Current state of pancreas transplantation in Japan based on the nationwide registry

Tomimaru, Yoshito; Eguchi, Hidetoshi; Doki, Yuichiro; Ito, Toshinori; Kenmochi, Takashi

doi:10.1002/ags3.12423

Cited by 14 publications

(17 citation statements)

References 29 publications

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“…In the pancreas‐kidney category, according to the International Pancreas Transplant Registry (IPTR), about 60 LD dual transplants were performed in Japan, South Korea, China, Sweden, and Norway 1,4,10,21,23,24 …”

Section: Discussionmentioning

confidence: 99%

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Dual living donor organ transplants

Gruessner

2023

Clinical Transplantation

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Introduction Dual organ donation and transplantation from living donors (LDs) is a rare practice. Dual organ transplants can be done from the same LD or from different LDs and either simultaneously or sequentially. Simultaneous dual organ transplants from the same LD are of considerable concern due to the magnitude of the donor procedure. Methods and Results According to the UNOS/OPTN and IPTR databases, the US experience of LD dual organ transplants from 1981 to 2021 comprised 101 simultaneous or sequential dual organ transplants from the same LD and 111 transplants from different LDs for a total of 212 LD dual transplants. The first simultaneous or sequential dual organ transplants from either the same LD or different LDs were pancreas‐kidney transplants (n = 92). Four additional LD organ transplant combinations have been performed in the United States: liver‐kidney (n = 93), lung‐kidney (n = 16), liver‐intestine (n = 9), and intestine‐kidney (n = 2). Only for dual pancreas‐kidney (n = 49) and liver‐intestinal transplants (n = 4), organs from the same LD have been procured simultaneously. Importantly, no donor deaths have been reported after any simultaneous or sequential procurement. LD dual organ outcomes in all recipient categories have been excellent. Conclusions LD dual organ donation and transplantation is safe and successful. Any potential dual organ LD candidate must be subject to the highest level of evaluation scrutiny. A (dual) organ donor registry is warranted for long‐term follow‐up.

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Section: Discussionmentioning

confidence: 99%

“…In the pancreas-kidney category, according to the International Pancreas Transplant Registry (IPTR), about 60 LD dual transplants were performed in Japan, South Korea, China, Sweden, and Norway. 1,4,10,21,23,24 Yet, in the absence of an international donor registry, the exact number of worldwide LD dual organ transplants remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Dual living donor organ transplants

Gruessner

2023

Clinical Transplantation

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“…Under this law, 86 cases of donation from brain-dead donors were carried out, and 62 cases of pancreas transplantation from brain-dead donors were performed in 13 years [ 25 , 26 ]. In this era, 27 cases of pancreas transplantation from living donors, including seven cases of ABO-incompatible transplantation, were also performed due to an insufficient number of brain-dead donors [ 18 , 27 ]. Since the shortage of donors in Japan was still serious, the law on organ transplantation from brain-dead donors was amended in 2009 and came into effect in 2010.…”

Section: Pancreas Transplantation In Japanmentioning

confidence: 99%

The History of Clinical Islet Transplantation in Japan

Ito

Kenmochi

Kurihara

et al. 2022

JCM

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Islet transplantation shows the promise of being capable of relieving glucose instability and improving QOL of patients with type 1 diabetes that cannot be controlled due to severe hypoglycemia unawareness. In Japan, following the first human islet isolation from a donor after cardiac death in 2003 and the first clinical islet transplantation in 2004, islet transplantation was performed for the improvement of type 1 diabetes as a single-center trial in several centers. Although it was discontinued due to the possibility of contamination of collagenase by bovine brain component in 2007, the phase II clinical trial of islet transplantation started using ATG induction and a TNF-α inhibition protocol in 2012. The primary endpoints of this trial were the proportion of patients with HbA1c < 7.4% and freedom from severe hypoglycemic events at one year after the first islet cell infusion. In an interim analysis, this endpoint was achieved in 75% of cases. In April 2020, clinical islet transplantation was finally covered by health insurance in Japan, thanks to these outcomes. We herein introduce more than 20 years of history of clinical islet transplantation in Japan.

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“…However, the outcomes of PTx remain unsatisfactory. For example, in Japan, the 5- and 10-year survival rates for post-transplant pancreas grafts are 76.2% and 67.4%, respectively 9 , 10 . These post-transplant survival rates are comparable to outcomes reported in other countries 11 , and this universal problem of unsatisfactory PTx outcomes is thought to be due to post-transplant pancreas graft loss.…”

Section: Introductionmentioning

confidence: 99%

“…DWFG can be caused by cerebrovascular disease, cardiovascular disease, infection, or malignancy. Thus, pancreas graft loss has a variety of causes 9 , 10 . Each cause is likely to exhibit different clinical characteristics, including the frequency of the cause, the timing of the occurrence, and influencing factors.…”

Section: Introductionmentioning

confidence: 99%

Different timing and risk factors of cause-specific pancreas graft loss after simultaneous pancreas kidney transplantation

Tomimaru

Kobayashi

Ito

et al. 2022

Sci Rep

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In cases after pancreas transplantation (PTx), the pancreas graft might be lost for various reasons, including a pancreatoduodenal graft-related complication or patient death with a functioning graft. Although the causes seem to have distinct characteristics, the causes of pancreas graft loss have not been characterized. This study aimed to characterize the causes of pancreas graft loss by analyzing data from a Japanese nationwide registry. This study included 391 patients who received simultaneous pancreas-kidney transplantation among 461 patients with PTx during the study period in approved institutions in Japan. We characterized each cause in terms of the timing of the cause-specific graft loss and preoperative factors associated with graft loss based on nationwide data from a Japanese nationwide registry. Among the 391 cases, 113 lost the pancreas graft due to patient death with a functioning graft (DWFG; n = 34, 44.2%), graft thrombus (n = 22, 28.6%), or chronic rejection (CR; n = 7, 9.1%). Average (± standard deviation) time from PTx to graft loss due to DWFG, graft thrombus, and CR was 3.70 ± 4.36, 0.02 ± 0.01, and 2.37 ± 2.08 years, respectively. Duration of type 1 diabetes mellitus and donor body mass index were significantly associated with pancreas graft loss due to DWFG and graft thrombus, respectively. This characterization showed that the timing and preoperative factors associated with pancreas graft loss were significantly different for different causes of graft loss. These results may inform PTx follow-up protocols to ensure that appropriate care is based on the cause of graft loss.

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Current state of pancreas transplantation in Japan based on the nationwide registry

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 14 publications

References 29 publications

Dual living donor organ transplants

Dual living donor organ transplants

The History of Clinical Islet Transplantation in Japan

Different timing and risk factors of cause-specific pancreas graft loss after simultaneous pancreas kidney transplantation

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