Etsuko Soeda, PhD, RN, is an Associate Professor at Keio University, School of Nursing and Medical Care Tokyo, Japan. In 1988 was a Staff Nurse, Pediatric Surgical Unit, Keio University Hospital. In 1992, she moved to Pittsburgh, USA, to study about organ transplant. In 1995, she did BSN from University of Pittsburgh, School of Nursing. In 1998, she completed her Master’s Degree from Duquesne University, School of Nursing. From 2010 till now she is an Associate Professor in Keio University, School of Nursing and Medical Care. She was the President of The Japan Transplant Coordinators Organization from 2008-2009. She is the Director of The Japan Academy of Transplantation and Regeneration Nursing from 2003 till now.



Objectives: Almost three decades has passed since the first living donor liver transplant (LDLTx) was performed in Japan in 1989. Nowadays, there are many reports about problems in their adherence with those transplant children who received LDLTx because there is no transition strategy for those children and parents/guardian. The objective of this study is to measure the effect of nature and outdoor activity to improve transplant children’s adherence.

Methods: Recruited participants age from 9 years who are coming out-patient liver transplant clinic with stable condition (no event such as rejection or infection within 6 months). Taking participants for snow camp and measured its effect by using IKR (Ikiru Chikara) tool which contain 28 items divided into three categories: psychosocial ability, moral fitness, and physical ability. They were tested for three times, before, after and 1 month after the camp.

Results: Seventeen patients participated to the snow camp and seven patients were eligible for the study. The average age was 14.9 with range 9-29 yr. and 13 males and 4 females. The IKR total score (value 28~168) before, after, and 1 month after were 131.7, 131.2 and 130.7 (average). There were positive feedbacks from patients and their parents and all patients have come to out-patients clinic regularly.

Conclusion: There was no significant change in those score for this short observation. Longer observation is needed to measure the effect use of nature and outdoor activities.