What has changed in kidney transplantation in small islands in Japan? Experience in our center

• Main Authors: Hajime Hirano, Ryoichi Maenosono, Tomohisa Matsunaga, Hirofumi Uehara, Hayahito Nomi, Takuya Tsujino, Naoki Tanda, Kenkichi Saito, Taizo Uchimoto, Naokazu Ibuki, Teruo Inamoto, Yoshihiro Tokeshi, Haruhito Azuma
• Format: Article
• Language: English
• Published: BMC 2017-09-01
• Series: Renal Replacement Therapy
• Subjects: Remote islands; Kidney transplantation
• Online Access: http://link.springer.com/article/10.1186/s41100-017-0127-6

Abstract Background Okinoerabu Island and Tokunoshima Island lie in the sea to the south of the Japanese mainland, about 100 km north of Okinawa and about 500 km south of Kyushu. There are no facilities that specialize in kidney transplants, so the patients need to leave the island to undergo the procedure. Up to a few years ago, there were less than five kidney transplant patients on the island. We report the status of transplant medicine on these remote islands, including concrete methods for periodic examinations and how emergencies are handled. Case presentation Recipient age was 60.0 ± 8.9 years (mean ± SD); 15 were males and 10 were females. Donor age was 57.9 ± 8.48 years (mean ± SD); 14 were males and 11 were females. Recipient diseases leading to ESRD were diabetes (36.0%), chronic glomerulonephritis (28.0%), and ADPKD (12.0%). The duration of dialysis prior to transplantation was 382.6 ± 233.2 days (mean ± SD). We physicians specializing in kidney transplants formed an alliance with local facilities a few years back to create specialized outpatient facilities, and the number of transplant patients has gradually increased. Delayed graft function was observed in only one patient, biopsy-proven acute rejection in four patients, and chronic allograft nephropathy in two patients. In these cases, the local doctor performed the treatment in their facilities under our direction. Most of the treatments were performed safely and successfully. The mean follow-up period was 1208 ± 1809 days. None of the patients has had graft loss, with mean SCr (serum Cr level) of 1.35 ± 0.85 mg/dl. Conclusions To coordinate medical care recipients with their primary care physicians, physicians specializing in kidney transplants no longer need to travel long distances to receive follow-up outpatients. Recently, likelihood of kidney transplantation has been much higher among these islands. The number of transplant patients has gradually increased.