Clinical lung transplantation in Japan: Current status and future trends

The first successful lung transplantation (LTx) was performed in 1983. Since then, more than 10 000 LTx have been performed in the world, with approximately 1000 new cases each year in recent years. Lung transplantation is established as the ultimate treatment for end-stage pulmonary diseases. Clinical application of LTx was delayed in Japan because of difficulty in acceptance of brain death. The Japanese Brain Death Act (JBDA) for organ transplantation was enforced in October 1997. Now, LTx from a brain-dead cadaver donor (BDCD) becomes a clinical option for end-stage lung diseases in this country. Four LTx centers were selected and the registration of candidates for LTx started in August 1998. In total, up until May 2001, 51 patients had been registered on a waiting list. Patients' diseases for LTx in Japan are different from those in the US and Europe. So far, primary pulmonary hypertension (PPH; n = 23), idiopathic pulmonary fibrosis/interstitial pneumonia (IPF/IIP; n = 8), lymphangioleiomyomatosis (LAM; n = 7) and bronchiectasis (BE; n = 6) are the major indications for LTx in Japan. Fourteen patients (27%) have died while waiting for LTx and only eight patients (14%) have received lung allografts. The BDCD are quite precious and, thus far, only 13 donors have become available after enforcement of the JBDA. Although the average utilization of BDCD for LTx was reported to be only 10-20%, positive utility of marginal donors in Japan has led to a higher rate (five of 13; 36%). Six LTx were performed from five BDCD. These included five single LTx (LAM n = 3; IPF/IIP n = 2) and one bilateral LTx (PPH n = 1). Because there are few BDCD in Japan, living-donor lobar LTx (LDLTx) is thought to be the optimal choice for selected patients. Eight LDLTx (BE n = 2; bronchiolitis obliterans n = 2; IPF/IIP n = 2; LAM n = 1; and PPH n = 1) have been performed. All recipients who received a LTx in Japan are alive and doing well at present.