Preface: why is the outcome good?—secrets of lung transplantation in Japan
The 5- and 10-year survival of lung transplantation in Japan is currently approximately 73% and 60%, respectively (1). Compared with the international registry data, which show 5- and 10-year survival of lung transplantation is approximately 55–60% and 35–40%, respectively (2), the outcome of lung transplantation in Japan is relatively good. However, the reason has not been well documented.
In this special series entitled “Why is the Outcome Good? Secrets of Lung Transplantation in Japan” in the Journal of Thoracic Disease, we, the authors participating lung-transplant practice in active lung-transplant centers, have tried to explore the reasons why the outcome of lung transplantation has been relatively good. Through the 10 review articles and 1 original article from active lung transplant centers in Japan, we have figured out that this is (perhaps not surprisingly) multifactorial and the outcome is the net sum of each single component of lung transplantation that has been meticulously managed and refined. Namely, there was no real secret or magic bullet of lung transplantation in Japan.
This special series would be a good lesson to learn for the medical and surgical professionals involved in lung transplantation worldwide, especially for those who are starting or have started a new lung-transplant program as a center or as a nation. On the other hand, there remains a question as to the sustainability of the lung-transplant system in Japan. The number of lung transplantation in Japan has been relatively small in general (in total approximately 1,000 cases in the last 20 years). However, now the number is increasing relatively rapidly (126 cases in 2023) and further incase is anticipated because of the increasing number of deceased organ donations. It is possible that the outcome was achievable only because of the limited number of patients, for whom Japanese transplant surgeons/physicians have taken overwhelming time and effort. It is indeed a serious issue for some relatively high-volume centers in Japan like ours (now conducting 40–50 cases/year) to maintain the quality of patient management with the limited personnel. Thus, each article of the special series will be a good indicator even for Japanese lung transplant physicians and surgeons as to the standard of care in 2024 in Japan and what could be changed in the pursuit of efficacy and what should be perpetuated in the future.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Thoracic Disease, for the series “Why is the Outcome Good? Secrets of Lung Transplantation in Japan”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1070/coif). M.S. served as the unpaid Guest Editor of the series. The series “Why is the Outcome Good? Secrets of Lung Transplantation in Japan” was commissioned by the editorial office without any funding or sponsorship. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Japanese lung and heart-lung transplant society registry report 2024. Available online: https://www2.idac.tohoku.ac.jp/dep/surg/shinpai/registry/
- The International Thoracic Organ Transplant Registry Data, 2019. The International Society for Heart and Lung Transplantation. Available online: https://ishltregistries.org/registries/slides.asp?yearToDisplay=2019
