ObjectiveUterus transplantation (UTx) is a potential option for women with uterine factor infertility to have a child, but there has been no large-scale survey of the views on UTx in women of reproductive age in Japan. The present study was aimed to clarify the views of Japanese women of reproductive age on UTx for uterine factor infertility.MethodsA questionnaire on UTx was conducted by an Internet research company in December 2014 as a cross-sectional study in 3,892 randomly chosen women aged 25 to 39 years old. Responses were analyzed from 3,098 subjects (mean age 32.1±4.2 years old), after exclusion of inappropriate respondents in screening.ResultsOf the respondents, 62.1%, 34.7% and 18.1% favored adoption, UTx and gestational surrogacy, respectively. In contrast, 7.0%, 21.9% and 63.3% opposed adoption, UTx and gestational surrogacy, respectively. In choices of candidates for UTx based on highest priority, deceased persons (33.8%) and mothers (19.0%) were favored as donors, and women with congenital absence of the uterus (54.4%) and hysterectomy due to a malignant uterine tumor (20.0%) as recipients. Regarding societal acceptance of UTx, the answer rates were 15.7% for "UTx should be permitted", 77.6% for "UTx should be permitted with discussion", and 6.7% for "UTx should not be permitted, even with discussion". Regarding personal opinions on UTx, 44.2% were in favor, 47.5% had no opinion, and 8.3% were against.ConclusionOur results suggest that many Japanese women of reproductive age feel that UTx is socially and individually acceptable, but that concerns requiring further discussion remain among these women. There was also a tendency for UTx to be viewed more favorably than gestational surrogacy.

This is the first national survey of the incidence of de novo malignancy in Japan. Further study is required to identify the risk of de novo malignancy in organ transplant recipients in comparison to the general population, namely the standardized incidence ratio.

To the editor, The most important issue in living donor liver transplantation (LDLT) is the safety of the living liver donors. Besides surgical complication, the health-related quality of life (HRQOL) of living liver donors has been called into question. [1][2][3] This study aimed to evaluate the longterm HRQOL of living liver donors based on the nationwide survey.

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4 4 0 Supplement to Transplantation July 27, 2008, Volume 86 Number 2S match. Median follow-up duration was 28.0 months (0~93). And 56 recipients underwent one more acute rejection episodes. In univariate analysis, positive lymphocytotoxic cross-match was not signifi cant risk factor of acute rejection (p=0.625), while HCV (p=0.003), low MELD score (p=0.011), and no induction of anti-IL-2 receptor antibody (p=0.034) were revealed as risk factor for acute rejection. In multivariate analysis by Cox-Regression hazard model, younger recipient age (p=0.030, HR 0.965, CI 0.935~0.997), HCV (p=0.003, HR 0.268, CI 0.112~0.642), lower MELD score (p=0.006, HR 0.956, 0.926~0.987) were signifi cant risk factors. Conclusion: Positive lymphocytotoxic cross-match is not risk factor for acute cellular rejection. Purpose: In 2004, the Japanese National Insurance began to cover medical expenses for Adult-to-adult Living Donor Liver Transplantation (A2ALL) and the number of transplant candidates increased. However, not all candidates could receive A2ALL for a variety reasons. We report the outcome of candidates evaluated in one of the metropolitan university hospitals in Tokyo, Japan. This university is a major hospital with a special interest and experience in ABO blood type incompatible living donor liver transplants. Methods: The records of consecutive 170 candidates from 2003 to 2007 were reviewed and analyzed. Outcome: Of the 170 candidates (mean age=51.6,), 41 (24.1%) underwent A2ALL and 129 (75.9%) did not. The primary diagnoses established were Hepatitis B and/or C (108, 63.5%), alcoholic liver cirrhosis (20, 11.2%), fuluminant hepatitis (15, 0.9%). Seventy one candidates had HCC (71, 65.7%), beyond Milan criteria (52.1%). Of the 129 candidates, 107 were unsuitable for A2ALL, 15 went overseas and 7 went other Japanese hospitals to receive liver transplants. The main reasons identifi ed for those who did not receive A2ALL were 1) too late for transplant (46, 42.9%), 2) no donor (31, 28.9%), 3) other reasons such as considered social factors preferred deceased donor liver transplant (11, 10.2%). Conclusion: In Japan, only one-forth of candidates underwent A2ALL.Because of the diffi culty of fi nding a suitable living donor, about half cases were assessed too late for A2ALL. As a clinical transplant coordinator, facilitating meaningful communication among those patients and patients' family to make the right decision at the right time, it was very important to not miss the chance of a potentially life saving liver graft. An increase in organ donation from deceased donors in Japan is an urgent requirement.