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Oishi H, Hirama T, Watanabe T, Watanabe Y, Niikawa H, Noda M, Suzuki T, Notsuda H, Okada Y. Single lung transplantation using a lung graft from a donor whose contralateral lung is not suitable for lung transplantation. Gen Thorac Cardiovasc Surg 2024; 72:408-416. [PMID: 38180695 DOI: 10.1007/s11748-023-01999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024]
Abstract
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.
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Affiliation(s)
- Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan.
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Takaya Suzuki
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan
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2
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Watanabe T, Hirama T, Onodera K, Notsuda H, Oishi H, Niikawa H, Imaizumi K, Okada Y. Native-lung complications following single-lung transplantation for interstitial lung disease: an in-depth analysis. BMC Pulm Med 2024; 24:202. [PMID: 38658879 PMCID: PMC11044553 DOI: 10.1186/s12890-024-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) represents a heterogeneous group of lung disorders characterized by fibrotic lung tissue changes. In regions with severe donor shortages, single-lung transplantation (SLTx) is often preferred over bilateral lung transplantation for advanced ILD. However, temporal changes and complications in the retained native lung remain poorly understood. METHODS A retrospective analysis of 149 recipients who had undergone SLTx was conducted, including 34 ILD SLTx recipients. Native-lung volume, radiological alterations, and perfusion were assessed at distinct post-SLTx time points. Statistical analyses compared ILD and non-ILD SLTx groups. RESULTS Our study revealed a progressive reduction in native-lung volume over time, accompanied by radiographic deterioration and declining perfusion. Complications in the retained native lung were observed, such as pneumothorax (29.4%), pulmonary aspergillosis (11.8%), and acute exacerbation (8.9%). Long-term survival rates were similar between ILD and non-ILD SLTx recipients. CONCLUSIONS This study illuminates the unique challenges and complications with respect to the native lung following SLTx for ILD. Ongoing monitoring and tailored management are essential. Despite limitations, this research contributes to our understanding of the temporal progression of native-lung complications post-SLTx for ILD, underscoring the need for further investigation.
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Affiliation(s)
- Toshikazu Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan
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3
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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4
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Outcome After Lung Transplantation From a Donor With Bacterial Pneumonia Under the Japanese Donor Evaluation System. Transplant Proc 2022; 54:782-788. [DOI: 10.1016/j.transproceed.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 01/20/2023]
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5
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Kitagaki K, Ono R, Shimada Y, Yanagi H, Konishi H, Nakanishi M. Cardiac rehabilitation program improves exercise capacity in heart transplantation recipients regardless of marginal donor factors. Heart Vessels 2020; 36:659-666. [PMID: 33245491 DOI: 10.1007/s00380-020-01735-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/13/2020] [Indexed: 01/31/2023]
Abstract
Cardiac rehabilitation (CR) is recommended to improve exercise capacity after heart transplantation (HTx); however, the effects of marginal donor factors are unclear. Forty-one recipients participated in a 3-month CR program early after HTx (mean age 39 ± 14 years; 88% male). Patients were divided into marginal (≥ 2 marginal donor factors; n = 24) and control groups (< 2 marginal donor factors; n = 17). We examined donor and recipient factors related to change in peak oxygen uptake (peak VO2) during the CR program using multiple linear regression analysis. Baseline characteristics were similar between groups, although the mean age was higher in the marginal group (43 ± 13 vs. 34 ± 14 years, p = 0.043). Peak VO2 and knee extensor muscular strength (KEMS) improved significantly in both groups (p < 0.05), but there were no observed inter-group differences. Multiple analysis revealed change in KEMS (β = 0.52, 95% CI = 0.023-1.01) as an independent predictor of change in peak VO2 after adjustment for recipients' age, sex, and CR attendance frequency (adjusted R2 = 0.25, p = 0.0084), whereas marginal donor factors were not a predictor (p = 0.76). The CR program improved exercise capacity in HTx recipients regardless of marginal donor factors, suggesting that recipients of marginal donor hearts should be referred to CR programs.
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Affiliation(s)
- Kazufumi Kitagaki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Yukihiro Shimada
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Hidetoshi Yanagi
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Harumi Konishi
- Department of Nursing, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michio Nakanishi
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan. .,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
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6
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Yanase M, Iwasaki K, Watanabe T, Seguchi O, Nakajima S, Kuroda K, Mochizuki H, Matsuda S, Takenaka H, Ikura M, Tadokoro N, Fukushima S, Fujita T, Ishibashi-Ueda H, Nakatani T, Kitamura S, Kobayashi J, Tsujita K, Ogawa H, Fukushima N. Effect of Therapeutic Modification on Outcomes in Heart Transplantation Over the Past Two Decades - A Single-Center Experience in Japan. Circ J 2020; 84:965-974. [PMID: 32350231 DOI: 10.1253/circj.cj-19-1209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center.,Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Keiichiro Iwasaki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Hiroki Mochizuki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Sachi Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Hiromi Takenaka
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Megumi Ikura
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | | | - Soichiro Kitamura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center.,Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
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7
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Nishimura N, Kasahara M, Ishikura K, Nakagawa S. Current status of pediatric transplantation in Japan. J Intensive Care 2017; 5:48. [PMID: 28729907 PMCID: PMC5518126 DOI: 10.1186/s40560-017-0241-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/06/2017] [Indexed: 01/01/2023] Open
Abstract
Brain-dead donor organ transplantation has been available to children in Japan since the 2010 revision of the Organ Transplant Law. Of the 50–60 brain-dead donor organ transplants performed annually in Japan, however, very few (0–4 per year) are performed in children. Again, while those receiving liver, heart, and kidney transplants are reported to fare better than their counterparts in the rest of the world, organ shortage is becoming a matter of great concern. Very few organs become available from brain-dead donors or are transplanted to adults if made available at all, with some children dying while on the brain-dead organ waiting list. Against this background, living-donor transplants, split-liver transplants, domino transplants, and hepatocyte transplants represent alternative modalities, each of which is shown to be associated with favorable outcomes. Challenges exist, include streamlining the existing framework for promoting organ donation for children and between children.
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Affiliation(s)
- Nao Nishimura
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Ohkura 2-1-1, Setagaya, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Ohkura 2-1-1, Setagaya, Tokyo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Ohkura 2-1-1, Setagaya, Tokyo, Japan
| | - Satoshi Nakagawa
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Ohkura 2-1-1, Setagaya, Tokyo, Japan
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8
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Fukushima N, Ono M, Saiki Y, Sawa Y, Nunoda S, Isobe M. Registry Report on Heart Transplantation in Japan (June 2016). Circ J 2017; 81:298-303. [PMID: 28070058 DOI: 10.1253/circj.cj-16-0976] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
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9
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Hoshikawa Y, Okada Y, Ashikari J, Matsuda Y, Niikawa H, Noda M, Sado T, Watanabe T, Notsuda H, Chen F, Inoue M, Miyoshi K, Shiraishi T, Miyazaki T, Chida M, Fukushima N, Kondo T. Medical Consultant System for Improving Lung Transplantation Opportunities and Outcomes in Japan. Transplant Proc 2015; 47:746-50. [DOI: 10.1016/j.transproceed.2014.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/31/2014] [Indexed: 11/16/2022]
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10
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Nakagiri T, Inoue M, Minami M, Hoshikawa Y, Chida M, Bando T, Oto T, Shiraishi T, Yamasaki N, Ashikari J, Sawa Y, Okumura M. Interim report of the Japanese original donor evaluation and management system: the medical consultant system. Surg Today 2015; 44:1227-31. [PMID: 24077998 DOI: 10.1007/s00595-013-0731-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/04/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Lung transplantation (LTx) is an established therapy for end-stage lung failure. However, in Japan, the donor organ shortage is extremely severe compared with other developed countries, because of the strict Japanese Organ Transplantation Law. To maximize LTx opportunities in Japan, we have established a special donor evaluation and management system termed the medical consultant (MC) system. METHODS Data from 171 lung donor candidates registered in Japan from May 1998 to May 2012 were obtained and investigated in a retrospective manner. The candidates were separated into the non-MC-intervened and MC-intervened groups, and then data regarding the PaO2/FiO2 ratio, donation rate and organ survival rate were analyzed and compared between the groups. RESULTS The PaO2/FiO2 ratio of the MC-intervened group was ameliorated from the time of first brain death diagnosis to organ harvest. Although the base condition of the MC-intervened group was significantly worse than that of the non-MC-intervened group, the donation rates showed no significant difference (0.64 and 0.66, respectively; p = 0.89). There was a difference in the organ survival rate between the non-MC and MC-intervened groups (5-year survival rates of 67.2 and 88.3 %, respectively; p = 0.16). CONCLUSION The MC system used for organ donor evaluation and management in Japan has achieved acceptable interim results.
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11
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Ashikari J, Omiya K, Konaka S, Nomoto K. Correlation between donor age and organs transplanted per donor: our experience in Japan. Transplant Proc 2015; 46:1049-50. [PMID: 24815124 DOI: 10.1016/j.transproceed.2013.11.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- J Ashikari
- Japan Organ Transplant Network, Medical Headquarters, Tokyo, Japan.
| | - K Omiya
- Japan Organ Transplant Network, Medical Headquarters, Tokyo, Japan
| | - S Konaka
- Japan Organ Transplant Network, Medical Headquarters, Tokyo, Japan
| | - K Nomoto
- Japan Organ Transplant Network, Medical Headquarters, Tokyo, Japan
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12
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Imamura T, Kinugawa K, Nitta D, Fujino T, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Yao A, Kyo S, Ono M. Is the Internal Jugular Vein or Femoral Vein a Better Approach Site for Endomyocardial Biopsy in Heart Transplant Recipients? Int Heart J 2015; 56:67-72. [DOI: 10.1536/ihj.14-156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Kan Nawata
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Atsushi Yao
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Shunei Kyo
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Minoru Ono
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
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13
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Fukushima N, Ono M, Saito S, Saiki Y, Kubota S, Tanoue Y, Konaka S, Ashikari J. Heart Donation in Japan Before and After the revision of the Japanese Transplantation Act. Transplant Proc 2014; 46:2050-3. [DOI: 10.1016/j.transproceed.2014.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Fukushima N, Ono M, Saito S, Saiki Y, Kubota S, Tanoue Y, Minami M, Konaka S, Ashikari J. Japanese strategies to maximize heart and lung availabilities: experience from 100 consecutive brain-dead donors. Transplant Proc 2014; 45:2871-4. [PMID: 24156994 DOI: 10.1016/j.transproceed.2013.08.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Because the donor shortage is extremely severe in Japan because of a strict organ transplantation law, special strategies have been established to maximize heart and lung transplantations (HTs and LTs, respectively). We reviewed 100 consecutive brain-dead donors to evaluate our strategies to identify and manage heart and lung donors. METHODS We retrospectively reviewed all 100 consecutive brain-dead donors procured since the law was issued in 1997. There were 56 mens and the overall mean donor age was 43.5 years. The causes of death were cerebrovascular disease (n = 62), head trauma (n = 20), and asphyxia (n = 16): Since November 2002, special transplant management doctors were sent to donor hospitals to assess cardiac and lung functions, seeking to identify transplant opportunities. They stabilized donor hemodynamics and lung function by administering antidiuretic hormone intravenously and performing bronchofibroscopy for pulmonary toilet. RESULTS Seventy-nine HTs, 1 heart-lung transplantations, and 78 LTs (46 single and 32 bilateral) were performed. By applying these strategies organs per donor were increased from 4.5 to 6.8. Among heart donors, 61/80 were marginal: high inotrope requirement (n = 29), cardiopulmonary resuscitation (n = 28), and/or >55 years old (n = 20). None of the 80 HT recipients died of primary graft failure (PGF). Patient survival rate at 10 years after HT was 95.4%. Among lung donors, 48/65 were marginal: pneumonia (n = 41), chest trauma (n = 4), and >55 years old (n = 9). Only 2/78 LT recipients died of PGF. Patient survival rate at 3 years after LT was 72.2%. After inducing frequent pulmonary toilet, lung procurement and patient survival rates increased significantly after LT. CONCLUSIONS Although the number of cases was still small, the availability of organs has been greater and the outcomes of HT/LT acceptable.
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Affiliation(s)
- N Fukushima
- Department of Therapeutics for End-Stage Organ Dysfunction, Osaka University.
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15
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Fukushima N, Ono M, Saiki Y, Minami M, Konaka S, Ashikari J. Donor evaluation and management system (medical consultant system) in Japan: experience from 200 consecutive brain-dead organ donation. Transplant Proc 2013; 45:1327-30. [PMID: 23726564 DOI: 10.1016/j.transproceed.2013.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE As the donor shortage is extremely severe in Japan because of a strict Organ Transplantation Act, special strategies must be established to maximize organ transplant opportunities. The purpose of this study was to evaluate our strategies to identify and manage 200 consecutive brain-dead organ donors. METHODS AND MATERIALS We retrospectively reviewed the 200 donors procured since the Organ Transplantation Act was issued in 1997, including 118 males, a mean overall age of 45.1 years and cause of death being cerebrovascular disease (n = 119), head trauma (n = 37), and asphyxia (n = 44). DONOR EVALUATION AND MANAGEMENT SYSTEM: Since November in 2002, special transplant management doctors ("medical consultants") were sent to donor hospitals to assess organ function and identify transplantable organs. They also provided intensive care to stabilize hemodynamics and improve cardiac and lung functions by administering antidiuretic hormone intravenously and providing bronchofiberscopic pulmonary toilet. RESULTS We obtained 146 heart, 1 heart-lung, and 154 lung (87 single and 67 bilateral), 175 liver (28 splitted liver), 142 pancreas (114 pancreas-kidney), 253 kidney and 12 small bowel grafts. Organs procured from 1 donor increased from 4.5 to 6.8 after applying these strategies. CONCLUSIONS Although the number of cases was still small, the availability of organs and outcomes of transplantation have been acceptable.
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Affiliation(s)
- N Fukushima
- Department of Therapeutics for End Stage Organ Dysfunction, Osaka University, Suita, Japan.
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Kitamura S. Heart transplantation in Japan: a critical appraisal for the results and future prospects. Gen Thorac Cardiovasc Surg 2012; 60:639-44. [PMID: 22898800 DOI: 10.1007/s11748-012-0110-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Indexed: 01/20/2023]
Abstract
As of September 30, 2011, a total of 113 patients with end-stage heart failure underwent heart transplantation in Japan, and the early and late (10 years) survival rates appear better than those reported in 2011 by the Registry of the International Society of Heart and Lung Transplantation (ISHLT). Among the risk factors determining survival, use of both left ventricular assist devices (LVADs) during the pretransplant care and marginal donor hearts increased the risk while factors favoring survival included younger adult recipients and fewer patients with ischemic cardiomyopathy; factors noted in Japanese patients in comparison with those registered in the ISHLT report. Although only a few patients have reached 10 years follow-up, so far none has died or required retransplantation due to cardiac allograft vasculopathy (CAV). CAV may develop later in Japanese heart transplant patients than in those of mixed inter-ethnic transplants. Recently, survival rates with newer LVADs have dramatically improved and therefore, selection criteria for the permanent or destination use of an LVAD or for heart transplantation require further evaluation, depending upon the various factors in candidates with profound heart failure.
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Affiliation(s)
- Soichiro Kitamura
- Cardiovascular and Transplant Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
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Fukushima N, Konaka S, Kato O, Ashikari J. Professional Education and Hospital Development for Organ Donation. Transplant Proc 2012; 44:848-50. [DOI: 10.1016/j.transproceed.2012.03.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Konaka S, Kato O, Ashikari J, Fukushima N. Modification of the Education System for Organ Procurement Coordinators in Japan After the Revision of the Japanese Organ Transplantation Act. Transplant Proc 2012; 44:851-4. [DOI: 10.1016/j.transproceed.2012.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Egawa H, Tanabe K, Fukushima N, Date H, Sugitani A, Haga H. Current status of organ transplantation in Japan. Am J Transplant 2012; 12:523-30. [PMID: 22054061 DOI: 10.1111/j.1600-6143.2011.03822.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To overcome severe donor shortage, Japanese doctors over the years have developed innovative strategies to maximize organs transplanted per brain death donor and expanded the donor pool using living donors. They also used living and marginal organs and drastically improved living donor lung, liver, pancreas and kidney transplantations. Moreover, they initiated ABO blood type incompatible liver transplantation advancements and succeeded in overcoming the blood type barrier in kidney and liver transplantations. Similar efforts are underway for pancreas transplantation. Furthermore, Japanese doctors have developed a nonaggressive step to achieve immunosuppression following organ transplantation by carefully monitoring donor-specific hyporesponsiveness and infectious immunostatus. However, the institution of amendments to allocation systems and the intensification of efforts to decrease living donor morbidity and to increase the number of brain death donors have remained important issues needing attention. Overall, the strategies Japan has adopted to overcome donor shortage can provide useful insights on how to increase organ transplantations.
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Affiliation(s)
- H Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Hashimoto S, Kato TS, Komamura K, Hanatani A, Niwaya K, Funatsu T, Kobayashi J, Sumita Y, Tanaka N, Hashimura K, Asakura M, Kanzaki H, Kitakaze M. The utility of echocardiographic evaluation of donor hearts upon the organ procurement for heart transplantation. J Cardiol 2011; 57:215-22. [DOI: 10.1016/j.jjcc.2010.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/30/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
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21
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Nakajima I, Kato TS, Komamura K, Takahashi A, Oda N, Sasaoka T, Asakura M, Hashimura K, Kitakaze M. Pre- and Post-Operative Risk Factors Associated With Cerebrovascular Accidents in Patients Supported by Left Ventricular Assist Device - Single Center's Experience in Japan -. Circ J 2011; 75:1138-46. [PMID: 21372403 DOI: 10.1253/circj.cj-10-0986] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ikutaro Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomoko S. Kato
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Organ Transplantation, National Cerebral and Cardiovascular Center
| | - Kazuo Komamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Organ Transplantation, National Cerebral and Cardiovascular Center
| | - Ayako Takahashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noboru Oda
- Department of Cardiovascular Medicine, Hiroshima University Hospital
| | - Taro Sasaoka
- Department of Cardiology, Tokyo Medical and Dental University
| | - Masanori Asakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Abstract
Lung transplantation is well-established in the treatment of end-stage lung disease in children. Our understanding of the problems associated with transplantation has increased rapidly over the past 25 years. Recent figures suggest this knowledge is starting to translate into improvements in management and survival. The common indications for lung transplantation in children, the process of assessment and the outcomes and complications of transplantation are reviewed. We discuss briefly some of the ethical issues relevant to lung transplantation and review strategies for the future. This information may help the respiratory paediatrician prepare potential candidates and their families for the process of assessment and help him or her anticipate common problems that may occur.
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Affiliation(s)
- Gary M Doherty
- Department of Paediatric Respiratory Medicine, Kings College Hospital, Great Ormond Street Hospital for Children, London WC1N 3JH
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