Low volume centerでの肺移植の取り組み

Lung Transplantation at a Low Volume Center

本邦では脳死肺移植実施施設として10施設が認定されており，2020年末までに9施設で838例の肺移植が実施された1）．3施設が100例以上の肺移植を実施し（high volume center），3施設が40～80例（middle volume center），残り3施設が20例未満（low volume center）であった1）．一般に，手術成績と手術数は相関する2）ことが指摘されている．本邦における肺移植数の多寡が手術成績と関連しているのか，あるいは移植実施施設は審査により選ばれた施設であり手術数と手術成績に関連がないのかは明らかでない．国際的にみて少ない肺移植数の中で移植実施施設を増やすことの是非や，移植実施施設の更新審査が必要とされる中，この問題は避けて通れないと考えられる．

The number of lung transplantation performed in Japan is extremely low compared to other countries, whereas we have 10 facilities certified as cadaveric lung transplantation in Japan, meaning that there are low volume centers. By August 2021, we performed lung transplantation in 21 cases for 12 years, therefore, our facility should be considered as low volume center. Surgical outcomes at low volume centers are generally considered poor. However, the overall five-year survival rate of total cases was 84.8％， and that of cadaveric cases was 94.4％ in our hospital. It was better than the average of about 73％ of all facilities in Japan. These data suggested that the accreditation system in Japan is functioning well. On the other hand, there may be a disparity between facilities. At our facility, we are actively performing inverted lung transplantation so as not to lose the opportunity for transplantation, and we have performed it in three cases so far and have achieved good results.