記述言語：日本語   掲載種別：研究論文（学術雑誌）  

(Objective) Pregnancy in kidney transplant recipient continues to remain challenging due to a high rate of cesarean section along with preterm delivery, and concern for worsening renal function. This study examined the prognosis and perinatal management of post-transplant pregnancies. (Patients and methods) A total of nine post-transplant recipients at Niigata University Medical and Dental Hospital between 2007 and 2021 were retrospectively examined. (Results) All pregnancies were planned. Calcineurin inhibitors and steroids were continued, and antimetabolites were changed to azathioprine. The mean age at delivery was 33±3.8 years, and the mean time from renal transplantation to delivery was 6.5±3.5 years. Five patients (55.5%) had cesarean sections, while four (44.5%) patients had normal vaginal deliveries. The mean gestational age was 35±3.0 weeks, and the mean birth weight was 2,336±565.4 g. No congenital malformation was observed. The most common reason for early delivery was worsening renal function, seen in six (66.7%) patients. The mean serum creatinine level before pregnancy was 1.11±0.23 mg/dL and then worsened to 1.59±0.37 mg/dL during pregnancy. However, it recovered to 1.14±0.40 mg/dL after delivery. One patient had antibody-mediated rejection with donor specific antibody (DSA) prior to pregnancy, and her renal graft function worsened slightly after delivery. Another patient had a de novo DSA after delivery, which was not detected before pregnancy. (Conclusions) In our hospital, pregnancy in kidney transplant recipients were safe and renal graft function after delivery was relatively stable. Patients may require adjustment of calcineurin inhibitors during pregnancy, and the appearance of DSA after delivery should be noted.

DOI： 10.5980/jpnjurol.114.8

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to determine the appropriate body mass index (BMI) in Japanese kidney transplant (KTx) recipients. We analyzed the effects of pre- and post-transplant (Tx) obesity on graft and patient survival, perioperative complications, post-transplant diabetes mellitus (PTDM), and cardiovascular disease (CVD) in Japanese KTx recipients. METHODS: This retrospective study included 269 recipients who underwent KTx from 2008 through 2020 at Niigata University Hospital. Obesity was defined as a body mass index (BMI) ≥25 kg/m2. We examined the association between pre- and post-Tx obesity and graft survival, patient survival, the incidence of PTDM and CVD, and perioperative surgical complications. RESULTS: The graft survival rate was lower in the pre-Tx BMI ≥25 kg/m2 group, although there was no significant difference in patient survival. There was no difference in graft and patient survival between the post-Tx BMI ≥25 kg/m2 group and the <25 kg/m2 group. A pre-Tx BMI ≥25 kg/m2 was an independent risk factor for biopsy-proven allograft rejection. New-onset DM after transplantation was significantly more common in the BMI ≥25 kg/m2 group than in the BMI <25 kg/m2 group (36% vs 13%; P = .002). The incidence of CVD was significantly higher in the post-Tx BMI ≥30 kg/m2 group than in the BMI <30 kg/m2 group (50% vs 11%; P = .023). There were no differences in surgical operating time, intraoperative blood loss, or perioperative complications between the obese and non-obese groups. CONCLUSION: Pre-Tx BMI ≥25 kg/m2 may be a risk factor for allograft rejection and graft loss. Post-Tx BMI should be <25 kg/m2 to reduce the risk for PTDM.

DOI： 10.1016/j.transproceed.2022.10.058

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: ABO antigens expressed on the red blood cells (RBCs) are not identical to those expressed on the renal endothelial cells. The isohemagglutinin assay employing the RBCs is the gold standard for evaluating anti-ABO antibody (Ab) levels. However, it remains unclear whether the anti-ABO Abs detected by the isohemagglutinin assay after ABO-incompatible (ABOi) kidney transplantations (KTx) that are not associated with antibody-mediated rejection can bind to renal graft endothelial cells. METHODS: Ninety plasma samples were collected from patients with stable graft function after ABO-compatible (ABOc) or ABOi KTx. Anti-ABO Ab titers were examined by both the isohemagglutinin assay and the CD31-ABO microarray, which was developed as a mimic of the ABO antigens expressed on the renal endothelial cells. RESULTS: The antibody titers detected by the isohemagglutinin assay and the CD31-ABO microarray after the ABOc KTx relatively correlated with each other. However, the CD31-ABO microarray results showed low antibody levels against donor blood group antigens after ABOi KTx and did not correlate with the isohemagglutinin assay. In contrast, the antibody levels against non-donor blood group antigens after ABOi KTx were comparable to those after the ABOc KTx. Fourteen patients received graft biopsies, and no antibody-mediated rejection was observed in ABOi KTx recipients, except for two patients who had anti-donor-HLA Abs. CONCLUSION: The present study suggested that the anti-ABO Abs detected by the isohemagglutinin assay after ABOi KTx with stable graft function were hyporeactive to the ABO antigen of graft renal endothelial cells.

DOI： 10.1007/s10157-022-02280-3

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00083&link_issn=&doc_id=20221028010394&doc_link_id=%2Fcl8isoke%2F2022%2Fs057s1%2F157%2F0324-0324%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2022%2Fs057s1%2F157%2F0324-0324%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient. CASE PRESENTATION: A 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery. CONCLUSIONS: Hernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection.

DOI： 10.1016/j.transproceed.2021.09.076

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: As the number of long-term survivors after organ transplantation increases, malignancy has become a problem as a late complication. We herein report a case of endometrial cancer during the follow-up of pancreas transplantation after kidney transplantation. CASE PRESENTATION: A 49-year-old woman was diagnosed with endometrial cancer. The patient had developed type 1 diabetes at 8 years old and started insulin treatment, and at 29 years old, she started hemodialysis for diabetic nephropathy. At 31 years old, she received living donor kidney transplantation and withdrew from dialysis. Hypoglycemia unawareness began to occur frequently from around 36 years old, and at 48 years old, the patient underwent deceased donor pancreas transplantation after kidney transplantation and achieved insulin independence. At 49 years old, she was diagnosed with endometrial cancer. Surgical treatment (total abdominal hysterectomy with left salpingo-oophorectomy) was performed. The pathologic diagnosis was confirmed as stage 1A uterine endometrioid carcinoma grade 1. The postoperative course was uneventful. She was discharged from our hospital on postoperative day 8. There has been no evidence of recurrence and/or metastasis of endometrial cancer for 16 months since the surgery. CONCLUSIONS: Carcinogenesis after pancreas transplantation may be a lethal late complication. It is important to carry out regular screening examinations with carcinogenesis in mind.

DOI： 10.1016/j.transproceed.2021.12.021

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記述言語：英語  

We herein report the case of a 20 year-old-man who developed bronchiolitis obliterans after living-donor renal transplantation. The patient presented with dyspnea on exertion and wheezing two years after renal transplantation, and spirometry showed an obstructive pattern. Surgical lung biopsy revealed subepithelial fibrosis that constricted and obstructed the intrabronchiolar space. Based on these findings, the patient was diagnosed with bronchiolitis obliterans. He was prescribed bronchodilators and azithromycin, and he achieved stable respiratory function for two years. The differential diagnosis of respiratory symptoms after renal transplantation includes opportunistic infection and drug-induced lung injury; however, bronchiolitis obliterans should also be considered.

DOI： 10.1016/j.resinv.2020.12.003

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会  

(背景)アルドステロンは高血圧のみならず,心機能障害や腎機能障害の原因になるとされる.慢性血液透析患者の中に著明な高アルドステロン血症を呈する症例が存在し,移植腎への影響が懸念される.腎移植後のアルドステロンの長期的な変化や移植患者への影響は不明な点が多い.(対象と方法)当院で1996年から2018年に施行された210名の患者の腎移植前後の血漿レニン活性(PRA)と血漿アルドステロン濃度(PAC)を後方視的に評価した.(結果)腎移植前は60%の症例でPRAは基準値より高値を示し,腎移植後も60%の症例が高レニン血症だった.腎移植後の高レニン血症は,アンギオテンシン受容体阻害薬(ARB)やアンギオテンシン変換酵素阻害薬(ACEI)を使用していた患者で有意に多かった.また,60%の症例で腎移植前のPACが基準値より高かったが,そのほとんどが腎移植後に自然に改善していた.腎移植後のPRA,PACの値と移植腎機能,年齢,収縮期および拡張期血圧に有意な相関はなかった.腎移植後PAC基準範囲内と高値の2群比較を行い,PAC高値群(n=29)は,拡張期血圧が有意に高く,レニン-アンギオテンシン-アルドステロン(RAAS)系阻害薬の使用が有意に少なかった.(結語)腎移植後に高アルドステロン血症が持続する患者にはRAAS系阻害薬の使用を考慮し,長期的な移植腎や心血管系への影響を観察する必要はある.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cytomegalovirus (CMV) infection is one of the major factors that affect morbidity and mortality in kidney transplant (KTx) patients. The rate of CMV seropositivity in children before KTx is lower than that in adults; therefore, pediatric KTx patients have a higher risk of CMV infection. In Japanese pediatric KTx patients, preemptive therapy for CMV infection is a main conventional therapy. This study investigated whether this preemptive treatment would affect kidney function at 2 years post-KTx. METHODS: A total of 163 patients, that is approximately half of the Japanese pediatric KTx patients nationwide, were recruited to participate in our study. We compared the values of the sequential estimated glomerular filtration rate (eGFR) at two years post-KTx and other influencing factors in CMV viremia, CMV disease, and no-infection groups. RESULTS: Cytomegalovirus infection after KTx occurred in 75 patients (46.0%), 38.7% of whom developed CMV disease. The sequential eGFR values post-KTx did not differ significantly between the three groups. CMV infection was not significantly correlated with other factors, other infections (including Epstein-Barr [EB] virus infection), acute rejection (AR), or adverse events. Only prolonged duration of total hospitalization was significantly associated with CMV infection (P = .002). In the multivariate analysis, younger age, CMV infection, and adverse effects were independently significantly related to prolonged total hospitalization. CONCLUSION: Preemptive therapy for CMV infection evidenced by viremia and disease did not significantly influence kidney function in Japanese pediatric KTx patients at two years after the operation.

DOI： 10.1111/tid.13271

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記述言語：日本語   出版者・発行元：(一社)日本臨床腎移植学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

(Background) It has become evident in recent year that aldosterone has a pathogenic role in hypertension, heart failure and renal disease. Elevation of aldosterone occurs in a certain fraction of hemodialysis patients, and the adverse effects of hyperaldosteronism could pose a problem after kidney transplantation. Long-term effects of aldosterone level in renal transplant recipients remain unknown. (Materials and methods) All recipients underwent transplantation between 1996 and 2018 in Niigata university hospital were included in the study. Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were retrospectively analyzed in 210 recipients before and after kidney transplantation. (Results) Sixty percent of recipients had higher PRA than normal upper limit before and after transplantation. The use of angiotensin receptor blocker (ARB) or angiotensin-converting-enzyme inhibitor (ACEI) was significantly more frequent in the patients with hyperreninemia than those without one after transplantation. Sixty percent of recipients had higher PAC than normal upper limit before transplantation and it spontaneously decreased to normal level after transplantation in most of them. There was no significant correlation between PAC and blood pressure, recipient age, and renal graft function after transplantation. We divided the patients into two groups, with and without post-transplant hyperaldosteronemia. The patients with post-transplant hyperaldosteronemia (n=29) had higher diastolic blood pressure and less use of renin-angiotensin-aldosterone system (RAAS) inhibitors than those with normal PAC level. (Conclusions) The use of RAAS inhibitors should be considered in post-transplant hyperaldosteronemia patients to control blood pressure and to save their long-term renal graft and heart function.

DOI： 10.5980/jpnjurol.111.74

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 68-year-old male patient received a living donor kidney transplantation 8 years earlier for end-stage kidney disease secondary to IgA nephropathy. His post-transplantation follow-up had been routinely performed with laboratory examinations, ultrasound, and computed tomography (CT). His kidney graft function had been excellent and stable, as shown by a baseline serum creatinine level of 1.0 mg/dL. At referral, regular follow-up ultrasound and CT showed allograft hydroureteronephrosis. He did not have any complaints, but his physical examination revealed right inguinal bulging that was 3.5 × 3.5 cm. Abdominal enhanced CT revealed transplant allograft hydroureteronephrosis due to ipsilateral herniation of ureteroneocystostomy into the right inguinal canal. His serum creatinine level was slightly elevated (1.1 mg/dL). Then, he underwent an open right inguinal hernia repair. Paraperitoneal allograft hydroureteronephrosis and bladder herniation was confirmed at surgery, and hernioplasty with polypropylene mesh reinforcement was successfully performed. The postoperative course was uneventful. He was discharged on the seventh day after surgery. Six weeks after surgery, CT revealed disappearance of allograft hydroureteronephrosis and no sign of inguinal hernia recurrence with the serum creatinine stable at 1.0 mg/dL. Transplant ureteral obstruction due to inguinal hernia is a rare complication after kidney transplantation. However, transplant ureter or bladder herniation should be considered in the differential diagnosis of graft hydroureteronephrosis for preventing allograft loss.

DOI： 10.1016/j.transproceed.2020.02.131

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To analyze the prevalence of systemic de novo thrombotic microangiopathy in ABO-incompatible kidney transplantation and risk factors associated with this condition. METHODS: A total of 201 patients who received living-donor kidney transplantation (114 patients with ABO-identical kidney transplantation and 87 patients with ABO-incompatible kidney transplantation) were retrospectively analyzed. Systemic de novo thrombotic microangiopathy was diagnosed clinically according to the presence of thrombocytopenia with microangiopathic hemolytic anemia and pathological findings of thrombotic microangiopathy. Anti-A and anti-B antibodies were purified from human plasma, and these antibodies' bindings to human kidney were investigated in vitro. RESULTS: ABO-incompatible kidney transplantation was a significant risk factor of systemic de novo thrombotic microangiopathy (odds ratio 55.9, 95% CI 1.8-8.9, P < 0.001) after transplantation. Multivariate logistic regression analysis showed that non-use of mycophenolate mofetil, pretreatment immunoglobulin G antibody titer ≥64-fold and pretransplant immunoglobulin M antibody titer ≥16-fold were significant risk factors for systemic de novo thrombotic microangiopathy in ABO-incompatible kidney transplantation. Microvascular inflammation of 1-h post-transplant biopsy could be observed more frequently in thrombotic microangiopathy patients than in non-thrombotic microangiopathy patients. Anti-A and anti-B antibodies purified from human plasma showed a strong in vitro reaction against human kidney when the antibody titer was ≥16-fold. CONCLUSIONS: Antibody titer should be decreased to ≤16-fold until the day of ABO-incompatible kidney transplantation by desensitization therapy including mycophenolate mofetil. The 1-h biopsy results might help to diagnose systemic de novo thrombotic microangiopathy.

DOI： 10.1111/iju.14118

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hepatitis E virus (HEV) infection has been recognized as an acute condition. However, recent reports have shown that immunocompromised patients, such as those receiving solid-organ transplantation, can develop chronic hepatitis with HEV infection. We report two cases of chronic hepatitis E after kidney transplantation (KT) who were successfully treated with ribavirin monotherapy. Several years after KT, both patients had sustained elevations in the levels of liver enzymes for a period of more than 6 months. Both patients had HEV infection, genotype 3a. Histological studies showed infiltration of inflammatory cells without fibrosis. Treatment included ribavirin monotherapy at a dosage of 600 mg daily for 3 months. One month after therapy initiation, HEV-RNA turned to negative, and remained negative at 24 weeks after ribavirin therapy without severe complications. Although the treatment of chronic hepatitis E is not fully established, ribavirin therapy can be a safe and effective treatment for chronic hepatitis E.

DOI： 10.1111/hepr.13363

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Plasma cell-rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.

DOI： 10.1016/j.transproceed.2019.02.038

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

<p> (背景) 腎移植後の再発性IgA腎症（recurrent IgA nephropathy：以下rIgAN）の標準的治療法は未だ確立していない．</p><p> (対象と方法) 原発性IgA腎症による末期腎不全に対して腎移植術を施行されたレシピエントのうち，移植腎生検にてrIgANと診断された20症例を対象とし，扁桃腺摘出術とステロイドパルス併用療法の効果について後方視的に解析を行った．</p><p> (結果) 尿蛋白については，治療前が0.84±0.81g/day，治療後が0.27±0.31g/dayと治療により有意に尿蛋白は改善していた（P=0.007）．顕微鏡的血尿は治療半年後，1年後でそれぞれ58.3%，66.6%の患者が消失もしくは改善していた．血清クレアチニン値は，移植腎機能喪失した3症例を除いて，治療後5年間で有意な変化は見られず安定していた．治療前後で移植腎生検を施行し得た16症例のうち，7例（43.75％）の患者でメサンギウム領域のIgAの沈着が消失もしくは著明に減弱していた．また，メサンギウム細胞増多，管内細胞増多，半月体形成などの急性期病変は治療によりそれぞれ3例（18.8％），6例（37.5％），4例（25％）の患者で改善していた．</p><p> (結論) 移植後rIgANに対する扁桃腺摘出術とステロイドパルス併用療法は臨床的にも組織学的にも有用である可能性が示唆された．</p>

DOI： 10.5980/jpnjurol.110.92

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The purposes of the present study were to evaluate growth rate of nonfunctioning adrenal incidentalomas (AIs) and their development to hormonal hypersecretion on follow-up. MATERIALS AND METHODS: A retrospective study was conducted from the electronic medical records. A total of 314 patients were diagnosed with adrenal tumors between 2000 and 2016. After excluding patients who had overt adrenal endocrine disorders or whose adrenal tumors were clinically diagnosed as metastatic malignancies, we investigated 108 patients with nonfunctioning AIs including characteristics, the treatment, the way of follow-up and pathology. RESULTS: Fifteen patients received immediate adrenalectomy because of the initial tumor size or patient's preference. Pathological examination revealed malignancy in 2 patients. In the remaining 93 patients, radiological examinations were performed periodically. Tumor enlargement of ≥ 1.0cm was observed in 8.6% of the patients who were followed up as nonfunctioning AIs with a median follow-up period of 61.5 months (range: 4-192). Eleven patients underwent adrenalectomy. On the pathological examinations, all of the tumors, which showed a size increase, were diagnosed as benign tumors. Regarding the followed up patients without adrenalectomy, only 2.4% of the patients had tumor enlargement during the prolonged follow-up. Furthermore, none of the patients developed hormonal hypersecretion or clinical signs such as obesity, glucose intolerance or poorly controlled hypertension. CONCLUSIONS: Tumor enlargement of AIs did not correlate with malignancy. The value of repeat radiological and hormonal examinations may be limited in the long-term follow-up of patients whose AIs are not enlarged.

DOI： 10.1590/S1677-5538.IBJU.2018.0235

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：腎移植・血管外科研究会  

【背景】移植後リンパ増殖性疾患(post-transplant lymphoproliferative desorder:PTLD)は、近年増加傾向にある。【対象と方法】当院で1988-2015年の間に行われた413症例を対象に、PTLDを発症した5症例を後方視的に検討した。【結果】男性3例、女性2例で、移植時の年齢の中央値は51歳、PTLD診断時の年齢の中央値は55歳、腎移植後にPTLDと診断されるまでの期間の中央値は142ヵ月だった。5例のうち1例は死亡、3例は透析再導入となった。死亡した症例を除き、全例で免疫抑制薬の減量・中止が行われ、1例で外科的切除術、1例で化学療法、1例で両者併用が行われた。【結論】5人のPTLDのうち、4人がLate onsetであり、腎移植後の継続的なスクリーニングが必要であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本臨床工学技士会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Biologic agents are a beneficial therapy for juvenile idiopathic arthritis (JIA). However, there is a lack of evidence with regard to management of these agents for JIA patients who undergo kidney transplantation (KTx). A 36-year-old woman with JIA who was treated with tocilizumab targeting interleukin-6 (IL-6) receptor underwent ABO-incompatible kidney transplantation (ABOi KTx). To prevent over-immunosuppression, tocilizumab was discontinued before ABOi KTx. Rituximab, tacrolimus, mycophenolate mofetil, everolimus, and methylprednisolone were used for immunosuppression. Clinical remission of joint pain was maintained for over 3 years despite complete discontinuation of tocilizumab. Both serum IL-6 and soluble IL-6 receptor levels were markedly decreased, suggesting that multitargeted immunosuppression for ABOi KTx induced long-term clinical remission of JIA through inhibition of the IL-6 pathway. However, levels of C-reactive protein (CRP) and matrix metalloproteinase-3 (MMP-3) gradually increased thereafter and abatacept was initiated to prevent joint deterioration. These levels decreased without any adverse events. The patient's renal graft function was well maintained.

DOI： 10.1016/j.transproceed.2017.12.052

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

(Backgrounds) The efficacy of bortezomib for chronic antibody mediated rejection (CAMR) after kidney transplantation is still obscure. (Materials and methods) CAMR were persisted in 5 recipients who were treated with plasma exchange, low dose of IVIG, steroid pulse therapy, and rituximab. 1.3 mg/m2 of bortezomib was administered on days 1, 4, 8, 11. Serum creatinine (sCr) levels, anti-HLA antibodies, and histology were analyzed. (Results) Stable sCr levels were obtained in 3 out of 5 recipients. No one lost renal graft function during follow-up periods. Anti-HLA class I antibodies were significantly decreased after bortezomib treatment, however anti-HLA class II antibodies were not changed. Histology showed no improvement at 6 months after bortezomib administration. Two recipients whose sCr levels increased during follow-up had already had interstitial fibrosis and tubular atrophy (IF/TA) in histology before bortezomib treatment. (Conclusions) The use of bortezomib after IF/TA could be detected in histology may not contribute to stabilize renal graft function in CAMR.

DOI： 10.5980/jpnjurol.109.68

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

(Background) Long-term care is necessary for normal growth and development of pediatric recipients of kidney transplants. We report on our experience with pediatric kidney transplantation (KTx) during the past 19 years. (Methods) We retrospectively analyzed the data from 26 recipients who received KTx between 1996 and 2014 at Niigata University Hospital (one patient underwent two consecutive KTx during the designated period). All recipients were 16 years old or younger at the time of KTx. (Results) The graft survival rates at 1, 5, and 10 years after transplantation were 96%, 96%, and 88%, respectively. Three recipients lost the renal graft function due to graft thrombosis, antibody mediated rejection and steroid resistant rejection. Drug non-adherence was associated with rejection episodes, which led to the increasing of estimated glomerular filtration rate (eGFR) level. In addition, renal graft function was related to the growth after KTx. Eighteen recipients graduated from high school during follow-up periods and 17 recipients obtained employment. (Conclusion) Interventions promoting adherence should be implemented among pediatric recipients and parents to optimize graft survival and growth after KTx. Successful KTx contributed the high rate of social participation and employment after pediatric KTx.

DOI： 10.5980/jpnjurol.109.14

PubMed

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：腎移植・血管外科研究会  

移植医療におけるドナー不足は大きな問題であり、高齢者ドナーや心停止後摘出臓器の利用が世界的にも増加している。移植後の腎機能に影響する因子を検討することは以前より行われてきた。当院における59例の心停止下献腎移植の移植腎機能にかかわるレシピエント因子、ドナー因子、graft因子をそれぞれ後方視的に解析した。その結果、UNOSの定義するExpanded criteria donor(ECD)とgraft hyalinosisの程度が移植後腎機能に大きく影響する因子であることが分かった。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The mechanism of long-term B cell immunity against donor blood group antigens in recipients who undergo ABO-incompatible (ABOi) living-donor kidney transplantation (LKTx) is unknown. To address this question, we evaluated serial anti-A and anti-B antibody titers in 50 adult recipients. Donor-specific antibody titers remained low (≤1:4) in 42 recipients (84%). However, antibodies against nondonor blood group antigens were continuously produced in recipients with blood type O. We stimulated recipients' peripheral blood mononuclear cells in vitro to investigate whether B cells produced antibodies against donor blood group antigens in the absence of graft adsorption in vivo. Antibodies in cell culture supernatant were measured using specific enzyme-linked immunosorbent assays (ELISAs). Thirty-five healthy volunteers and 57 recipients who underwent ABO-compatible LKTx served as controls. Antibody production in vitro against donor blood group antigens by cells from ABOi LKTx patients was lower than in the control groups. Immunoglobulin deposits were undetectable in biopsies of grafts of eight recipients with low antibody titers (≤1:4) after ABOi LKTx. One patient with blood type A1 who received a second ABOi LKTx from a type B donor did not produce B-specific antibodies. These findings suggest diminished donor-specific antibody production function in the setting of adult ABOi LKTx.

DOI： 10.1111/ajt.13937

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 56-year-old woman had complained of two year's consecutive left-side abdominal pain. Retroperitoneal tumor was diagnosed and the patient was referred to our institute in December 2014. Laboratory data including endocrinological activity and serological markers were within the normal ranges. Imaging studies showed that the solid tumor measuring 5 cm in diameter was uncovered in the retroperitoneum, between the abdominal aorta and left kidney. The patient underwent surgical removal of the tumor with the left kidney because the mass was highly adhesive to the left ovarian vessels and left renal vein. Histological examination showed proliferating spindle cells in the tumor, and immunoreactivity for desmin and alfa-smooth muscle actin in tumor cells confirmed the diagnosis of leiomyosarcoma originated in left ovarian vein with left renal vein invasion. The patient has been free of disease 21 months after the surgery. Ovarian vein leiomyosarcoma is extremely rare and we have found 18 cases in literature. Furthermore, only three cases of leiomyosarcoma arising from the ovarian vein with the renal vein invasion were reported including our case.

DOI： 10.5980/jpnjurol.108.210

PubMed

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BASKENT UNIV  

The ABO-incompatible living-donor kidney transplantation was developed in Japan in 1989. Currently, most transplant physicians and surgeons have noted that outcomes are unexpectedly excellent, and no hyperacute rejections have been reported since 2001. In the registry of the Japanese ABO-Incompatible Kidney Transplantation Committee, the data of 2434 ABO-incompatible living-donor kidney transplants were collected from 120 Japanese kidney transplant centers. Overall patient and graft survival rates were 97% and 94% at 1 year, 93% and 86% at 5 years, 90% and 71% at 10 years, and 73% and 52% at 20 years. The patient survival and graft rates in 2001 to 2012 were 93% and 81%, which were significantly better than 83% and 55% reported in 1989 to 2000. The addition of novel immunosuppressive treatments has improved results. Azathioprine has been replaced by mycophenolate mofetil since 2000 to 2001, and basiliximab and rituximab were introduced in 2002 and 2004. The titer of antidonor blood group antibody before transplantation was not correlated with graft survival in 2001 to 2012. De novo antibodies against vascular endothelium of peritubular and glomerular capillaries seemed to be more important than natural antibodies against red blood cells. Therefore, recipients with antidonor blood group antibody titers &lt; 1:128 did not require antibody-removal procedures such as plasmapheresis or immunoadsorption. In particular, children (regardless of their peritoneal dialysis status) do not need to be catheterized for plasmapheresis or immunoadsorption. It is better to avoid the risks of catheterization and antibody removal procedures in children with end-stage renal failure.

DOI： 10.6002/ect.mesot2014.L24

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

ABO血液型不適合腎移植におけるaccommodationのメカニズムはいまだに解明されていない。移植腎に発現するABO血液型抗原や、抗ドナー血液型抗体の移植腎血管内皮細胞に対する親和性を解析することが、accommodationのメカニズムの解明につながるのではないかと、近年当科でも基礎研究を行っている。質量分析計を用いた解析により、腎臓に発現するABO血液型糖鎖抗原が結合する蛋白質をほぼすべて同定できた。また、ヒト由来の抗A、抗B抗体を精製し、それらの抗体の赤血球に対する凝集反応と腎臓への結合を解析している。さらに、ヒトリンパ球を培養しin vitroで抗A・抗B抗体が産生される条件を追究し、ABO不適合腎移植後の抗ドナー血液型抗体産生能の解析を行っている。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本医学館  

糖尿病性腎症の腎移植における免疫抑制療法について検討した。腎移植を施行した374例中、原疾患が糖尿病性腎症(DMN)の23例を対象とした。1型DMNは9例中4例に拒絶反応を認め、3例はデオキシスパガリン(DSG)、1例はDSGに加えSTパルス療法を行った。2型DMNは14例中3例が拒絶反応を認め、DSGで治療した。DMN全体の生存率は、1年100%、5年90%、10年80%、生着率は、1年100%、5年90%、10年72%であった。導入免疫抑制療法は、2001年以降は、膵腎同時移植症例以外はシクロスポリン(CyA)+ミコフェノール酸モフェチル(MMF)+ST+バシリキシマブを導入した。維持免疫抑制療法は10例がSTを中止し、CyA+MMFの2剤で行った。13例はSTを継続した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We aimed to examine the influence of donor age on living-donor kidney transplantation (KTx), particularly with regard to long-term graft survival in young recipients with aged kidney grafts.
Between 1988 and 2012, 287 living-donor KTxs were performed in our center. The recipients were divided into 3 groups according to age in years: under 30 (young), 30-49 (middle-aged), and over 50 (old). The data regarding the influence of kidneys from donors aged over 50 years were retrospectively analyzed.
Graft survival at 1, 5, 10, and 15 years was 94.7, 94.7, 90.2, and 75.2 %, respectively, in young recipients who received grafts from donors aged under 50 years, and 96.4, 91.9, 65.4, and 41.4 %, respectively, in young recipients who received grafts from donors aged over 50 years (P = 0.023). In contrast, there were no significant differences regarding graft survival and donor age in the middle-aged and old recipient groups. Multivariate analysis revealed that young recipient and rejection episode were significant predictors of graft loss in transplantation from older donors. Histological examination revealed significant age-related changes in the grafts before transplant and a significant higher rate of glomerular hypertrophy at the 1-month protocol biopsy in young recipients with aged kidney grafts.
Kidney grafts from older living donors affected long-term graft survival in young recipients. In addition to the damage from rejection, aged kidney grafts, which have less nephron mass, may have a limited capacity to appropriately respond to increases in physiological or metabolic demands of young recipients, leading to a greater reduction in renal function.

DOI： 10.1007/s11255-014-0655-8

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 36-year-old female received protocol biopsy at 1 month after living donor kidney transplantation. At 3 months post-transplantation, presence of a growing cystic mass in the kidney graft which had not been detected preoperatively, was demonstrated by ultrasound and computed tomography. The patient had an abdominal pain around the graft. Percutaneous drainage and sclerotherapy with minocyclin were performed twice, but the cystic mass, nevertheless, became enlarged and the abdominal pain recurred again. Laparoscopic fenestration was then performed. Immunohistochemistry of the cystic mass wall showed that it was CD34 (-), EMA (-), Megalin (-), but D2-40 (+). These results suggested that the cystic mass was derived from lymphatic vessels, which developed into lymphocele in the graft. We concluded that lymphatic vessels could have been injured and obstructed by the protocol biopsy. This is the first report of successful laparoscopic fenestration for lymphocele in the kidney graft.

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記述言語：日本語   出版者・発行元：腎移植・血管外科研究会  

【目的】献腎提供の少ない日本では、長い待機期間を有しないとレシピエントとして選定されることが少ない。そのため高齢者、長期透析患者が選定される事が非常に多い。そこで、このようなマージナルなレシピエントに若年者の提供腎がどのような影響をうけるのか、また高齢者の提供腎が、若年者のレシピエントの予後にどのような影響をうけるのか検討した。【対象と方法】われわれの施設における献腎移植55症例に対してドナー・レシピエントを50歳未満・50歳以上でそれぞれ分類し、その予後を検討した。【結果】10年生着率はG1 84.2%、G2 54.4%、G3 83.3%、G4 53.8%で若年者のレシピエントにおいて若年者ドナー(G1)に比べ高齢者ドナー(G2)では有意に生着率は低かった(P=0.014)。しかし高齢者レシピエントではドナー年齢で生着率に有意差を認めなかった(G3:G4 P=0.409)。【結語】若年者のレシピエントに高齢者の提供腎を移植する事は、その予後を不良とする可能性が高い。余命の長い若年者のレシピエントに対しては、年齢による振り分け選定を検討する必要性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The adenosine triphosphate assay using peripheral lymphocytes may be useful to evaluate the risks of acute rejection and infection in kidney transplant patients. We used the adenosine triphosphate assay to evaluate differences between recipients who were treated with cyclosporine- or tacrolimus-based immunosuppressive therapy. MATERIALS AND METHODS: Adenosine triphosphate levels were measured in peripheral CD4+ cells before and after transplant and were correlated with clinical outcomes in 45 kidney transplant recipients. These recipients received immunosuppressive therapy with either cyclosporine (23 patients) or tacrolimus (22 patients). RESULTS: Adenosine triphosphate levels were significantly lower in the cyclosporine- than tacrolimus-based therapy groups from 2 to 6 weeks after transplant. Adenosine triphosphate levels were similar between these groups before and 1 week after transplant. The frequency of cytomegalovirus infection was greater in the recipients who received cyclosporine (17 patients [74%]) than tacrolimus (6 patients [27%]; P ≦ .003). The frequency of acute rejection episodes was similar between the cyclosporine and tacrolimus groups. CONCLUSIONS: These observations suggest that cyclosporine-based immunosuppressive therapy causes excessive immunosuppression compared with tacrolimus-based therapy, evidenced by the lymphocyte adenosine triphosphate levels. The adenosine triphosphate assay using peripheral CD4+ cells may be a useful method for predicting the occurrence of cytomegalovirus infections in kidney transplant recipients.

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

腎移植は免疫抑制薬の進歩などにより成績が向上しており,優れた腎代替療法として有用性が確立している.糖尿病性腎症(DM腎症)の慢性腎不全患者は,心血管疾患(CVD)による死亡リスクが高く,透析導入後の予後は非常に悪い.一方,腎移植では透析に比べて生命予後の改善が望める.さらに透析による合併症を避けて腎移植を行うことが,移植腎生着率・生存率の上昇につながる.DM腎症患者ではとくにCVDを含む合併症の評価が重要であり,術前に十分な精査を行う.術後は手術侵襲,免疫抑制薬などにより糖尿病が悪化することが多く,厳密な血糖コントロールが必要となる.またDM腎症の再発が腎生着率を低下させるため,移植後も長期にわたり糖尿病の治療が必要である.(著者抄録)

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：Elsevier Science  

In Japan, multiple organ retrieval from brain-dead heart-beating donors has been gradually increasing since the law was adopted in 1997 and amended in 2009. However, almost more than 90% of total deceased donor kidney transplantation (DDKT) in Japan are still obtained from non-heart-beating donors (NHBD). The majority of NHBD are Maastricht categories IV and III. In category IV, we usually place a double balloon arterial and a venous drainage catheter via the femoral vessels after the diagnosis of clinical brain death and acquisition of informed consent from the family. After controlled cardiac arrest, the double balloons are inflated and in situ cold perfusion started as soon as possible to minimize warm ischemic time (WIT), seeking to achieve a zero to within a few minutes WIT in most cases. In category III, it is impossible to place the device prior to cardiac arrest. In these cases, after declaration of cardiac death, cardiopulmonary compression is accompanied by systemic heparinization, immediate laparotomy, and insertion of a cold perfusion catheter at the aortic and caval bifurcations to minimize WIT. NHBD kidney retrieval is critical
extirpation must be performed as rapidly as possible. The results of NHBD kidney transplantation in Japan are excellent, according to the advancement and utilization of in situ cannulation, organ perfusion, and sophisticated retrieval techniques. The patient and graft survival rates of DDKT at 1, 3, and 5 years in most recent 2001 to 2007 era were 95.4%, 92.2%, 89.1% (n = 945) and 89.2%, 83.7%, 77.8% (n = 919), respectively. © 2013 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2013.08.062

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記述言語：日本語   出版者・発行元：(一社)日本臓器保存生物医学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Vascular endothelial cells (VECs) play crucial roles in physiological and pathologic conditions in tissues and organs. Most of these roles are related to VEC plasma membrane proteins. In the kidney, VECs are closely associated with structures and functions; however, plasma membrane proteins in kidney VECs remain to be fully elucidated. METHODS: Rat kidneys were perfused with cationic colloidal silica nanoparticles (CCSN) to label the VEC plasma membrane. The CCSN-labeled plasma membrane fraction was collected by gradient ultracentrifugation. The VEC plasma membrane or whole-kidney lysate proteins were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis and digested with trypsin in gels for liquid chromatography-tandem mass spectrometry. Enrichment analysis was then performed. RESULTS: The VEC plasma membrane proteins were purified by the CCSN method with high yield (approximately 20 μg from 1 g of rat kidney). By Mascot search, 582 proteins were identified in the VEC plasma membrane fraction, and 1,205 proteins were identified in the kidney lysate. In addition to 16 VEC marker proteins such as integrin beta-1 and intercellular adhesion molecule-2 (ICAM-2), 8 novel proteins such as Deltex 3-like protein and phosphatidylinositol binding clathrin assembly protein (PICALM) were identified. As expected, many key functions of plasma membranes in general and of endothelial cells in particular (i.e., leukocyte adhesion) were significantly overrepresented in the proteome of CCSN-labeled kidney VEC fraction. CONCLUSIONS: The CCSN method is a reliable technique for isolation of VEC plasma membrane from the kidney, and proteomic analysis followed by bioinformatics revealed the characteristics of in vivo VECs in the kidney.

DOI： 10.1007/s10157-012-0708-1

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for approximately 30% of all living donor kidney transplantations performed in Japan.We have been making a lot of efforts to elucidate the mechanism of acute antibody-mediated rejection in ABOI-KTx in order to overcome the ABO barrier and to improve the outcome. From careful and precise clinical observations, proteomic analysis of ABO histo-blood group antigens in graft endothelial cells and deep insight into immunology and biology, we have reached the hypothesis that the structural difference of ABO histo-blood group antigens and de novo corresponding antibody production would be the key and keyhole of the development of acute AMR in ABOI-KTx. Preoperative desensitization therapy would be the best solution for the suppression of acute AMR and graft loss, which is now widespread and improves the outcome. © 2013 Elsevier Inc.

DOI： 10.1016/j.trre.2012.07.003

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記述言語：日本語   出版者・発行元：(一社)日本臓器保存生物医学会  

移植手術を予定された腎移植患者20名を対象に、移植前、移植2、4、6週後の末梢血単核細胞のカルシニューリン阻害薬感受性測定を行った。移植前測定可能例は17例(男性12例、女性5例、平均43.5歳)、移植2週後では9例(男性7例、女性2例、平均34.7歳)、4週後では9例(男性7例、女性2例、平均32.0歳)、6週後では12例(男性10例、女性2例、平均44.5歳)であった。シクロスポリン/タクロリムスの平均IC50値(ng/mL)は、移植前は439.0/177.6で、Kendall(r=0.468)、Spearman(r=0.612)と両者に有意な相関が認められた。移植2週後では38.8ng/0.24で相関性は認めなかった。移植4週後では399.5/1414.3であり、Kendall(r=0.592)、Spearman(r=0.728)と両者に有意な相関を認め、移植6週後では578.8/251.2で、Kendall(r=0.481)、Spearman(r=0.62)と両者に有意な相関が認められた。移植2週後では移植臓器の挿入や初期の免疫抑制療法による変動の可能性が考えられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J03926&link_issn=&doc_id=20130405220006&doc_link_id=10.11378%2Forganbio.20.45&url=https%3A%2F%2Fdoi.org%2F10.11378%2Forganbio.20.45&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pentraxin-3 (PTX3) is an acute phase reactant produced by a variety of cell types at sites of local inflammation. We examined by immunohistochemistry renal biopsies from patients with acute rejection (n = 10), protocol biopsies without rejection (n = 37), and peri-operative donor biopsies of the same transplant patients (n = 94) for intra-renal expression of PTX3, and its correlation with clinical, laboratory, and histopathologic parameters. PTX3 was mainly expressed in the interstitium of renal allograft. In the non-rejection biopsies (pre- and post-reperfusion and protocol biopsies), PTX3 expression area (PTX3%) was equally maintained at a low level, whereas in the rejection biopsies, PTX3% was significantly higher (p < 0.0001). Treatment of acute rejection resulted in a significant reduction of PTX3% (p < 0.0001). PTX3% positively correlated with the degree of allograft dysfunction and acute rejection scores of Banff classification (2009). This study suggests that PTX3% may be an available histological marker of acute renal allograft rejection.

DOI： 10.1111/j.1399-0012.2012.01641.x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

A prospective trial of corticosteroid (steroid) withdrawal after pediatric renal transplantation was started in 1990. Fifty-eight recipients with functioning grafts reached their final height. They were transplanted at a mean age of 10.7 yr. Immunosuppressive therapy with CyA, MP, and MZ was started after transplantation. MP was reduced to an alternate-day dose in 49 patients and was withdrawn in 23. Their mean height SDS was -2.4 at the time of transplantation and -2.1 at their final height. Mean final height was 157.9 cm in men and 147.6 cm in women. In 18 patients who had been withdrawn from MP for more than two yr before reaching final height, mean age at transplantation was 8.9 yr. Their mean height SDS of -2.2 at the time of transplantation increased to -1.6 at their final height (p = 0.02), and mean final height was 163.8 cm in men and 147.8 cm in women. The height SDS in all 58 patients was maintained during the immunosuppressive therapy with steroid minimization, and final height SDS increased in recipients older than five yr at transplantation with steroid withdrawal.

DOI： 10.1111/j.1399-3046.2011.01614.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The lymphocyte immunosuppressant sensitivity test (LIST) with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay procedure can predict the pharmacological efficacy of immunosuppressive agents. A previous study reported the pharmacological efficacy of tacrolimus evaluated by LIST just before renal transplantation significantly correlated with the incidence of acute rejection episodes. However, the pharmacological efficacy of tacrolimus has not been estimated after renal transplantation. Therefore, the present study evaluated the pharmacological efficacy of tacrolimus by LIST using the MTT assay procedure before and 1, 3, and 12 months after transplantation in 17 renal transplant recipients that received tacrolimus-based immunosuppressive therapy. The tacrolimus pharmacological efficacies before and after the procedure were also compared with incidence of acute rejection and cytomegalovirus (CMV) infection episodes. The individual values of tacrolimus 50% inhibition of lymphocyte proliferation (IC50) varied widely before transplantation, and the mean value of the IC50 was 126.4 ± 337.7 ng/ml. The patients were divided into two groups according to the tacrolimus IC50 values evaluated before transplantation. The rate of acute rejection episodes in the tacrolimus high-sensitivity group was significantly lower than that in the tacrolimus low-sensitivity group (p = 0.005). The tacrolimus IC50 deviation between patients expanded further at one and three months after surgery. However, the sensitivity deviation almost converged at 1 year after surgery. Moreover, the pharmacological efficacy of tacrolimus evaluated at 1, 3, and 12 months after transplantation did not significantly correlate with the incidence of acute rejection episodes. The pharmacological efficacies of tacrolimus evaluated at both before and after surgery were not significantly correlated with the episodes of CMV infection. These findings suggest that the pharmacological efficacy of tacrolimus evaluated with LIST before surgery is a useful biomarker for predicting the occurrence of acute allograft rejection in renal transplantation.

DOI： 10.3727/215517912X639360

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Basiliximab is a recently developed immunosuppressive agent for the prevention of acute allograft rejection in renal transplant recipients. The combination use of basiliximab and a calcineurin inhibitor was suggested to be more effective in comparison to immunosuppressive therapy using calcineurin inhibitor without basiliximab. Cyclosporine has been generally administered with basiliximab for renal transplant recipients. However, in cases of tacrolimus-based immunosuppressive regimen, the clinical efficacy and safety of combined use of tacrolimus and basiliximab remains to be elucidated. This study evaluated the tacrolimus pharmacological efficacy using a lymphocyte immunosuppressant sensitivity test (LIST) with MTT assay procedures in 16 cases of renal transplant recipients treated by tacrolimus without basiliximab and in 13 cases treated by tacrolimus in combination with basiliximab. The rate of acute rejection episodes in the recipients treated with tacrolimus plus basiliximab was 1/13 (7.7%), whereas the rate in the recipients treated with tacrolimus without basiliximab was 6/16 (37.5%). The recipients were divided into two groups according to their peripheral blood mononuclear cell (PBMC) sensitivity to tacrolimus [i.e., including a tacrolimus high sensitivity group (IC(50) <1.0 ng/ml) and a low sensitivity group (IC(50) >1.0 ng/ml). In the recipients treated with tacrolimus without basiliximab, the rate of acute rejection episodes in the tacrolimus high sensitivity group was 1/10 (10.0%), which was significantly lower than the rate in the low sensitivity group of 5/6 (83.3%; p = 0.008). The incidence of cytomegalovirus infection was not significantly different between the tacrolimus high and the low sensitivity groups of the recipients treated with tacrolimus with and without basiliximab. Therefore, in the case of selected tacrolimus-based immunosuppressive therapy for renal transplant recipients, the tacrolimus pharmacological efficacy should be evaluated using LIST at a time just before the transplant procedure in order to accurately predict allograft rejection. The data also suggested that low tacrolimus sensitivity recipients should be treated with tacrolimus-based immunosuppressive therapy in combination with basiliximab.

DOI： 10.3727/096368911X605493

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記述言語：日本語   出版者・発行元：腎移植・血管外科研究会  

ABO血液型不適合腎移植では、抗血液型抗体によって抗体関連型拒絶反応(AMR:antibody mediated rejection)を引き起こす可能性があるため、抗血液型抗体価が高い症例は、いままでは移植困難とされてきた。今回我々は、抗血液型抗体価が高い症例に対し脱感作療法、抗体除去療法を行うことでAMRを発症することなく経過良好な血液型不適合腎移植を3症例経験したので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：腎移植・血管外科研究会  

症例は65歳男性。IgA腎症のため末期腎不全となり血液透析療法に導入された。透析歴15年で献腎移植を受けたが、術後腎機能発現が遅れ、透析は術後18日目まで必要であった。術後2ヵ月より降圧薬抵抗性の高血圧や頭痛が出現し、体重増加、血清クレアチニンの上昇を認めた。造影CT検査で、移植腎動脈狭窄(Transplant renal artery stenosis:TRAS)が疑われたため、血管造影検査で診断を確定し、直ちに経皮経管的血管形成術(Percutaneous transluminal angioplasty:PTA)を施行した。その後は、速やかに血圧、体重増加、腎機能の改善がみられた。しかしPTA3ヵ月後に、再び体重増加を認め、TRAS拡張部の再狭窄の診断で、再度PTAが必要であった。TRASについて、若干の文献的考察を含め報告する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BK virus (BKV) nephropathy is one of the major causes of allograft dysfunction or graft loss in kidney transplant recipients. Early diagnosis and timely reduction in immunosuppressant is important for proper treatment. We report a 35-yr-old male case of cadaveric renal transplantation with BK viral related tubulointerstitial nephritis complicated by acute rejection. The diagnostic biopsy showed severe inflammatory infiltrates, tubulitis, and peritubular capillaritis. Discontinuation of mycophenolate mofetil, prednisone pulse therapy, and r-globulin was successful in relieving allograft dysfunction.

DOI： 10.1111/j.1399-0012.2011.01481.x

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

The phenomenon of accommodation in recipients of blood group ABO incompatible kidney transplantation (iKTx), in which grafts survive despite the presence of blood group A or B antigen in the graft and the presence of corresponding antibodies in the recipient&apos;s blood, is not uncommon. alpha 1,3-N-Acetylgalactosaminyltransferase and alpha 1,3galactosyltransferase associated with the synthesis of blood group A and B antigen (A and B enzymes), respectively, were measured by a highly specific enzyme-linked immunosorbent assay in the sera and transplanted tissues of patients who underwent an ABO iKTx. Allogeneic A and B enzymes were present in the sera and tissues as well as A and B antigens in the tissues for a long period, which hitherto have never been seen in recipients prior to an iKTx. However, activities of these enzymes in the sera after an iKTx decreased in patients who experienced a serious acute antibody-mediated rejection and disappeared in patients who had an unrepairable rejection, leading to graft loss without establishment of accommodation. Our observations on the presence of allogeneic A and B enzymes in the recipients&apos; sera should have implications in decision making for a successful iKTx.

DOI： 10.1093/glycob/cwq086

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本臓器保存生物医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The lymphocyte immunosuppressant sensitivity test (LIST) can predict the pharmacological efficacy of immunosuppressive agents. We herein estimated the mycophenolic acid efficacy using LIST before and 1, 3, and 12 months after the operation in 15 renal transplant recipients. The pharmacological efficacy of mycophenolic acid as assessed before transplantation showed small individual variations, whereas the variability greatly increased at 1 and 3 months after transplantation. Furthermore, the individual IC50 variation among these subjects at 1-year after operation was closely similar to that observed before surgery. No significant implications of these individual differences in the mycophenolic acid sensitivity were noted in regard to the clinical courses of these recipients.

DOI： 10.3109/08923970903490478

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

At the age of three yr, a male patient had surgical treatment for bilateral vesicoureteral reflux (VUR), and at the age of 19 yr, he developed nephrotic syndrome because of focal segmental glomerulosclerosis (FSGS). His renal function deteriorated despite treatment with temocapril and aspirin, and dialysis treatment was started when he was 19. After nine yr of dialysis, he received a living kidney transplantation from his 58-yr-old father, who had a long history of hypertension. A graft biopsy before perfusion showed moderate arteriolosclerosis. As urine protein increased to 2.15 g/d at 16 months after kidney transplantation, the graft biopsy was performed again. FSGS lesion with severe arteriosclerosis was recognized under light microscope, while the effacement of podocyte foot processes was seldom observed. The alteration of calcineurin inhibitor from cyclosporine to tacrolimus, combined with the new administration of angiotensin receptor antagonist (valsartan) and aldosterone receptor blocker, successfully decreased the amount of urine protein to 0.8 g/d within two wk. We considered that the present case showed two distinct types of FSGS lesions--one because of VUR and the other because of cyclosporine arteriolopathy--in each native kidney and transplanted kidney.

DOI： 10.1111/j.1399-0012.2010.01267.x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Nonocclusive mesenteric ischemia (NOMI) is an infrequent and fatal disorder. We describe a 54-year-old man who developed NOMI during the peritransplant period following ABO-incompatible living-donor kidney transplantation, but who was successfully treated with his renal graft function unimpaired. Abdominal pain appeared on the sixth postoperative day (POD), and emergency surgery was performed on POD 8. Discontinuous segmental necrosis extended throughout the small intestine, and the necrotic segments were entirely removed. He thereafter had ischemia of the ascending colon, which was treated with colectomy, and prostaglandin E1 delivered through the related artery prevented advanced necrosis. Temporary colostomy was closed 20 months after surgery. He maintains excellent graft function at present without secondary disorder. There has been no ABO-incompatible kidney transplant recipient complicated with NOMI. However, patients with end-stage renal disease are at the highest risk for this lethal condition, and physicians and urologists should correctly recognize its diagnostics and therapeutics.

DOI： 10.1007/s10157-009-0232-0

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01175&link_issn=&doc_id=20100323480651&doc_link_id=10.5980%2Fjpnjurol.101.326_4&url=https%3A%2F%2Fdoi.org%2F10.5980%2Fjpnjurol.101.326_4&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01175&link_issn=&doc_id=20100323480640&doc_link_id=10.5980%2Fjpnjurol.101.324_1&url=https%3A%2F%2Fdoi.org%2F10.5980%2Fjpnjurol.101.324_1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is generally admitted that ABO(H) blood group antigens are linked to lipids and proteins. Although glycolipids carrying ABO antigens have been well characterized in human kidneys, glycoproteins carrying ABO antigens are largely unknown, and their molecular properties remain to be elucidated. METHODS: All the blood group A antigen-linked proteins in human kidney could be solubilized and captured on immobilized Helix pomatia lectin that recognizes A antigens. These proteins were separated on SDS-PAGE gels. The gel pieces containing protein bands immunoreactive with anti-A antibody were excised, in-gel digested with trypsin, and analyzed by nanoLC tandem mass spectrometer. Protein candidates that carry ABO antigens were confirmed by immunoprecipitation and double-labeled immunofluorescense microscopy. RESULTS: All the glycoproteins carrying ABO antigens were found to be Asn-linked glycoproteins, and presented as multiple bands on SDS-PAGE with molecular masses ranging from 60 to 270 kDa. The protein bands were subjected for mass spectrometric analysis, which identified 121 distinct proteins with high confidence. Of the identified proteins, 55 N-glycosylated, membrane proteins were selected as glycoprotein candidates that carry ABO antigens. Among them, most abundantly expressed proteins as estimated by the number of peptide matches in the MS spectrometric analysis, such as platelet endothelial cell adhesion molecule 1, plasmalemmal vesicle-associated protein, and von Willebrand factor, were further characterized. CONCLUSIONS: Several glycoproteins were identified that represented major glycoproteins carrying ABO antigens in the human kidney, which exhibited distinct features in localization to most of vascular endothelial cells.

DOI： 10.1097/TP.0b013e31819e0054

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

ABO血液型不適合腎移植においては、抗A抗B抗体による抗体関連型急性拒絶反応による移植腎喪失を防ぐことが最大の課題であり悲願であった。近年、B細胞表面に発現する機能分子であるCD20に対するヒトマウスキメラ型モノクローナル抗体であるリツキシマブを脱感作療法に用いることにより、多くの症例で脾摘を行うことなく安全に抗体関連型急性拒絶反応を回避し、"免疫学的順応"を誘導することが可能となった。(著者抄録)

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.100.256_3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The lymphocyte immunosuppressant-sensitivity test (LIST) has been reported extensively as being able to estimate the pharmacological efficacy of immunosuppressive drugs in individual patients. This study measured the IC50 values for 6 drugs, cyclosporine, tacrolimus, methylprednisolone, 6-mercaptopurine, mycophenolic acid, and mizoribine, against mitogen-induced proliferation of peripheral-blood lymphocytes in 29 renal transplant recipients. We also examined relationship between the IC50 values and 4 factors; age, duration of dialysis, percentage of lymphocytes in total white blood cells, and blastogenesis stimulation index by mitogen. There were no significant correlations between the IC50 values and these factors, except that the tacrolimus IC50 value was correlated weakly with the stimulation index (p<0.05, r=-0.429). It was concluded that the pharmacological efficacy of immunosuppressive drugs cannot be inferred from the patient characteristics or their laboratory data. LIST is an effective method to elucidate the pharmacodynamic properties of immunosuppressive agents in individual renal transplant recipients without being influenced by the recipient clinical data.

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

移植後高血圧(PTHT)は、頻度の高い内科的合併症である。その臨床的特徴は、慢性腎臓病患者の高血圧に順ずる。つまり、夜間高血圧、早朝高血圧を特徴とする。PTHTはグラフト腎機能のみでなく、レシピエントの生命予後を左右する。したがって、降圧療法は充分なされるべきである。ただし、PTHTには免疫抑制薬の副作用が関与しており、免疫抑制薬の変更あるいは減量という手段が治療手段の一つであることが特異な点である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

We present here two cases of kidney transplantation from a non-heart beating deceased donor after long cold-ischemic time (CIT) more than 24 h. The donor was a young male who died of severe subarachnoid hemorrhage. Grafts were transplanted into two different patients one after another in our hospital. Their total ischemic times were 24 and 43 h because they were the fourth and fifth candidates on the waiting list. Although the anuric phase continued for more than three wk in both cases, finally their grafts functioned well with the nadir serum creatinine of 2.2 and 1.8 mg/dL, respectively. We evaluated protocol biopsies after 50 d from the transplantation. Both biopsy specimens revealed diffuse interstitial fibrosis, particularly more severe in the second recipient. The expression of 8-OHdG, one of the histochemical markers of oxidative stress, was more strongly expressed in the biopsy specimens of pre-perfusion and protocol biopsy in the same case. From these results, it was suspected that the interstitial fibrosis was induced by oxidative stress derived from the longer CIT and the following reperfusion.

DOI： 10.1111/j.1399-0012.2008.00854.x

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present the case of a young lady who developed renal cell carcinomas (RCC) in the allograft and bilateral native kidneys metachronously within one year. She received a living donor kidney transplantation from her father. A solid tumor of 4 cm in diameter was uncovered first in the allograft kidney 103 months after transplantation, and was treated with graftectomy. Six months after graftectomy, a right renal tumor measuring 3.5 cm and left renal tumors emerged in the native kidneys. She underwent laparoscopic right and left radical nephrectomy in separate sessions. The pathological diagnosis in the allograft and right renal tumors was clear cell RCC with eosinophilic cytoplasm and that in the left kidney was clear cell carcinoma. Fluorescence in situ hybridization and human leukocyte antigen typing showed that each tumor was most probably primary disease. She was free of disease 18 months postoperatively. This is the first report on RCC arising both in the allograft and bilateral native kidneys.

DOI： 10.1111/j.1442-2042.2007.01941.x

PubMed

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

For the desensitization of A/B antigens, we had developed and reported a new potent immunosuppressive treatment, which is the pre-prescription of anti-CD20 monoclonal antibody with mycophenolate mofetil and low-dose steroid. Using this kind of desensitization therapy, splenectomy is not required at the kidney transplantation. Complement C4d deposition on peritubular capillary (PTC) in graft biopsy has been reported as a relatively reliable marker for humoral rejection. However, the C4d deposition was often observed in the graft biopsy of ABO-incompatible kidney transplantation even with no rejection findings. The aim of this study was to examine the effect of this treatment on C4d deposition on PTC. Baseline and protocol graft biopsies obtained from 12 recipients of ABO incompatible kidney transplants were evaluated by light and immunofluorescence microscopy. To elucidate the involvement of classical and/or lectin pathway of complement cascades in C4d deposition, we examined the deposition of the initial activating proteins on PTC, IgG and IgM in the classical pathway and mannose-binding lectin (MBL), H-ficolin, L-ficolin, MBL-associated serine protease (MASP)-1 and MASP-2 in the lectin pathway. Three out of nine available baseline biopsy specimens showed diffuse C4d and IgM deposition on PTC. In the protocol biopsy, nine of 12 specimens revealed diffuse C4d deposition on PTC. Five of them had positive deposition of IgM and H-ficolin on PTC, whereas the other initial proteins were not detected in all specimens. Apart from one case, the histological findings of the protocol biopsies were normal or borderline changes. Our study suggested that although the new treatment with anti-CD20 antibody treatment and without splenectomy was clinically effective, it did not perfectly inhibit C4d deposition on PTC. It also confirmed the dual activation of both classical and lectin pathways in the process of C4d deposition on PTC in ABO-incompatible transplantation.

DOI： 10.1111/j.1399-0012.2007.00709.x

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(株)日本医学館  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J01175&link_issn=&doc_id=20070309270139&doc_link_id=10.5980%2Fjpnjurol.98.152_2&url=https%3A%2F%2Fdoi.org%2F10.5980%2Fjpnjurol.98.152_2&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Kidney transplantation has a powerful influence on the nutritional status of patients with end-stage renal disease. How to control diet varies in different races and periods after kidney transplantation. In general, malnutrition in patients with end-stage renal disease slowly recovers after kidney transplantation; however, several dietary interventions are required throughout the post transplant course. While hyperalimentation is warranted to control the hypercatabolic state immediately following the transplant operation, dietary restriction of protein, salt and calories is recommended to prevent life-style related diseases, which affect patient and graft survival. No consensus on dietary control in kidney transplant recipients has been reached yet. Herein, we present the nutritional status of Japanese kidney allograft recipients, discuss some unresolved nutritional problems and review the recent literature.

DOI： 10.1159/000101001

PubMed

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

Background. Complement 4d (C4d) deposition in the peritubular capillary (PTC) in the kidney allograft is a useful diagnostic marker for humoral rejection. C4d is produced not only by the classical pathway but also by the lectin pathway of the complement activation cascade. We have recently reported the in situ role of the later phase of the complement cascade in renal allografts with C4d deposition; however, the initial process prior to C4d deposition is yet to be resolved.
Methods. To clarify the early phases of the complement activation cascade, we evaluated the deposition of initial proteins of the above two pathways; IgG, IgM, mannose-binding lectin (MBL), H-ficolin, L-ficolin, MBL-associated serine protease (MASP)-1 and MASP-2 in kidney allografts with PTC C4d deposition.
Results. Sixty kidney allograft specimens were divided into two groups on the basis of the presence of C4d deposition in PTC. The C4d-positive group (n = 18) included nine ABO-identical and nine ABO-incompatible cases, and the C4d-negative group (n = 42) had 34 ABO-identical and eight ABO-compatible (but not identical) cases. In the C4d-positive group, 16 of 18 cases showed diffuse H-ficolin and IgM deposition in PTC. In contrast, H-ficolin and IgM were not detected in PTC in the C4d-negative group. Other initial proteins were not detected in all cases.
Conclusions. Our study suggested for the first time that the lectin pathway activated by H-ficolin may be involved in C4d deposition on PTC in the kidney allograft.

DOI： 10.1093/ndt/gfl210

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Up to 2005, the number of patients on dialysis therapy exceeded more than 250,000 in Japan
however, only 200 deceased and 800 living kidney transplants have been performed annually. We have been making continuous efforts in ABO-incompatible kidney transplantation since 1989 to expand the opportunities for living kidney transplantation in Japan. From the Japanese registry, we have reviewed the long-term patient and graft outcome of ABO-incompatible kidney transplantation. This survey focused on 685 patients who received ABO-incompatible kidney grafts from January 1989 to December 2004 in whom monitoring follow-up could be achieved in 75 institutions. The overall patient survival rates at 1, 3, 5 and 10 years after transplantation were 94%, 91%, 87% and 82%, with overall graft survival rates of 87%, 83%, 76% and 57%, respectively. The graft survival rate was significantly higher in patients aged 29 and younger compared with those aged 30 and older. Especially in children aged 15 and younger, they have shown excellent graft survival rate. The patients with anticoagulation therapy showed significantly higher graft survival rate than those without anticoagulation. There were no significant differences between A- and B-incompatibility with respect to clinical outcomes. There were also no significant difference in numbers of HLA mismatches, induction and maintenance calcinurine inhibitors (ciclosporine vs. tacrolimus) and donor/recipient relationships with respect to the outcomes. A result of most recent 245 cases since 2001 had dramatically improved with 1-year graft survival is 96% and there is a significant difference between the groups in 2001 onwards and before. This study confirms that the outcome of ABO-incompatible living kidney transplantation in Japan is excellent and is similar to that in ABO-compatible cases. ABO-incompatible kidney transplantation has already become one of a standard, safety and effective treatment choice for end-stage renal disease. © 2006.

DOI： 10.1016/j.ics.2006.05.004

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

Background: We have been making continuous efforts in ABO-incompatible kidney transplantation since 1989 to expand the opportunities for kidney transplantation from living donors in Japan. Patients and method: From the Japanese registry, we reviewed the long-term patient and graft survival of ABO-incompatible kidney transplantation. This survey focused on 564 patients who received ABO-incompatible kidney grafts from January 1989 to December 2003 in whom monitoring follow-up could be achieved in 60 institutions all over Japan. The mean age of 367 (65%) male and 197 (35%) female patients at surgery was 34.5 yr. Pre-operative anti-A/B antibody (Ab) removal and splenectomy (n=553, 98%) were routinely performed combined with triple or quadruple immunosuppression using calcinurine inhibitor (CNI), anti-metabolites and steroids with or without deoxyspurgualin (DSG) or anti-lymphocyte Abs. Results: The overall patient survival rate at 1, 3, 5 and 10 yr after transplantation was 94, 91, 88 and 81%, with overall graft survival rates of 86, 82, 74 and 53%, respectively. The graft survival rate was significantly higher in patients aged 29 and younger compared with those aged 30 and older. Children aged 15 or younger in particular have shown excellent graft survival rates at 1, 3, 5 and 10 yr of 90, 90, 86 and 76%, respectively. Patients with anticoagulation therapy (n=285) showed a significantly higher graft survival rate than those without anticoagulation (n=213), with 10-yr graft survival rates of 59 vs. 48%. There were no significant differences between A and B incompatibility with respect to clinical outcomes. There were also no significant difference in numbers of human leukocyte antigen mismatches, induction and maintenance CNI (cyclosporin A (CYA) vs. tacrolimus) and donor/recipient relationships with respect to the outcomes. We divided the patients into five groups according to the transplanted year periods. The outcome of the most recent 124 cases since 2001 had dramatically improved, with 2-yr graft survival of 94%, and there is a significant difference between the groups in 2001 onwards and the other four groups. Conclusion: This study confirms that the long-term outcome of ABO-incompatible living kidney transplantation is excellent and is similar to that of ABO-compatible cases. Recent data show that short-term graft survival has also improved. ABO-incompatible kidney transplantation is a radical, but safe and effective, treatment choice for end-stage renal disease. © Blackwell Munksgaard, 2006.

DOI： 10.1111/j.1399-3089.2006.00278.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In Japan, ABO-incompatible (ABO-I) kidney transplantation began in 1989; these transplantations have flourished because of the lack of cadaveric donors, and more than 600 cases were performed up to 2004. Splenectomy has been considered to be necessary for successful ABO-I kidney transplantation, and the majority of pre-conditioning protocols include splenectomy in Japan. However, we have lost some grafts due to antibody-mediated rejection (AMR) accompanying explosive elevation of anti-A/B antibody (Ab) titer even though the patients had a low pre-operative Ab titer. PATIENTS AND METHODS: We utilized two doses of anti-CD20, rituximab, simply combined with mycophenolate mofetil (MMF)/low-dose steroid desensitization started 1 month before surgery in ABO-I kidney transplantation. Two sessions of pre-operative Ab removal by double filtration plasmapheresis or plasma exchange were carried out. We performed six ABO-I kidney transplantations without splenectomy. Anti-A/B Ab titers were more than 16 to 32 times before treatment. We did not plan any post-operative repeated Ab removal or intravenous immunoglobulin G (IVIG). RESULTS: Pre-operative anti-A/B Ab titers were successfully reduced to less than eight times in all cases. Except for one case in which we had to remove the graft due to aspiration pneumonia and methicillin-resistant staphylococcus epidermidis (MRSE) sepsis, the other five cases did not experience antibody-mediated rejection (AMR). An additional session of post-operative Ab removal and/or IVIG was not necessary. In all patients, B cells (CD19+, CD20+, CD21+) and activated T cells (CD25+) were selectively suppressed, although CD3+, CD4+ and CD8+ cell populations remained stable, thus we call our protocol "pinpoint targeted immunosuppression." Plasma immunoglobulin level was also successfully suppressed, especially after 6 weeks of surgery. CONCLUSION: Anti-CD20/MMF desensitization is safe and allows successful ABO-I kidney transplantation without splenectomy.

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ndt/gfh822

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2003&ichushi_jid=J01175&link_issn=&doc_id=20030221040369&doc_link_id=10.5980%2Fjpnjurol.94.202_1&url=https%3A%2F%2Fdoi.org%2F10.5980%2Fjpnjurol.94.202_1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)日本医学館  

52歳女.妊娠中毒症の後に慢性腎不全となり34歳で血液透析を導入した.血液型一致,HLA1MMの伯母をドナーとする生体腎移植を希望し,陳旧性肺結核再燃予防目的の3剤併用療法を6ヵ月施行した.全経過を通じて白血球減少症が認められたことが,アスペルギルス,ノカルジア感染症のrisk factorとなっていた.組織適合性が良好であること,感染症予防の為に免疫抑制療法は代謝拮抗薬を外していたにも拘わらずアスペルギルス感染症が発症し,治療の過程でノカルジア感染症も認められた.感染症のrisk factorが存在する場合は胸部CT等による厳重な管理が必要である

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Vascular endothelial cells (ECs) are considered to be a primary target for injury in allograft rejection. However, the relationship between serum antibody activity to ECs and rejection episodes has not been examined extensively in renal transplantation. Twenty-two renal transplant recipients were included in this study. Serum antibody activity to vascular endothelial cells (AECA) was measured using a cellular enzyme-linked immunosorbent assay (ELISA) in which human umbilical vein endothelial cells (HUVEC) and human glomerular endothelial cells (HGEC) were preincubated with TNF-alpha used as target cells. Serum samples were obtained just before transplantation and once a week during the immediate 1-3-month post-transplantation period. There was a significant correlation between the presence of AECA against HGEC and rejection episodes (P < 0.05). Patients with multi-episodes of rejection showed significantly higher frequencies of AECA than patients with mono-episodic rejection (P < 0.0005). It should be noted that patients suffering from multi-episodes of rejection revealed higher AECA titres before transplantation. These findings imply that the HGEC-ELISA could be used as a prospective, informative test to identify patients with a higher risk of acute rejection in renal transplantation.

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.93.225_3

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.93.224_2

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：日本小児腎不全学会  

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記述言語：日本語   出版者・発行元：日本小児腎不全学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MUNKSGAARD INT PUBL LTD  

Recurrence of IgA nephropathy (IgAN) following renal transplantation has been described in 40-50% of such patients and it usually has a good outcome. We present the case of a 20-yr-old woman with IgAN who developed end-stage renal failure in 1995. In November 1996, she received a kidney from a living-related donor and was treated with tacrolimus, azathioprine and steroids. Zero- and one-hour biopsies were performed, which revealed minor glomerular abnormalities in light microscopy, thin basement membrane disease (TBMD) in electron microscopy. Eight months later she developed microscopic hematuria and proteinuria; however, the graft function was normal. Renal biopsy revealed an IgAN that is thought to be due to recurrence of the original disease.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.89.325_3

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記述言語：日本語   出版者・発行元：(株)日本医学館  

症例は34歳男である.移植後早期からtransplant glomerulopathyを呈し,糸球体内に多量の泡沫細胞を認めたABO不適合腎移植について,文献的考察を加えて報告した.これらはABO不適合腎移植に伴った所見である可能性が考えられた

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Very late antigen‐4 (VLA‐4) composed of α and β, a member of the β ‐integrin subfamily, facilitates cell‐to‐cell interaction with vascular celladhesion molecule‐1 (VCAM‐1) on endothelial cells (EC). Attachment of bloodborne tumor cells to EC is a crucial step for hematogenous metastasis, and VLA‐4‐positive tumor cells can attach to EC by binding to VCAM‐1. Renalcell cancer (RCC) reveals proportionally greater percentages of metastases than other carcinomas at initial diagnosis. We investigated whether VLA‐4 is expressed on RCC, and how such expression on RCC correlates with the metastatic potential of RCC. Immunohistochemical staining on 66 primary and 4 metastatic RCC showed that 4 out of 4 metastatic and 5 out of 8 primary RCC from patients with lung and /or brain metastases expressed α4 and β1 chains. On the other hand, 13 of 58 RCC without metastases expressed α4 chain. α4 and β expressions were also detected on 5 out of 5 human RCC cell lines, ACHN,KRC/Y, A498, Caki1 and Caki2, by flowcytometric analysis. Reversetranscriptasepolymerasechainreaction (RT‐PCR), followed by Southernblot hybridization with cDNA probe for a α4 chain, also confirmed mRNA production in 4 out of 5 RCC cell lines. Furthermore, adhesion of α4‐positive RCC cell lines to human umbilicalvein endothelial cells (HUVEC) was augmented by treatment of HUVEC with tumor necrosis factor‐α (TNF‐α). This adhesion was inhibited by anti‐α4 or anti‐VCAM‐1 antibodies, suggesting that VLA‐4‐VCAM‐1 interaction was involved in the adhesion between RCC cells and HUVEC. Taken together, VLA‐4 on RCC cells might play a crucial role in their hematogenous metastasis. © 1995 Wiley‐Liss. Inc. Copyright © 1995 Wiley‐Liss, Inc., A Wiley Company

DOI： 10.1002/ijc.2910600604

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We have investigated the effects of various extracellular matrix (ECM) components on the behaviour of human mesangial cells (HMC) in a gel culture system using a modified MTT assay method. When cultured on a reconstituted basement membrane, Matrigel (M gel), HMC aggregated and formed isolated colonies initially, then extended an array of cell processes to form a dendritic network structure and proliferated very slowly as the culture period progressed. On type I collagen gel (CI gel), however, HMC developed elongated bipolar shapes, migrated into the gel, and showed rapid cell growth. Next, separate ECM components, such as type III and IV collagens, laminin, heparin and heparan sulphate, were incorporated into CI gel and HMC proliferation was assessed. Although attachment of HMC to each gel did not differ significantly, HMC proliferation was inhibited markedly on gels containing type III collagen, heparin and heparan sulphate
type IV collagen suppressed HMC proliferation slightly
and laminin had no significant effect. These data suggest that interstitial type I and III collagens, which are often observed in diseased glomeruli, as well as the basement membrane components, may play important roles in the regulation of HMC proliferation under pathophysiological conditions in vivo. We conclude that HMC behaviour is affected by the surrounding ECM constituents, which appear to function as a refined modulator.

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記述言語：日本語   出版者・発行元：日本臨床腎移植学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2019209828

記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.tp.0000543276.46991.4b

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.tp.0000543287.07980.0b

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.tp.0000543456.88760.cc

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.tp.0000543594.62792.27

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記述言語：日本語   出版者・発行元：(株)東京医学社  

腎移植の成績と悪性腫瘍の発生について検討した。1988〜2015年末に当施設で腎移植を実施した416例(生体腎移植320例、献腎移植96例)を対象とした。レシピエントの移植時年齢中央値は38.5歳、男性272例、女性144例、ドナー年齢の中央値は55.0歳であった。1・5・10・15・20年後の患者生存率は生体腎99.4、97.8、95.6、93.4、82.0%、献腎97.1、92.6、87.4、84.1、84.1%、死亡症例は24例(5.8%)であった。全416例中29例(7%)に32件の悪性腫瘍が発生した。悪性腫瘍あり群29例と非悪性腫瘍群387例を比較検討したところ、移植時年齢、性別、透析期間、生体腎移植の比率、ABO血液型不適合の比率、ドナー年齢に有意差は認められなかった。しかし、癌なし群は癌あり群と比較して有意差をもって生存・生着率が良好であった。

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.juro.2017.02.251

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.juro.2017.02.2169

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

DOI： 10.1093/ndt/gfv185.46

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00990&link_issn=&doc_id=20141225160022&doc_link_id=%2Fdg3nigta%2F2014%2Fs12808%2F014%2F0408-0408%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2014%2Fs12808%2F014%2F0408-0408%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2014230050

記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2014230053

記述言語：日本語   出版者・発行元：(一社)日本泌尿器内視鏡学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/xen.12060_2

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/xen.12060_19

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

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J-GLOBAL

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記述言語：英語   掲載種別：速報，短報，研究ノート等（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/TP.0b013e3181c89307

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：BLACKWELL PUBLISHING  

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記述言語：日本語   出版者・発行元：日本小児高血圧研究会  

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J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：BLACKWELL PUBLISHING  

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記述言語：日本語   出版者・発行元：日本アフェレシス学会  

新潟大学医歯学総合病院における最近のABO血液型不適合腎移植の免疫抑制療法を含め, 術前後の二重濾過血漿分離交換(DFPP)の管理・問題点, 合併症について検討した.術前のDFPPは膜分離特性から選択的ではあるが, 低アルブミン血症と, これに伴う血管内脱水, 低血圧, 腹水, 腸管浮腫を併発してしまう.そこで以前から施行していた8.5%置換液を12.5%の置換液に変更することで, これらの問題点の解決を試みた.12.5%では8.5%に比べBV(循環血液量)%の低下が軽度で, ヘマトクリット濃縮, 血管内脱水の軽減がはかられていることがわかった.移植腎を含む周術期の循環動態に及ぼす安全性を考慮した場合, 置換液アルブミンの濃度を12.5%以上に設定することは, 有効な治療法と考えられた.術後, 抗A・抗B抗体による液性拒絶反応が疑われた場合, その治療法としてまず抗体除去を目的としてDFPP・Plasma Exchange (PEX)を施行する.DFPPはターゲットとしている分子量にあわせ, この近傍の分子を選択的に除去するのに最適な方法であるが, しかし術前と同様, 実際には必要な物質も除去されてしまう.バシリキシマブはIL-2受容体(CD 25)に対するキメラ型モノクローナル抗体で, 近年, 腎移植における拒絶反応抑制のために頻用されている.免疫グロブリン分画に属するため, DFPPにより容易に除去されてしまう.筆者らは移植後, DFPPにてバシリキシマブが除去された症例を経験したので報告する.

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その他リンク： http://id.nii.ac.jp/1141/00150610/

記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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