Impact of the revision of the law on pancreatic transplants in Japan—An analysis of the Japanese Pancreas Transplants Registry

Abstract

Background In Japan, it has been about 10 years since the revision of the law on donating brain‐dead organs. The present study compared the outcomes of pancreatic transplant before and after the revision of the law. Methods The 437 patients who had received pancreas transplantation were divided into two groups according to the time when pancreas transplantation was performed between era 1 (before the revision) and 2 (after the revision), and compared in the patient and pancreas graft survival. Results While the annual number of brain‐dead donors was <10 in era 1, and this number significantly increased in era 2 to >50. This resulted in an increased number of pancreas transplantations: >30 cases per year. The comparison data after a propensity score‐matched analysis revealed that the death‐censored pancreatic graft survival at 1, 3, and 5 years after pancreas transplantation in era 2 was 94.9%, 92.0%, and 92.0%, which, while lacking significance, tended to be better than the values of 90.5%, 83.1%, and 78.2%, respectively, in era 1. Conclusions The revision of the law on donating brain‐dead organs increased the number of pancreas transplantations. Technical improvements in surgery due to increased experience with performing pancreas transplants may help improve pancreatic graft survival.

The History of Clinical Islet Transplantation in Japan

“…Since 2010, the number of brain-dead donor organ donations has gradually increased, reaching a record high of 98 cases in 2019 [ 28 ]. As a result, the number of brain-dead pancreas transplants also increased, reaching 49 cases in 2019.…”

“…As a result, the number of brain-dead pancreas transplants also increased, reaching 49 cases in 2019. The rate of pancreas transplants per brain-dead donor was 100% in 2009; however, as brain dead donation increased, the rate gradually fell to 50% in 2018 and 2019 [ 28 ]. With this decrease in the utilization rate of pancreatic grafts for organ transplantation, pancreatic grafts from brain-dead donors began to be used for islet transplantation in 2013 [ 29 ].…”

An Examination of Packing Methods for Grafts to Prevent Freezing Injury during Transportation for Liver Transplantation

“…In Japan, the number of liver transplants from brain-dead donors has been on the rise since the revision of the Organ Transplant Law in 2010 [1][2][3][4]. However, while 80 cases of liver transplantation from brain-dead donors are performed annually, and it has been established as a standard treatment method, many processes are required in the field of transplantation medical care, from organ transportation to transplantation surgery and the procured organ must be maintained at some degree of cold ischemia [5,6].…”

Clinical Islet Transplantation Covered by Health Insurance in Japan

“…The main modification of the law was that the declaration of a person’s intent to donate before brain death was no longer required for DBD [ 6 ]. After the law was amended, the number of DBD has gradually increased, reaching a record high of 98 cases in 2019 [ 14 ], although the number of DBD is still low compared with that in the United States and Europe. As DBD in Japan has increased, the rate of pancreas transplants per DBD has gradually decreased and some pancreata with DBD have been used for CIT from 2013 [ 14 ].…”