Medical Consultant System for Improving Lung Transplantation Opportunities and Outcomes in Japan

Hoshikawa, Yasushi; Okada, Yoshinori; Ashikari, J.; Matsuda, Yasushi; Niikawa, Hiromichi; Noda, Masafumi; Sado, Tetsu; Watanabe, Tatsuaki; Notsuda, Hirotsugu; Chen, F.; Inoue, Masayoshi; Miyoshi, Kentaroh; Shiraishi, Takeshi; Miyazaki, Takuro; Chida, Masayuki; Fukushima, Norihide; Kondo, Takashi

doi:10.1016/j.transproceed.2014.12.041

Cited by 17 publications

(17 citation statements)

References 6 publications

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“…This unique system, which we call the "medical consultant system", has contributed to excellent quality control in donor information used in the recipient selection process, pre-procurement donor management, and communication between donor hospital staff and transplant centers. A high organ utilization rate has been achieved in our country, since this consulting regime was implemented [22]. Successful use of contaminated donor lungs in this study cohort was also attributed to those national efforts to enhance organ utilization.…”

Section: Discussionmentioning

confidence: 70%

Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

Konishi

Miyoshi

Kurosaki

et al. 2019

Gen Thorac Cardiovasc Surg

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Background Optimal management of early airway infection is essential for the survival of lung transplant (LTx) recipients during the first 12 months after transplantation. This study aimed to explore the main cause of post-lung transplant pneumonia (PLTP) within 30 days after LTx. Methods Forty LTx patients were retrospectively analyzed. Sputum sampling from donors' and recipients' airways was performed pretransplant and posttransplant daily for the first 30 days after LTx. Organisms in the recipient's and donor's original airways were compared to pathogens responsible for PLTP. Patients with and without PLTP were also compared to identify relevant risk factors. Results Seventeen (42.5%) patients developed pneumonia (PLTP group) and 23 had no episode of pneumonia (Non-PLTP group) during the first 30 days. In the PLTP group, median time from LTx to PLTP onset was 6 days. A significantly higher incidence of PLTP was caused by recipient's rather than donor's original airway bacteria (62% vs 13%, p < 0.01). Smoking history of the donor and pretransplant airway bacterial colonization of the recipient were independent risk factors of PLTP which was associated with prolonged posttransplant mechanical ventilation with longer intensive care unit stay and worse survival outcomes. Conclusions The recipient's original airway microflora rather than the donor's, was highly associated with PLTP. A combination of donor smoking history and recipient airway infection should be avoided, while evidence of donor lung infection is not a contraindication for LTx.

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Section: Discussionmentioning

confidence: 70%

Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

Konishi

Miyoshi

Kurosaki

et al. 2019

Gen Thorac Cardiovasc Surg

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“…In particular, the opt‐out systems led to an increase in deceased organ donation 14‐16 . Although no opt‐out system has been introduced, the revision of the law on donating brain‐dead organs in 2010 increased the number of donations from brain‐dead patients, which resulted in an increase in the number of pancreas transplantation procedures, as well as heart 11,17 and lung 18,19 transplantation procedures, in Japan.…”

Section: Discussionmentioning

confidence: 99%

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

Ito

Kenmochi

Aida

et al. 2021

J Hepato Biliary Pancreat

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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.

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“…We utilize a medical consultant system in which medical consultants give suggestions to the intensivists who care for possible donors. This system helps to improve the graft condition and increase the number of actual donors (2).…”

Section: Medical Consultants For Donor Managementmentioning

confidence: 99%

Current situation of lung transplantation in Japan

Konoeda¹,

Sato²

2022

Curr Chall Thorac Surg

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The first lung transplantation (LTx) from a neurologically dead donor (NDD) was performed in 2000 in Japan. This was 2 years after the first LTx from living donors. A total of 250 patients underwent bilateral and 276 patients underwent unilateral LTx procedures from NDDs from then to 2019. The number of LTx s has been increasing since revision of the Japanese organ transplantation law in 2010. However, the shortage of donors and the long waiting time (>2 years) remain problematic. Donation after cardiac death is impractical because controlled death is not permitted in Japan. We challenge the donor shortage with the use of a medical consultant system in which medical consultants give suggestions to the intensivists who care for possible donors, aggressive use of marginal donors such as older donors, smokers, suicidal hanging donors, donors who have contralateral pneumonia, and donors with a long intubation time, preoperative extracorporeal membrane oxygenation support, and living-donor LTx. In total, 234 cases of living-donor LTx were performed. Despite the aggressive use of marginal donors, outcomes in Japan are comparable with international outcomes. Careful assessment of marginal donors and meticulous management of possible donors are important key factors in rescuing as many patients as possible in the currently difficult situation of LTx in Japan.

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Medical Consultant System for Improving Lung Transplantation Opportunities and Outcomes in Japan

Cited by 17 publications

References 6 publications

Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

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

Current situation of lung transplantation in Japan

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