Roles of respirologists in lung transplantation in Japan: narrative review

BACKGROUND AND OBJECTIVE: Lung transplantation (LTx) in Japan has taken steps toward increasing the number of donors and recipients and is at the maturity stage of development, at which point pulmonologists (hereinafter referred to as “respirologists”) become involved in transplant practice. Because of severe donor shortage and limited number of LTx surgeries, most of transplant process from candidacy evaluation to post-operative management has been handled only by thoracic surgeons, which takes away opportunities from respirologists to manage LTx recipients. Given the growth of both LTx and the number of patients with complex problems, cooperation with respirologists in transplant practice is urgently needed to achieve transplant success in Japan. METHODS: Authors summarized current transplant circumstance in Japan from the transplant physician’s standpoint. A systematic search through PubMed database and Google Scholar was performed by terms of “respirologists”, “pulmonologist”, “lung transplant” or “Japan” from 2000 and 2022. Thoracic surgeons working at each transplant center were asked to complete a questionnaire on physicians’ intervention to LTx. KEY CONTENT AND FINDINGS: The roles of respirologists in LTx differ with facility size and function, depending on whether they are working at a non-transplant center with other respirologists or at a transplant center with transplant physicians. LTx centers are currently devoted to educating respirologists who work at non-transplant or low-volume transplant centers in order for them to deal with patients before and after transplantation. CONCLUSIONS: Joint efforts and training of outstanding personnel who can take care of recipients are required, this being the greatest issue for the success of transplantation in Japan.