels before cardiac standstill (CS) and ISP was initiated after CS, while in remaining 403 cases inserted following laparotomy after CS. Graft survival rate (GSR), the rate of non-function kidney (NFK), posttransplant dialysis period (PDP) and posttransplant serum creatinine (sCr) level by donor status (age, gender, cause of death, sCr, anuria, hypotension and body temperature), warm and total ischemic time (WIT, TIT), TR/DBC insertion before or after CS, the discontinuation of ventilator and preservation solution were investigated. All data were collected from 173 KTx institutes by Japan Organ Transplant Network. Results: The mean age was 46.2±16.8 (1∼74) y.o. for donor and 44.8±11.6 (2∼72) y.o. for recipient. The mean WIT and TIT were 8.1±10.6 (0∼72) min and 14.1±6.6 (2.5∼38.6) hr. GSR for within 30 min of WIT was higher than GSR for more than 30 min of WIT at 3 (89.3 vs. 70.6%), 6 (88.0 vs. 65.6%) and 12 months (85.3 and 65.6%), respectively. GSR by TIT at 3, 6 and 12 months was 91.5, 90.9 and 88.8% for less than 12 hr, 86.0, 83.6 and 81.2% for 12 to 24 hr, and 84.0, 81.8 and 76.5% for more than 24 hr, respectively. With WIT less than 30 min, GSR by TIT at 3 and 6 months was 91.3 and 90.7 for less than 12 hr, 87.9 and 85.5% for 12 to 24 hr, and 85.9 and 85,1% for more than 24 hr. With WIT over 30 min, GSR by TIT at 3 and 6 months was 63.4 and 60.8% for 12 to 24 hr and 60.0 and 40.0% for over 24 hr, whereas 100 and 100% for less than 12 hr. Posttransplant sCr was significantly higher for over 30 min of WIT and/or over 12 hr of TIT at 3 months, while same at 6 months. TR/DBC insertion before CS significantly improved GSR, the rate of NFK and PDP as compared with after CS (p=0.0026, 0.01). In case with TR/DBC inserted before CS, the discontinuation of ventilator did not influence GSR, while with TR/DBC inserted after CS, GSR with ventilator discontinued (Maastricht Classification Category (MCC) 4) was superior to that with ventilator continued (MCC 3) (96.2 vs. 82.2% at 3, 94.2 vs. 80.1% at 6 months, p=0.0198). Donor age, sCr, body temperature, existence of anuria, duration of hypotension and the type of preservation solution did not influence GSR or the rate of NFK. Conclusions: WIT, TIT and the timing of TR/DBC insertion strongly influenced GSR, the rate of NFK and PDP.