[History of organ transplantation in the field of pediatric surgery in Japan].
In Japan, liver transplantation was first attempted 50 years ago, around the same time as the development of pediatric surgery. In 1989, clinical liver transplantation in Japan started with a living related-donor transplantation in a boy with biliary atresia. In the early years, the majority of recipients were children worldwide, which is why pediatric surgeons played a major role in the establishment of liver transplantation in Japan. From 1998, most of the indications for pediatric patients needing liver transplantation have been covered by governmental health insurance. Since that year, the annual number of pediatric liver transplantations, mainly living-donor transplantations, has remained stable at around 130. Biliary atresia is still the most common indication, but others like metabolic disease and hepatoblastoma have been increasing. Deceased-donor liver transplantation started in 1999 in Japan, but pediatric donors are very rare. Intestinal transplantation in Japan also started in a pediatric patient with short bowel syndrome in 1996. Deceased-donor intestinal transplantation is also performed, but the number of those on the waiting list for bowel transplantations in Japan has been very limited, probably due to financial constraints and relatively poor long-term results. With the change in the Organ Transplant Law in 2010, organ donations in Japan have increased slightly. Cadaveric split-liver transplantation has the potential to expand the benefit to pediatric recipients. A universal system for the long-term follow-up of pediatric recipients should be established to manage their transition to adulthood.