肺メディカルコンサルタント制度の効果および現状と課題

Current Status and Tasks of the Lung Medical Consultant System

2020年の1年間に本邦では75件の肺移植が実施され，総数は838件となった1）．一方，新規待機登録者数は肺移植実施数を大きく上回り，2020年は173名であった2）．2021年10月末現在の累積登録者1,918名のうち687名（36％）が肺移植を受けたが，718名（37％）が待機中に死亡している2）．ドナー肺不足は依然として深刻である．

In order to overcome challenges of serious short supply of donor organs, a unique partnership between transplant consultant doctors and local physicians, named medical consultant （MC） system, started in 2002 to maximize the organ utilization rate. As the first step of this system, skillfull heart transplant surgeons were sent to procurement hospitals as MCs to assess donor organ function and provide intensive care to donors. Since 2006, the MC doctors have requested the donors’ attending physicians to perform aggressive bronchial suctioning using bronchoscopy, leading to an improved lung utilization rate and better graft survival. Since 2011, more than 25 lung MCs have been registered to assess donor lungs and provide advices on intensive respiratory care to donors. The effects of this system on lung transplantation opportunities and outcomes were retrospectively reviewed in 187 brain-dead lung donor candidates, which were chronologically divided into 3 phases：Ⅰ （May 1998 to November 2006, n＝44） and Ⅱ （December 2006 to January 2011, n＝64）, before and after MCs requested local attending physicians to perform aggressive bronchial suctioning using bronchoscopy, respectively；and phase Ⅲ （February 2011 to January 2013, n＝79）, after the emergence of lung MCs （Hoshikawa Y, et al. Transplant Proc 47 （3）：746-750, 2015）. The lung utilization rates in phases Ⅰ, Ⅱ, and Ⅲ, were 61, 72, and 75％ （per donor）；51, 65, and 68％ （per lung, p＝0.03）. Graft death due to primary graft dysfunction was significantly more frequent in phase Ⅰ （13.3％） than in phases Ⅱ （3.6％） and Ⅲ （3.7％, per lung, p＝0.04）. The lung utilization rate of 63 brain-dead lung donor candidates for a period of one year from June 2020 to May 2021, which was analyzed anew for this article, was 83％ （per donor） and 72％ （per lung）. We discussed current status and tasks of the lung MC system which has been operated for 10 years.