2022/5/25

令和４年度 外科学I

Organ transplantation
臓器移植

広島大学病院
消化器・移植外科
Organ Donation Videos
https://www.organdonor.gov/awareness/materials/videos.html

1 2

What is organ transplantation? What is organ transplantation?

臓器移植と ？ 臓器移植と ？

The only fundamental and The donated organ may be

radical treatment for patients from a living donor or a
with end-stage diseases of deceased donor.
vital organs, which cannot
be replaced by any other 健康な家族からの臓器の部分提
therapeutic modalities. 供による移植と、亡くなられた人
（脳死また 心臓停止後）からの
重い病気や事故などにより臓器の 臓器提供による移植がある。
機能が低下した人の臓器を他者の
健康な臓器と取り替えて機能を回復
させる医療である。

3 4

What is brain death? Criteria for diagnosis of brain death

脳死と ？ 脳死判定基準
1. Deep coma
Brain death is designed for organ donation as the
irreversible functional loss of the entire brain, 2. Dilated and fixed
pupils
including the brain stem.
“臓器提供のために定義された 3. Loss of brain stem
reflex
呼吸・循環機能の調節や意識の伝達など、生きていくために
必要な働きを司る脳幹を含む、脳全体の機能が失われた状態 4. Flat brain waves
Brain death Vegetative state
5. Loss of spontaneous
respiration
6. No changes after a
second test
conducted six or
more hours later.

5 6

1
 2022/5/25

What is organ donation? What is organ donation?

臓器提供と ？ 臓器提供と ？
Organ donation from a brain dead donor was permitted Kidneys, corneas and pancreas can be donated from
only when he/she had a documented will both to non-heart beating cadavers, diagnosed based on the
accept the brain death diagnosis and to donate his/her triad of the Japanese conventional death criteria.
organs for organ transplantation, and also his/her
family did not refuse either of them.

7 8

Annual numbers of organ donation Annual numbers of organ donation

in Japan in Japan

改正法施行
臓器移植法施行

改正法施行
98

臓器移植法施行

9 10

The present status of organ transplantation

registrant in Japan Annual numbers of deceased donor
臓器移植登録者の現状 (2019年4月30日現在) organ transplantation in Japan
Small
Heart Lung Liver Kidney Pancreas 合計
intestine 2014年 2015年 2016年 2017年 2018年 直近5年平均

現登録者合計 738 347 324 12,044 209 2 13,664

Heart 37 44 52 56 55 48.8

死体移植済 459 454 522 3,838 359 16 5,648

Lung 41 45 50 56 58 50.0

生体移植済 - 55 503 2,925 4 0 3,487

Liver 45 57 57 69 60 57.6

海外渡航 66 3 34 - 0 0 103
Kidney 125 165 174 191 179 166.8

取消 36 29 367 20,817 81 3 21,333

Pancreas 29 36 38 43 34 36.0

死亡 385 579 1282 4,159 62 6 6,473 Small

0 0 1 0 3 0.8
intestine
登録者累計 1,684 1,467 3,032 43,795 715 27 50,720

11 12

2
 2022/5/25

The present status of organ transplantation The present status of organ transplantation
registrant in Japan registrant in Japan
臓器移植登録者の現状 (2019年4月30日現在) 臓器移植登録者の現状 (2019年4月30日現在)
Small Small
Heart Lung Liver Kidney Pancreas 合計 Heart Lung Liver Kidney Pancreas 合計
intestine intestine

現登録者合計 738 347 324 12,044 209 2 13,664 現登録者合計 738 347 324 12,044 209 2 13,664

死体移植済 459 454 522 3,838 359 16 5,648 死体移植済 459 454 522 3,838 359 16 5,648

生体移植済 - 55 503 2,925 4 0 3,487 生体移植済 - 55 503 2,925 4 0 3,487

海外渡航 66 3 34 - 0 0 103 海外渡航 66 3 34 - 0 0 103

取消 36 29 367 20,817 81 3 21,333

移植に至った
31.2 34.9 34.9 15.4 50.8 59.3 18.2
割合(%)
死亡 385 579 1282 4,159 62 6 6,473

登録者累計 1,684 1,467 3,032 43,795 715 27 50,720 登録者累計 1,684 1,467 3,032 43,795 715 27 50,720

13 14

The present status of organ transplantation Difference in transplantation therapy between

registrant in Japan Japan and United States
臓器移植登録者の現状 (2019年4月30日現在) 日本とアメリカでの移植医療の違い
Small
Heart Lung Liver Kidney Pancreas 合計
intestine
The number of donation
現登録者合計 738 347 324 12,044 209 2 13,664
日本とアメリカの人口比 1 : 2.5

移植に至らな
25.0 41.4 54.4 57.0 20.0 33.3 54.8
かった割合(%)
The number of transplantation

取消 36 29 367 20,817 81 3 21,333

アメリカの移植数 日本の80倍

死亡 385 579 1282 4,159 62 6 6,473

登録者累計 1,684 1,467 3,032 43,795 715 27 50,720

15 16

Worldwide actual deceased donors What do you think about organ donation?
世界の臓器提供者数（人口100万対） 臓器提供についてどのように考えていますか？
United States

Korea
Japan

2016年臓器提供の意思表示に関する意識調査 日本臓器移植ネットワーク

17 18

3
 2022/5/25

What do you think about organ donation? Do you declare your intention by Organ Donation
臓器提供についてどのように考えていますか？ Decision Card?
臓器提供意思表示カードで意思表示していますか？

About 90% of people are willing to donate organs

2016年臓器提供の意思表示に関する意識調査 日本臓器移植ネットワーク 2016年臓器提供の意思表示に関する意識調査 日本臓器移植ネットワーク

19 20

Do you declare your intention by Organ Donation You can register your intention.
Decision Card?
臓器提供意思表示カードで意思表示していますか？

Only 10% of people declare their intention

2016年臓器提供の意思表示に関する意識調査 日本臓器移植ネットワーク

21 22

You can register your intention. How to fill out your Organ Donation Decision Card

1. I will donate my organs for transplantation following brain

death or cardiac death.
2. I will donate my organs for transplantation only following
cardiac death.
3. I will not donate my organs.

23 24

4
 2022/5/25

Selecting patients to receive a transplant

One person can donate up to
9 lifesaving organs.

To receive a transplant it is necessary for a patient to be

already registerd with the Japan Organ Transplant Network.
Heart 2 Lungs 2 Livers Pancreas 2 Kidnys Intestines
Recipients are selected based on a fair selection process
medical criteria to ensure selection of the most suitable
recipient.

25 26

Acceptable cold ischemic time for organs

臓器 虚血許容時間 搬送許容時間
Kidney Transplantation
心臓 4時間 2～3時間

肺 8時間 6時間 腎臓移植

肝臓、小腸 12時間 10時間

膵臓、腎臓 24時間 22時間

Cold ischemic time refers to the amount of time that an
organ is cold and not receiving a blood supply.
Cold ischemic time varies widely by organ, but in general,
the sooner an organ can be transplanted, the better.

27 28

Location of the kidney Function of the kidney

The kidneys are bean-shaped organs (about 10～11 cm
腎臓の機能
x 5～6 cm x 4～5 cm) that are located against the back 老廃物や余分な水分などを排泄する
muscles in the upper abdominal area. Remove waste products from the body

体液量やイオンバランスの調節をする
Balance the body's fluids and electrolyte levels

血圧を調整するホルモンを分泌する
Release hormones that regulate blood pressure

造血ホルモンを分泌して骨髄で赤血球が作られるようにする
Produce hormones that stimulate the production of red
blood cells

ビタミンDを活性化してカルシウムの吸収を促し骨を丈夫にする
They sit opposite each other on both the left and right Produce an active form of vitamin D that promotes
side of the body. strong, healthy bones

29 30

5
 2022/5/25

Indications for kidney transplantation Annual numbers of undergoing

kidney transplantation in Japan
腎移植希望者適応基準
末期腎不全患者である
透析を続けなければ生命維持が困難である、また 近い将来、
透析を導入する必要に迫られている保存期慢性腎不全
On dialysis or within months of needing dialysis with
calculated GFR of 20 or less.

Contraindications
Moderate heart disease and/or vascular disease,
Cerebrovascular disease, Ischemic ulcers, Severe obesity,
History of noncompliance to medical therapy, Active
infections, Active substance abuse, Active psychiatric
disorder which remains untreated or is untreatable, Current
incarceration or individual on parole,
Recent history of malignancy, Lack of insurance coverage
for transplant and/or post-transplant immunosuppression.

31 32

Current trends in kidney transplantation at Current trends in living donor kidney

Hiroshima Univ. transplantation at Hiroshima Univ.
(Since 2010, n=84) (Since 2010, n=69)

Deceased donor Living donor parent-child relation

marital relation

sibling relation

The majority of kidney transplantation

Unrelated kidney transplants are increasing.
were performed with living donor.

33 34

Current trends in living donor kidney Current trends in living donor kidney
transplantation at Hiroshima Univ. transplantation at Hiroshima Univ.
(Since 2010, n=69) (Since 2010, n=69)
Donor age Recipient age
Average 57.3 (37～75) Average 47.7 (22～73) 3 months after the No dialysis
initiation of dialysis

3 months within the

initiation of dialysis

Preemptive kidney transplants are increasing.

Both donor and recipient are aging

35 36

6
 2022/5/25

Current trends in living donor kidney Graft survival according to era of

transplantation at Hiroshima Univ. transplantation in Hiroshima Univ.
(Since 2010, n=69) (Living donor kidney transplantation)

Cross-match positive

(Generally, contraindication) ABO compatible

ABO incompatible

High-risk kidney transplants are increasing.

37 38

Strategy for reducing the burden of Strategy for reducing the burden of
living kidney donor living kidney donor (Video)
ミニマム創手術による移植用腎採取術
完全鏡視下移植用腎採取術 用手補助鏡視下移植用腎採取術

いずれにしても腎臓を摘出するために
最終的に 5～6cm程度の皮膚切開が必要

39 40

Strategy for reducing the burden of

living kidney donor
ミニマム創手術による移植用腎採取術
Liver Transplantation

肝臓移植

41 42

7
 2022/5/25

Location of the liver Function of the liver

肝臓の機能
Liver is located in the upper right quadrant of the abdomen,
below the diaphragm.

胆汁の生産 栄養分の代謝
Production of bile Metabolism
脂肪を分解する胆汁を生成 門脈から送り込まれた栄養分
肝臓で分解・合成・貯蔵され、必
要に応じて体が利用できる形に
作り変えて、全身に送られます

有害物の処理
Detoxification
細胞から出た有害なアンモニアを害の少ない尿
素に作り変えた後に、尿として排泄します。また
The liver is the largest internal organ 肝臓 一大化学工場 体内に入った有害物についても無害なものに作
り変えます。
(about the size of a football)

43 44

Indications for liver transplantation Indications for liver transplantation

Acute liver failure in Hiroshima Univ.
Hepatitis B, Wilson’s disease, Budd–Chiari syndrome
Chronic liver failure: Noncholestatic cirrhosis
Hepatitis B/C, Autoimmune hepatitis, Alcohol-induced cirrhosis
Chronic liver failure: Cholestatic cirrhosis Others
Primary biliary cirrhosis, Primary sclerosing cholangitis
Secondary biliary cirrhosis HCC + HCV
Acute liver failure
Chronic liver failure: Metabolic
Wilson’s disease, Hemochromatosis, Amyloidosis, Cystic fibrosis
Chronic liver failure: Vascular Autoimmune hepatitis
Budd–Chiari syndrome
Other indications Primary biliary cirrhosis
Primary oxalosis, Gycogen storage diseases
Hyperlipidemia, Polycystic liver disease HCC + HBV
Malignant disease Alcohol-induced cirrhosis
Hepatocellular carcinoma
Liver transplantation in pediatric patients LC + HBV
LC + HCV HCC
Biliary atresia, Autoimmune hepatitis, Hepatoblastoma

45 46

Living donor liver transplantation

Annual numbers of undergoing
(right lobe graft)
liver transplantation in Japan
Donor Recipient

47 48

8
 2022/5/25

Evaluation of donors for living Evaluation of donors for living

donor liver transplantation (LDLT) donor liver transplantation (LDLT)

Evaluation of Hepatic
Vascular Anatomy

49 50

Evaluation of donors for living Evaluation of donors for living

donor liver transplantation (LDLT) donor liver transplantation (LDLT)

Liver volumetry Evaluation of biliary Anatomy

51 52

Postoperative management
Optimization of the immunosuppressive
after liver transplantation
drugs according to immune status
移植後急性期（1週間以内） within 1 week
呼吸循環状態の安定化を図る全身管理 Intensive care
術後出血 Postoperative bleeding Tolerogenic Immunogenic
肝動脈、門脈、肝静脈血栓 Thrombosis
感染症対策 Infection 免疫寛容 免疫原性

移植後早期～中期（1～4週間）within 1 month
急性拒絶反応 Acute rejection
細菌感染症 Bacterial infection

移植後後期（4週間～2ヶ月）after 1 month
免疫応答のバランス
急性拒絶反応 Acute rejection
ウイルス感染症、真菌感染症 Appropriate medications
Virus infection, Fungal infection

53 54

9
 2022/5/25

Optimization of the immunosuppressive Optimization of the immunosuppressive

drugs according to immune status drugs according to immune status

免疫寛容 免疫原性
拒絶反応のリスク↑ 感染症のリスク↑

免疫原性 免疫寛容

免疫抑制剤の投与量が少ない 免疫抑制剤の投与量が多い

Increased risk of rejection Increased risk of infection

55 56

Patient survival according to era of

Optimization of the immunosuppressive transplantation in Hiroshima Univ.
drugs according to immune status

Tolerogenic Immunogenic
2010-2015 (n=85)
Patient survival

免疫寛容 免疫原性
2005-2009 (n=101)
2000-2004 (n=50)

年代別 1年 5年
2010-2015 86% 79%
2005-2009 82% 67%
免疫応答のバランス 2000-2004 68% 58%

Dose adjustments of the immunosuppressive drugs

are required for their effectiveness and safety Year post transplantation

57 58

Your intentions can save another person's life

59

10