Current status and future aspects of kidney transplantation in Japan

Abstract

In Japan, there are very few cases of organ donation, including kidneys. The number of deceased donor kidney transplants (DDKTs) is much less than that of other developed Asian and Western countries, although donation after brain death is increasing slowly. Living donor kidney transplants (LDKTs) are more popular than DDKTs in Japan. However, the number of LDKTs per million population was still less than that in Korea, the UK, and the USA. Living donor ABO-incompatible kidney transplants have been performed in Japan since 1989, and longterm outcomes proved similar to those for ABO-compatible kidney transplants. Preemptive kidney transplants comprised 30% of LDKTs. In spite of the small number of kidney transplants, patient, and graft survival rates in Japan are superior to those of any other country. The infusion of regulatory T cells may induce immunotolerance in kidney transplants although acute rejection frequently occurred when immunosuppression was withdrawn and anti-donor-specific antibodies (DSAs) production could not always be suppressed. Combined kidney and bone marrow transplantation may induce immunotolerance, although a few recipients produced DSA. Kidney regeneration has become a reality. Nephron progenitor cells have been generated from human-induced pluripotent stem cells, readily reconstituting three-dimensional nephrons, including vascularized glomeruli with podocytes. The niche method has been used to generate kidney, urinary tract, and bladder tissue. Many Japanese scientists are researching kidney regeneration, and a kidney regenerated from a recipient's cells could be transplanted without immunosuppression in the near future.

Importance of Considering Malnutrition and Sarcopenia in Order to Improve the QOL of Elderly Hemodialysis Patients in Japan in the Era of 100-Year Life

“…The society of Japan is aging, and the percentage of predialysis-chronic kidney disease (CKD) patients is greater in older populations; thus, it is not surprising that the number of elderly CKD patients who require renal replacement therapy (RRT) has been increasing. Since as few as 3% of dialysis patients can be maintained on peritoneal dialysis [ 1 ] and kidney transplantation is uncommon [ 2 ], nearly all end-stage CKD patients undergo hemodialysis (HD) as RRT. Moreover, over the last three-decade period, the average age of HD patients in Japan remarkably increased from 47 years in 1983 to 69 years in 2017, according to the registry of the Japanese Society of Dialysis Therapy (JSDT) [ 3 ].…”

Association and predictive value of geriatric nutritional risk index, body composition, or bone mineral density in haemodialysis patients

“…Second, all transplant recipients were excluded in this study. The incidence of living and deceased donor kidney transplants per million of the population were only 11.6. and 0.8, respectively, in 2016 in Japan and much lower in other Asian and Western countries 25 . Nonetheless, exclusion of kidney transplant recipients from this study could potentially have resulted in selection bias because kidney transplantation remains the best available treatment for end‐stage kidney disease 26 .…”

Double filtration plasmapheresis: Review of current clinical applications

“…Aikawa reported on the current status of kidney transplantation in Japan. 15 Desensitization is performed using DFPP and/or PE in Japan. In 2016, the number of ABO-ILKTs was 390 (29.3%) of 1331 living donor kidney transplants (LDKT).…”