| 1. |
Kurihara K, Kitada H, Terasaka S, Kaku K, Miyamoto K, Tsuchimoto A, Matsutani K, Tanaka M, Impact of flow cytometry crossmatch B-cell positivity on living renal transplantation, Transplant Proc, 45, 8, 2903-2906, 2013.04, BACKGROUND:
Various studies have reported poorer graft survival among individuals displaying T-cell-positive flow cytometry crossmatches (FCXM). Good outcomes have been observed in immunologically high-risk patients with the use of rituximab, plasmapheresis, and γ-globulin. Because the relevance of FCXM B-cell-positivity (BCXM (+)) alone remains controversial, we examined its impact on living donor renal transplantations.
PATIENTS AND METHODS:
We retrospectively studied 146 adult renal transplantation recipients from April 2007 to June 2012, dividing the patients into BCXM (+) (n = 31) versus BCXM (-) recipients (n = 115). We examined patient and graft survivals as well as rejection rates at 0 to 3, 3 to 12, and 12 to 24 months. We also determined the incidence of infectious diseases. We performed stepwise multivariate regression to identify risk factors contributing rejection episodes.
RESULTS:
One-year patient and graft survivals were 100% in both groups. The BCXM (-) group have a 16.8% rejection probability whereas the BCXM (+) group, 33.2% (P = .201). There were no significantly differences in the incidence of infectious diseases. Only the rate of a sensitizing history was an independent risk factor for a rejection episode.
CONCLUSION:
BCXM (+) showed only a tendency but not a significant impact on rejection episodes compared with BCXM (-); short-term graft survivals were similar.
. |
| 2. |
Noguchi H, Kitada H, Kaku K, Kurihara K, Kawanami S, Tsuchimoto A, Masutani K, Nakamura U, Tanaka M, Outcome of Renal Transplantation in Patients With Type 2 Diabetic Nephropathy: A Single-Center Experience, Transplantation Proceedings, 47, 3, 608-611, 2015.04, Background. Renal transplantation has been established as a treatment for end-stage renaldisease (ESRD) due to diabetic nephropathy. However, few studies have focused on theoutcome after renal transplantation in patients with ESRD and type 2 diabetic nephropathy.To investigate the effect of renal transplantation on ESRD with type 2 diabetic nephropathy,we retrospectively analyzed patients who received renal transplantation at our facility. Thisstudy aimed to compare the outcome of renal transplantation for type 2 diabeticnephropathy with that for nondiabetic nephropathy.Methods. We studied 290 adult patients, including 65 with type 2 diabetic nephropathy(DM group) and 225 with nondiabetic nephropathy (NDM group), who underwent livingdonorrenal transplantation at our facility from February 2008 to March 2013. Wecompared the 2 groups retrospectively.Results. In the DM and NDM groups, the 5-year patient survival rates were 96.6% and98.7%, and the 5-year
graft survival rates were 96.8% and 98.0%, respectively, with nosignificant differences between the groups. There were no significant differences in the ratesof surgical complications, rejection, and infection. The cumulative incidence of postoperativecardiovascular events was higher in the DM group than in the NDM group (8.5% vs 0.49%at 5 years; P ¼ .002).Conclusions. Patient and graft survival rates after renal transplantation for type 2 diabeticnephropathy are not inferior to those for recipients without diabetic nephropathy.Considering the poor prognosis of patients with diabetic nephropathy on dialysis, renaltransplantation can provide significant benefits for these patients.. |
| 3. |
Kaku K, Kitada H, Noguchi H, Kurihara K, Kawanami S, Nakamura U, Tanaka M, Living Donor Kidney Transplantation Preceding PancreasTransplantation Reduces Mortality in Type 1 Diabetics With End-stageRenal Disease, Transplantation Proceedings, 10.1016/j.transproceed.2014.12.048 , 47, 3, 733-737, 2015.04, ABSTRACTBackground. Simultaneous pancreas-kidney transplantation (SPK) is a definitivetreatment for type 1 diabetics with end-stage renal disease (ESRD). Because of theshortage of deceased donors in Japan, the mortality rate during the waiting period is high.We evaluated mortality risk in patients with type 1 diabetes waiting for SPK, and thebenefit of living-donor kidney transplantation (LDK) preceding pancreas transplantation,which may reduce mortality in patients awaiting SPK.Methods. This retrospective study included 71 patients with type 1 diabetes. Twenty-sixpatients underwent SPK, 15 underwent LDK, and 30 were waiting for SPK. Theircumulative patient and graft survival rates were retrospectively evaluated. Risk factorscontributing to mortality in patients with type 1 diabetes awaiting SPK were evaluatedwith the use of a Cox proportional hazards model.Results. The 5-year cumulative patient survival rates in the SPK and LDK groups were100% and 93.3%, res
pectively (P ｼ .19), and 5-year kidney graft survival rates were95.7% and 100% (P ｼ .46), respectively. The cumulative survival rate in patients awaitingSPK was 77.7% at 5 years after registration. Duration of dialysis was the only factorsignificantly associated with patient and graft survivals according to both univariate andmultivariate analyses.Conclusions. Patient and graft survival rates were similar in the SPK and LDK groups,but the survival rate of patients awaiting SPK decreased over time. Duration of dialysis wasan independent risk factor for patient and graft survival. LDK preceding pancreas transplantationmay be an effective therapeutic option for patients with type 1 diabetes andESRD.. |
| 4. |
Date S, Noguchi H, Kaku K, Kurihara K, Miyasaka Y, Okabe Y, Nakamura U, Ohtsuka T, Nakamura M, Laparoscopy-Assisted Spleen-Preserving Distal Pancreatectomy for Living-Donor Pancreas Transplantation, Transplant Proc, 10.1016/j.transproceed.2017.03.037, 49, 5, 1133-1137, 2017.04, BACKGROUND:Living pancreas transplantation plays an important role in the treatment of patients with severe type 1 diabetes. However, pancreatectomy is very invasive for the donor, and less-invasive surgical procedures are needed. Although some reports have described hand-assisted laparoscopic surgery for distal pancreatectomy in living-donor operations, less-invasive laparoscopy-assisted (LA) procedures are expected to increase the donor pool. We herein report the outcomes of four cases of LA spleen-preserving distal pancreatectomy (Warshaw technique [WT]) in living pancreas donors.PATIENTS AND METHODS:Four living pancreas donors underwent LA-WT at our institution from September 2010 to January 2013. All donors fulfilled the donor criteria established by the Japan Society for Pancreas and Islet Transplantation.RESULTS:The median donor age was 54 years. Two donors underwent left nephrectomy in addition to LA-WT for simultaneous pancreas-kidney transpl
antation. The median donor operation time for pancreatectomy was 340.5 minutes. The median pancreas warm ischemic time was 3 minutes. The median donor blood loss was 246 g. All recipients immediately achieved insulin independence. One donor required reoperation because of obstructive ileus resulting from a port-site hernia. Another donor developed a pancreatic fistula (International Study Group of Pancreatic Fistula grade B), which was controlled with conservative management. After a maximum follow-up of 73 months, no clinically relevant adverse events had occurred. These results were comparable with those of previous studies concerning living-donor pancreas transplantation.CONCLUSION:The LA-WT is a safe and acceptable operation for living-donor pancreas transplantation.. |
| 5. |
Noguchi H, Miyasaka Y, Kaku K, Nakamura U, Okabe Y, Ohtsuka T, Ishigami K, Nakamura M, Preoperative Muscle Volume Predicts Graft Survival after Pancreas Transplantation: A Retrospective Observational Cohort Study, Transplant Proc, 10.1016/j.transproceed.2018.03.018, 50, 5, 1482-1488, 2018.04, Abstract
Background
Several studies have suggested that decreased muscle volume is associated with attenuation of immune function. The recipient’s immune system is responsible for rejection of transplanted organs, which is a major cause of graft loss after transplantation. We aimed to determine whether muscle volume is correlated with graft survival after pancreas transplantation (PT).
Methods
Forty-three patients underwent PT for type 1 diabetes mellitus at our institution from August 2001 to May 2016. The quantity of skeletal muscle was evaluated using the psoas muscle mass index (PMI). The correlation between the PMI and outcome after PT was assessed.
Results
A total of 32 and 11 recipients underwent simultaneous pancreas–kidney transplantation (SPK) and PT alone/pancreas after kidney transplantation, respectively. Patients with a surviving graft showed a significantly lower PMI than those with graft loss (P = 0.0451). We divided the recipients into two groups according to the PMI cutoff values which were established using receiver operating characteristic curves. The cumulative graft survival rate was significantly higher in patients with a low than normal PMI (P = 0.0206). A multivariate Cox regression analysis revealed that a low PMI (P= 0.0075) is an independent predictive factor for better graft survival. A low PMI was not a significant predictive factor for acute rejection, but was an independent predictive factor for graft survival after the first acute rejection (P= 0.0025).
Conclusions
Our data suggest that muscle volume could be a predictor of graft survival after PT.
Key words
pancreas transplantation; sarcopenia; graft rejection; graft survival
Abbreviations
AR, acute rejection; ATG, rabbit antithymocyte globulin; BMI, body mass index; CI, confidence interval; CT, computed tomography; DM, diabetes mellitus; HR, hazard ratio; IL, interleukin; ND, not done; PAK, pancreas-after-kidney transplantation; PMI, psoas muscle mass index; PT, pancreas transplantation; PTA, pancreas transplantation alone; SPK, simultaneous pancreas–kidney transplantation; TNF-α, tumor necrosis factor-alpha; Tregs, regulatory T cells. |
| 6. |
Okabe Y, Noguchi H, Miyamoto K, Kaku K, Tsuchimoto A, Masutani K, Nakamura M, Preformed C1q-binding Donor-specific Anti-HLA Antibodies and Graft Function After Kidney Transplantation, Transplantation Proceedings, 10.1016/j.transproceed.2018.07.033, 50, 10, 3460-3466, 2018.04, Abstract
Background: De novo complement-binding donor-specific anti-human leukocyte antigen antibodies (DSAs) are reportedly associated with an increased risk of kidney graft failure, but there is little information on preformed complement-binding DSAs. This study investigated the correlation between preformed C1q-binding DSAs and medium-term outcomes in kidney transplantation (KT).
Methods: We retrospectively studied 44 pretransplant DSA-positive patients, including 36 patients who underwent KT between April 2010 and October 2016. There were 17 patients with C1q-binding DSAs and 27 patients without C1q-binding DSAs. Clinical variables were examined in the 2 groups.
Results: Patients with C1q-binding DSAs had significantly higher blood transfusion history (53.0% vs 18.6%; P = .0174), complement-dependent cytotoxicity crossmatch (CDC-XM)-positivity (29.4% vs 0%; P = .0012), and DSA median fluorescence intensity (MFI) (10,974 vs 2764; P = .0009). Among patients who were not excluded for CDC-XM-positivity and underwent KT, there was no significant difference in cumulative biopsy-proven acute rejection rate (32.5% vs 33.5%; P = .8354), cumulative graft survival, and 3-month and 12-month protocol biopsy results between patients with and without C1q-binding DSAs. Although patients with C1q-binding DSAs showed a higher incidence of delayed graft function (54.6% vs 20.0%; P = .0419), multivariate logistic regression showed that DSA MFI (P = .0124), but not C1q-binding DSAs (P = .2377), was an independent risk factor for delayed graft function.
Conclusions: In patients with CDC-XM-negativity, preformed C1q-binding DSAs were not associated with incidence of antibody-mediated rejection and medium-term graft survival after KT. C1q-binding DSAs were highly correlated with DSA MFI and CDC-XM-positivity.. |
| 7. |
Noguchi H, Tsuchimoto A, Ueki K, Kaku K, Okabe Y, Nakamura M, One-year Outcome of Everolimus With Standard doseTacrolimus Immunosuppression in De Novo ABO-incompatible Living Donor Kidney Transplantation: A Retrospective, Single-center, Propensity Score Matching Comparison With Mycophenolate in 42 Transplants, TrDirectansplant , 10.1097/TXD.0000000000000962, 6, 1, e514, 2019.04. |
| 8. |
Noguchi H, Tsuchimoto A, Ueki K, Kaku K, Okabe Y, Nakamura M, Reduced Recurrence of Primary IgA Nephropathy in Kidney Transplant Recipients Receiving Everolimus With Corticosteroid: A Retrospective, Single-Center Study of 135 Transplant Patients, Transplantation Proceedings, 10.1016/j.transproceed.2020.05.022, 52, 10, 3118-3124, 2020.04. |
| 9. |
Mei T, Noguchi H, Hisadome Y, Kaku K, Nishiki T, Okabe Y, Nakamura M, Hepatitis B virus reactivation in kidney transplant patients with resolved hepatitis B virus infection: Risk factors and the safety and efficacy of preemptive therapy, Transplant Infectious disease, doi.org/10.1111/tid.13234, 22, 2, e13234, 2020.04, BackgroundHepatitis B virus (HBV) reactivation is associated with complications and adverse outcomes in patients with clinically resolved HBV infection who are seronegative for hepatitis B surface antigen (HBs Ag), and seropositive for hepatitis B core antibody (HBc Ab) and/or hepatitis B surface antibody (HBs Ab) before kidney transplantation (KT).MethodsWe retrospectively analyzed 52 patients with resolved HBV infection who were HBV‐DNA negative. HBV‐DNA after KT was evaluated, and the occurrence of HBV reactivation and outcomes were monitored. We defined HBV reactivation as seropositivity for HBV‐DNA at or above the minimal detection level of 1.0 log IU/mL and treated preemptively (using entecavir) when the HBV‐DNA level was at or above 1.3 log IU/mL, in accordance with the Japanese Guidelines for HBV treatment.ResultsAmong the 52 patients, the mean age was 57.2 ± 10.8 years. The median HBc Ab titer was 12.8 (inte
rquartile range, 4.6‐42.6) cutoff index, and five (9.6%) cases of HBV reactivation occurred. No patients developed graft loss and died due to HBV reactivation. Statistical analysis showed that age and HBc Ab titer were significant risk factors for HBV reactivation (P = .037 and P = .042, respectively). No significant differences were found between graft survival and the presence or absence of HBV reactivation.ConclusionThese results suggest that HBc Ab titer and age could be significant risk factors for HBV reactivation. Resolution of HBV infection did not appear to be associated with patient or graft survival, regardless of whether HBV reactivation occurred, when following our preemptive strategy.. |
| 10. |
Araki T, Noguchi H, Kaku K, Okabe Y, Nakamura M, Hand-assisted Laparoscopic versus Hand-Assisted retroperitoneoscopic living-donor Nephrectomy: a retrospective, single-center, propensity-score analysis of 840 transplants using 2 techniques, Transplantation Proceedings, 10.1016/j.transproceed.2020.01.134, 52, 6, 1655-1660, 2020.04, ABSTRACT
Introduction. Living-donor kidney transplantation (LDKT) is the most realistic option for
patients with end-stage kidney disease because of a severe shortage of deceased donors.
Hand-assisted laparoscopic donor nephrectomy (HALDN) and hand-assisted
retroperitoneoscopic donor nephrectomy (HARDN) have been undertaken at our
institute. We compared these 2 surgical procedures with respect to donor outcome and
the graft function of recipients.
Methods. We reviewed data from 840 consecutive live-donor kidney transplants from
October 2003 to April 2019. Propensity scores were calculated for each patient using
bivariate logistic regression.
Results. After propensity-score matching, the 2 groups each contained 205 patients.
Donors in the HALDN group had a longer procedure time (217 minutes, P less estimated blood loss (51 mL, P postoperative day (POD) 1 (7.9 mg/dL, P There were 22 modified Clavien-classifiable complications among the study groups. A
significantly higher conversion to open surgery was noted in the HARDN group (P .
.0181) than in the HALDN group, but there was no significant difference in the
prevalence of complications in either group. There was no significant difference in the
estimated glomerular filtration rate of recipients at POD14 between the 2 groups.
Conclusions. Safety and early graft function of HALDN in LDKT are comparable to or
even better than that of HARDN.. |
| 11. |
Mei T, Noguchi H, Suetsugu K, Hisadome Y, Kaku K, Okabe Y, Masuda S, Nakamura M, Effects of Concomitant Administration of Vonoprazan Fumarate on the Tacrolimus Blood Concentration in Kidney Transplant Recipients, Biological and Pharmaceutical Bulletin, https://doi.org/10.1248/bpb.b20-00361, 43, 10, 1600-1603, 2020.04, Vonoprazan fumarate (vonoprazan) is a new kind of acid suppressant with potent acid inhibitoryeffects. Therefore, it has been administered to kidney transplant recipients for treatment or prophylaxis ofsteroid ulcers, refractory peptic ulcers, and gastroesophageal reflux disease. Because tacrolimus, which is awell-established immunosuppressant for kidney transplantation, and vonoprazan share the CYP3A4 systemfor metabolism, drug interactions are anticipated upon simultaneous administration. We retrospectivelyanalyzed 52 kidney transplant recipients who were converted from rabeprazole, which has a small effecton the tacrolimus trough blood concentration (C0), to vonoprazan between August 2016 and July 2019. Wecompared the tacrolimus C0/tacrolimus dose (C0/D) before and after conversion and serum liver enzymes,serum total bilirubin, and the estimated glomerular filtration rate (eGFR). As a result, mean tacrolimus C0/Dbefore and after conversion was 1.98
1.02 and 2.19 1.15 (ng/mL)/(mg/d), respectively, (p < 0.001). Additionally,mean aspartate transaminase (AST) before and after conversion was 18.6 4.2 and 19.6 5.2 IU/L,respectively, (p 0.037). Mean alanine transaminase (ALT) before and after conversion was 15.8 5.5and 17.6 7.1 IU/L, respectively, (p 0.007). Mean eGFR before and after conversion was 50.6 14.4 and51.4 14.7 mL/min/1.73 m2, respectively (p 0.021). Mean AST, ALT, and eGFR were slightly but significantlyelevated within normal ranges after conversion. In conclusion, our study suggests that the mean tacrolimusC0/D was elevated significantly by converting from rabeprazole to vonoprazan, but it had little clinicalsignificance. Vonoprazan can be administered safely to kidney transplant recipients receiving tacrolimus.. |
| 12. |
Hisadome Y, Noguchi H, Nakafusa Y, Sakihama K, Mei T, Kaku K, Okabe Y, Masutani K, Ohara Y, Ikeda K, Oda Y, Nakamura M, Association of Pretransplant BK Polyomavirus Antibody Status with BK Polyomavirus Infection After Kidney Transplantation: A Prospective Cohort Pilot Study of 47 Transplant Recipients, Transplantation Proceedings, 10.1016/j.transproceed.2020.01.164, 52, 6, 1762-1768, 2020.04. |
| 13. |
Kazuki Tomihara, Yu Hisadome, Hiroshi Noguchi, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single-center, observational cohort study, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.895, 28, 4, 365-375, 2021.04, Abstract
Background: Pancreas transplantation (PT) is a radical treatment for diabetes mellitus (DM). Although the results of PT have been improving, surgical complications remain. Few reports have focused on complications associated with pancreatic fluid (CAPF) after PT. We aimed to investigate the risk factors and predictors for CAPF after PT.
Methods: Sixty-nine patients, who underwent deceased-donor PT for type 1 DM at our institution from August 2001 to May 2020, were retrospectively studied. We identified CAPF from those with Clavien-Dindo Classification ≥ grade III, and assessed risk factors by univariate and multivariate analyses using logistic regression.
Results: Twenty-one (30.4%) patients had complications with Clavien-Dindo Classification ≥ grade III. Eleven (16.0%) patients were diagnosed with CAPF. Median serum pancreatic amylase (P-AMY) levels with CAPF on postoperative day (POD)1 and POD2 were significantly higher than those without CAPF (P=0.019 and P=0.027, respectively). In multivariable analysis, serum P-AMY levels on POD1 were an independent predictive factor for CAPF (odds ratio 1.83, 95% confidence interval 1.07-3.14, P=0.008).
Conclusions: CAPF after PT is associated with high serum P-AMY in the early postoperative period. Serum pancreatic enzymes in the first few postoperative days after PT may be a significant predictive factor for CAPF.
Keywords: amylase; complications associated with pancreatic fluid; lipase; pancreas transplantation; pancreatic fistula.. |
| 14. |
Yu Hisadome, Takanori Mei, Hiroshi Noguchi, Toshiaki Ohkuma, Yu Sato, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Safety and Efficacy of Sodium-glucose Cotransporter 2 Inhibitors in Kidney Transplant Recipients With Pretransplant Type 2 Diabetes Mellitus: A Retrospective, Single-center, Inverse Probability of Treatment Weighting Analysis of 85 Transplant Patients, Transplant Direct, 10.1097/TXD.0000000000001228, 7, 11, e772, 2021.04, Abstract
Whether sodium-glucose cotransporter 2 (SGLT2) inhibitors can be used effectively and safely in kidney transplant (KT) recipients with pretransplant type 2 diabetes as the primary cause of end-stage renal disease (ESRD) remains unclear. In this study, we retrospectively analyzed the efficacy and safety of SGLT2 inhibitors compared with other oral hypoglycemic agents (OHAs) in KT recipients with pretransplant type 2 diabetes as the primary cause of ESRD.
Methods: In this retrospective, observational, single-center, inverse probability of treatment weighting (IPTW) analysis study, we compared the outcomes of SGLT2 inhibitors (SGLT2 group) and other OHAs (control group) following KT. A total of 85 recipients with type 2 diabetic nephropathy as the major cause of ESRD before KT who were treated at our institute between October 2003 and October 2019 were screened and included. The variables considered for IPTW were recipient age, sex, body mass index, history of cardiovascular disease, ABO incompatibility, insulin therapy, estimated glomerular filtration rate (eGFR), and hemoglobin A1c (HbA1c) at the initiation of additional OHAs. Primary endpoints were changes in HbA1c, body weight, and eGFR 1 y after the initiation of additional OHAs.
Results: After IPTW analysis, there were 26 patients in the SGLT2 group and 59 patients in the control group (n = 85 overall). The body weights were significantly reduced in the SGLT2 group. There was no statistical difference in changes in HbA1c and eGFR. Similarly, there was no significant difference in the incidence of urinary infection, acute rejection, or other side effects between the groups.
Conclusions: Our findings suggested that SGLT2 inhibitors reduced the body weight of KT recipients and were used safely without increasing side effects.. |
| 15. |
Takanori Mei, Hiroshi Noguchi, Kanae Otsu, Yuki Shimada, Yu Sato, Yu Hisadome, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Risk Factors and Optimal Methods for Incisional Hernias After Kidney Transplantation: A Single-Center Experience From Asia, Transplantation Proceedings, 10.1016/j.transproceed.2021.02.012, 53, 3, 1048-1054, 2021.04. |
| 16. |
Keizo Kaku, Yasuhiro Okabe, Yu Sato, Yu Hisadome, Takanori Mei, Hiroshi Noguchi, Masafumi Nakamura, Predicting Operation Time and Creating a Difficulty Scoring System in Donor Nephrectomy, J Endourol
., 10.1089/end.2020.1181, 35, 11, 1623-1630, 2021.04. |
| 17. |
Yu Sato, Hiroshi Noguchi, Takanori Mei, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Impact of the Mayo Adhesive Probability score on donor and recipient outcomes after living-donor kidney transplantation: a retrospective, single-center study of 782 transplants
, Transplant Direct, 10.1097/TXD.0000000000001185, 7, 8, e728, 2021.04, Abstract
Background: This study was performed to assess the impact of the Mayo Adhesive Probability (MAP) score on donor and recipient outcomes after living-donor kidney transplantation (LDKT).
Methods: We retrospectively analyzed 782 transplants involving LDKT between February 2008 and October 2019 to assess the correlation between the MAP score and outcome after LDKT. We divided the transplants into 2 groups according to the donor MAP score: 0 (MAP0) and 1-5 (MAP1-5).
Results: Compared with the MAP0 group, donors in the MAP1-5 group were significantly older, had higher body mass index, and were more likely to be men. The prevalences of hypertension, hyperlipidemia, and diabetes were also higher among donors in the MAP1-5 group than among donors in the MAP0 group. Operative time, estimated blood loss during donor nephrectomy, and percentage of glomerular sclerosis were significantly greater in the MAP1-5 group than in the MAP0 group. Donor and recipient perioperative complications were comparable between the 2 groups; death-censored graft survival rates also did not significantly differ between groups. Although the recipient mean estimated glomerular filtration rate (eGFR) from postoperative d 1 to 7 was significantly higher in the MAP0 group than in the MAP1-5 group (P = 0.007), eGFR reductions within 5 y after transplantation were similar between groups. There were no significant differences between groups in recipient mortality and biopsy-proven acute rejection episodes within 1 y after transplantation. Additionally, multivariate analysis showed that the only factors affecting recipient eGFR at postoperative d 7 were donor age, recipient age, and female sex (P Conclusions: The MAP score did not influence surgical complications or graft survival; therefore, it should not affect donor selection.. |
| 18. |
Hiroshi Noguchi, Yu Hisadome, Yu Sato, Takanori Mei, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Impact of the introduction of pure retroperitoneoscopic living-donor nephrectomy on perioperative donor outcomes: a propensity score matching comparison with hand-assisted laparoscopic living-donor nephrectomy, Asian Journal of Endoscopic Surgery, 10.1111/ases.12922, 14, 4
, 692-699, 2021.04, Abstract
Introduction: We previously reported that the outcomes of pure retroperitoneoscopic donor nephrectomy are superior to those of hand-assisted retroperitoneoscopic donor nephrectomy. Consequently, we introduced pure retroperitoneoscopic donor nephrectomy in our hospital. Here, we compared perioperative outcomes between hand-assisted intra-abdominal laparoscopic donor nephrectomy and pure retroperitoneoscopic donor nephrectomy.
Methods: We retrospectively reviewed data from 315 living-donor kidney transplantation procedures performed between October 2015 and December 2020 (213 involving hand-assisted intra-abdominal laparoscopic donor nephrectomy, October 2015 to June 2019; 102 involving pure retroperitoneoscopic donor nephrectomy, May 2019 to December 2020). After propensity score matching, 90 transplantations were included in each group (n = 180 overall).
Results: Donors in the pure retroperitoneoscopic donor nephrectomy group had longer warm ischemia times (P Conclusion: The introduction of pure retroperitoneoscopic donor nephrectomy was safe and effective. Moreover, it was less invasive and less harmful for donors, compared with hand-assisted intra-abdominal laparoscopic donor nephrectomy; recipient outcomes were equivalent.
Keywords: kidney transplantation; living-donor nephrectomy; retroperitoneoscopic surgery.. |
| 19. |
Yu Sato, Keizo Kaku, Yu Hisadome, Takanori Mei, Hiroshi Noguchi, Yasuhiro Okabe, Masafumi Nakamura, Impact of Recipient Age on Outcomes After Pancreas Transplantation, Transplantation Proceedings, 10.1016/j.transproceed.2021.04.013, 53, 6, 2046-2051, 2021.04, Background: Few reports have provided the ages of pancreas transplant recipients. The aim of this study was to determine whether recipient age affects survival of pancreatic grafts after transplantation.
Methods: We analyzed 73 patients who had undergone pancreas transplantation at our institution from August 2001 to March 2020 and assessed the effects of recipient age on pancreas graft survival within 5 years after pancreas transplantation.
Results: The cutoff value for recipient age established by receiver operating characteristic curve was 35 years. The pancreas graft survival rate of recipients aged 35 years or younger (1, 3, and 5 years: 72.9%, 41.7%, and 41.7%, respectively) was significantly lower than that of recipients aged over 35 years (1, 3, and 5 years: 93.2%, 88.4%, and 88.4%, respectively). Multivariate Cox hazard regression analysis showed that recipient age 35 years or younger (hazard ratio = 3.60; 95% confidence interval, 1.04-12.50; P = .044) and solitary pancreas transplantation (hazard ratio = 10.72; 95% confidence interval, 2.72-42.28; P < .001) were significant risk factors for pancreas graft loss within 5 years.
Conclusion: Our data suggest that younger recipient age is a risk factor for pancreas graft loss after transplantation.. |
| 20. |
Kenji Ueki, Akihiro Tsuchimoto, Yuta Matsukuma, Kaneyasu Nakagawa, Hiroaki Tsujikawa, Kosuke Masutani, Shigeru Tanaka, Keizo Kaku, Hiroshi Noguchi, Yasuhiro Okabe, Kohei Unagami, Yoichi Kakuta, Masayoshi Okumi, Masafumi Nakamura, Kazuhiko Tsuruya, Toshiaki Nakano, Kazunari Tanabe, Takanari Kitazono
, Development and validation of a risk score for the prediction of cardiovascular disease in living donor kidney transplant recipients, Nephrology, Dialysis, Transplantation, 10.1093/ndt/gfaa275 , 36, 2, 365-374, 2021.04, Abstract
Background: Cardiovascular disease (CVD) is a major cause of death in kidney transplant (KT) recipients. To improve their long-term survival, it is clinically important to estimate the risk of CVD after living donor KT via adequate pre-transplant CVD screening.
Methods: A derivation cohort containing 331 KT recipients underwent living donor KT at Kyushu University Hospital from January 2006 to December 2012. A prediction model was retrospectively developed and risk scores were investigated via a Cox proportional hazards regression model. The discrimination and calibration capacities of the prediction model were estimated via the c-statistic and the Hosmer-Lemeshow goodness of fit test. External validation was estimated via the same statistical methods by applying the model to a validation cohort of 300 KT recipients who underwent living donor KT at Tokyo Women's Medical University Hospital.
Results: In the derivation cohort, 28 patients (8.5%) had CVD events during the observation period. Recipient age, CVD history, diabetic nephropathy, dialysis vintage, serum albumin and proteinuria at 12 months after KT were significant predictors of CVD. A prediction model consisting of integer risk scores demonstrated good discrimination (c-statistic 0.88) and goodness of fit (Hosmer-Lemeshow test P = 0.18). In a validation cohort, the model demonstrated moderate discrimination (c-statistic 0.77) and goodness of fit (Hosmer-Lemeshow test P = 0.15), suggesting external validity.
Conclusions: The above-described simple model for predicting CVD after living donor KT was accurate and useful in clinical situations.
Keywords: dialysis vintage; external validation; nutritional status; proteinuria; risk score.
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| 21. |
Hiroshi Noguchi, Yuta Matsukuma, Kaneyasu Nakagawa, Kenji Ueki, Akihiro Tsuchimoto, Toshiaki Nakano, Yu Sato, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Treatment of chronic active T cell-mediated rejection after kidney transplantation: A retrospective cohort study of 37 transplants, Nephrology, 10.1111/nep.14048, 27, 7, 632-638, 2022.04, Aim: Data on the treatment of chronic active T cell-mediated rejection (CA-TCMR) are scarce, and therapeutical strategies for CA-TCMR have not been established. We retrospectively evaluated the outcomes and effects of treatment on pathological and clinical findings in patients with CA-TCMR.
Methods: This study comprised 37 patients who underwent kidney transplantation at our institute who were diagnosed with CA-TCMR between January 2018 and December 2020. Patients were followed until October 2021.
Results: A total of 32 of the 37 patients were treated. During the observation period, two patients died (5%), and five patients developed allograft loss (13%). A univariate Cox proportional hazards model showed that indication biopsy, higher spot urine protein/creatinine ratio (UPCR) and Banff ci/ct scores were risk factors for allograft loss. Of the treated patients, 23 underwent follow-up biopsies. The Wilcoxon signed-rank test showed significant improvement in the Baff scores for "ti", "i-IFTA", "t" and "t-IFTA" after treatment. On pathology, 13 (57%) of the patients who underwent follow-up biopsy improved to "no evidence of rejection" or "borderline change." Assuming that improvement in pathology to "borderline change" or "no evidence of rejection" on follow-up biopsy indicates response to treatment, multivariate logistic analysis showed that lower UPCR was a predictive factor for response to treatment. No specific effect of treatment type was observed.
Conclusions: Our results indicate that treatment could improve the pathological findings in CA-TCMR.
Keywords: chronic active T cell-mediated rejection; kidney transplantation; treatment.. |
| 22. |
Yasuhiro Okabe, Hiroshi Noguchi, Yu Sato, Takanori Mei, Keizo Kaku, Kenji Ueki, Akihiro Tsuchimoto, Masafumi Nakamura, Outcomes of Everolimus Plus Standard-Dose Tacrolimus Immunosuppression in De Novo Kidney Transplant: A Retrospective, Single-Center Study of 225 Transplants, Experimental and Clinical Transplantation, 10.6002/ect.2022.0028, 20, 4, 362-369, 2022.04, Objectives: In this study, our aim was to compare the outcomes of everolimus versus mycophenolate mofetil plus standard-dose tacrolimus immunosuppression in patients who received de novo kidney transplant at our center in Fukuoka, Japan.
Materials and methods: In this retrospective, observational, single-center, inverse probability of treatment weighting analysis study, 225 recipients who underwent kidney transplant at our center between January 2013 and December 2018 were included. The variables considered were recipient age/sex, duration of dialysis, cytomegalovirus mismatch (seronegative recipient and seropositive donor), cause of end-stage renal disease, donor age/sex, and number of HLA mismatches.
Results: Our analyses included 85 transplant recipients in the everolimus group and 141 transplant recipients in the mycophenolate mofetil group (n = 226 overall). There were no significant differences between the groups at 1 year for incidence of patient death and allograft loss, biopsy-proven acute rejection, BK virus-associated nephropathy, surgical complications, delayed graft function, and posttransplant diabetes mellitus. Incidence of cytomegalovirus infection and estimated glomerular filtration rate were significantly lower in the everolimus group than in the mycophenolate mofetil group. Posttransplant triglyceride and low-density lipoprotein were higher in the everolimus group than in the mycophenolate mofetil group. Multivariate ordered logistic analysis showed that older donor age and an acute rejection episode, but not induction with everolimus or mean tacrolimus trough concentration throughoutthe firstpostoperative year,were significant risk factors for severity of interstitial fibrosis/tubular atrophy at the 1-year protocol biopsy (P = .004 and P Conclusions: Short-term outcomes with everolimus plus standard-dose tacrolimus in recipients of de novo kidney transplant were comparable to those with mycophenolate mofetil plus standard-dose tacrolimus.. |
| 23. |
Hirona Taira, Hiroshi Noguchi, Kenji Ueki, Keizo Kaku, Akihiro Tsuchimoto, Yasuhiro Okabe, Yusuke Ohya, Masafumi Nakamura, Initiation of dialysis for kidney graft failure: a retrospective single-center cohort study, Therapeutic Apheresis and Dialysis, 10.1111/1744-9987.13756, 26, 4, 806-814
, 2022.04. |
| 24. |
Hiroshi Noguchi, Kei Nishiyama, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Factors Associated With Height Among Pediatric Kidney Transplant Recipients Aged ≤ 16 Years: A Retrospective, Single-Center Cohort Study of 60 Transplants, Experimental and Clinical Transplantation, 10.6002/ect.2021.0311, 20, 1, 35-41, 2022.04, Objectives: The aim of this study was to describe the factors associated with growth before and after kidney transplant. Materials and Methods: We retrospectively reviewed 60 pediatric patients with end-stage kidney disease aged ?16 years who underwent kidney transplant at our facility between November 2001 and March 2018. Height standard deviation score and possible associated factors were also compared. Results: Among the 60 patients, median age was 11 years (interquartile range, 5.3-14 years), and 24 (40%) were female. All patients were alive during the observational period. The 2-, 5-, and 15-year graft survival rates were 96.7%, 94.4%, and 77.8%, respectively. Mean height standard deviation score for preoperative kidney transplant was -2.1 ± 1.5. Duration of dialysis (months) was associated with preoperative height standard deviation score (β = -0.020; standard error = 0.006; t = -3.23; P = .002). Higher ag
e and episode of rejection were significant factors for loss of catch-up growth (P < .001 and P = .023, respectively). In total, 26 patients (43.3%) and 19 patients (31.7%) had short stature preoperatively and at 2 years after kidney transplant, respectively. Although 23 patients (38.3%) presented with catch-up growth after kidney transplant, 14 (53.9%) remained with short stature even 2 years after kidney transplant. Height standard deviation score 2 years after kidney transplant was associated with age, preoperative height standard deviation score, and episodes of rejection (P = .032, P < .001, and P = .005, respectively).. |
| 25. |
Keizo Kaku, Yasuhiro Okabe, Yu Sato, Takanori Mei, Hiroshi Noguchi, Masafumi Nakamura, Efficacy of Linear Stapler With Polyglycolic Acid Felt for Preventing Graft Duodenal Perforation After Pancreas Transplant, Exp Clin Transplant, 10.6002/ect.2022.0126, 20, 6, 595-601, 2022.04, Objectives: Graft duodenal perforation is a serious complication in pancreas transplantation. The aim of this study was to evaluate whether using a reinforced linear stapler during bench surgery in pancreas transplant affects the risk of graft duodenal perforation.
Materials and methods: This retrospective study included 47 patients who underwent pancreas transplant at our institution from 2011 to 2020. A reinforced stapler with polyglycolic acid felt was used to dissect the graft duodenum during bench surgery in 16 of the 47 patients (reinforced group). A conventional linear stapler was used in the remaining 31 patients (conventional group). Demographic, perioperative, and postoperative parameters were compared between the reinforced group and the conventional group.
Results: Graft duodenal perforation occurred in 6 patients (19.4%) in the conventional group and in none of the patients in the reinforced group. Logistic regression analysis revealed no significant associations between donor- orrecipient-related factors and graft duodenal perforation. Among operative factors, use of a reinforced stapler was the only factor significantly associated with the risk of graft duodenal perforation (odds ratio = 0.12).
Conclusions: The use of a reinforced stapler during dissection of the duodenum in bench surgery for pancreas transplant was associated with a lower risk of graft duodenal perforation than use of a conventional stapler.. |
| 26. |
Keizo Kaku, Yasuhiro Okabe, Yu Sato, Yu Hisadome, Takanori Mei, Hiroshi Noguchi, Masafumi Nakamura, Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin-Based Anticoagulation Therapy, World J Surg, 10.1007/s00268-021-06232-y, 46, 1, 215-222, 2022.04, Background: To evaluate patients undergoing a new procedure, iliac vascular transposition, in pancreas transplantation regarding the risk of thrombosis and graft survival without heparin-based anticoagulation therapy.
Methods: Iliac vascular transposition (IVT) involves changing the positions of the external iliac artery and vein relative to each other. In this study, this technique was evaluated in patients undergoing the procedure compared with patients not undergoing the procedure (iliac vascular parallel (IVP) group).
Results: No patients received prophylactic heparin therapy. Two patients in the IVP group (n = 26) developed complete thrombosis and six developed partial thrombosis, compared with no patients with complete thrombosis and one with partial thrombosis in the IVT group (n = 29). The cumulative incidence of thrombosis was significantly higher in the IVP group (p Conclusions: IVT in pancreas transplantation is a simple technique that results in a lower thrombosis risk and better graft survival rates without heparin-based anticoagulation therapy.. |
| 27. |
Keizo Kaku, Yasuhiro Okabe, Shinsuke Kubo, Yu Sato, Takanori Mei, Hiroshi Noguchi, Yoshito Tomimaru, Toshinori Ito, Takashi Kenmochi, Masafumi Nakamura, Utilization of the Pancreas From Donors With an Extremely High Pancreas Donor Risk Index: Report of the National Registry of Pancreas Transplantation, Transplant International, 10.3389/ti.2023.11132. eCollection 2023., 2023.04. |
| 28. |
Keizo Kaku, Yasuhiro Okabe, Shinsuke Kubo, Yu Sato, Takanori Mei, Hiroshi Noguchi, Yoshito Tomimaru, Toshinori Ito, Takashi Kenmochi, Masafumi Nakamura, Size-mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study, Clinical Transplantation , 10.1111/ctr.15090, 37, 11, e15090, 2023.04, Introduction: Donor-recipient (D/R) size mismatch has been evaluated for a number of organs but not for pancreas transplantation.
Methods: We retrospectively evaluated 438 patients who had undergone pancreas transplantation. The D/R body surface area (BSA) ratio was calculated, and the relationship between the ratio and graft prognosis was evaluated. We divided the patients into two groups and evaluated graft survival. The incidence of pancreas graft thrombosis resulting in graft failure within 14 days and 1-year graft survival were compared using Kaplan-Meier curves, and the prognostic factors associated with graft thrombosis were identified by univariate and multivariate analyses.
Results: The mean/median donor and recipient BSAs were 1.63 m2 /1.65 m2 , and 1.57 m2 /1.55 m2 , respectively; the mean and median D/R BSAs were both 1.05. The receiver operating characteristic curve cutoff for the D/R BSA ratio was 1.09, and significant differences were identified between patients with ratios of ?1.09 (high group) versus <1.09 (low group). The incidence of graft thrombosis resulting in pancreas graft failure within 14 days was significantly higher in the high group than in the low group (p < .01). One-year overall and death-censored pancreas graft survival were significantly higher in the low group than in the high group (p < .01). Multivariate analysis identified recipient height, donor BSA, and donor hemoglobin A1c as significant independent factors for graft thrombosis. Cubic spline curve analysis indicated an increased risk of graft thrombosis with increasing D/R BSA ratio.
Conclusion: D/R size mismatch is associated with graft thrombosis after pancreas transplantation.. |
| 29. |
Takanori Mei, Hiroshi Noguchi, Ryutaro Kuraji, Shinsuke Kubo, Yu Sato,
Keizo Kaku, Yasuhiro Okabe, Hideya Onishi, Masafumi Nakamura
, Effects of periodontal pathogen-induced intestinal dysbiosis on transplant immunity in an allogenic skin graft model, Scientific Reports , 10.1038/s41598-023-27861-4, 13, 544, 2023.04, Periodontal disease can induce dysbiosis, a compositional and functional alteration in the microbiota. Dysbiosis induced by periodontal disease is known to cause systemic inflammation and may affect transplant immunity. Here, we examined the effects of periodontal disease-related intestinal dysbiosis on transplant immunity using a mouse model of allogenic skin graft in which the mice were orally administered the periodontal pathogen Porphyromonas gingivalis (Pg).
For 6 weeks, the Pg group orally received Pg while the control group orally received phosphate-buffered saline solution. After that, both groups received allogenic skin grafts. 16s rRNA analysis of feces revealed that oral administration of Pg significantly increased three short chain fatty acids (SCFAs) producing genera. SCFA (acetate and propionate) levels were significantly higher in the Pg group (p=0.040 and p=0.005). The ratio of regulatory T cells, which are positively correlated with SCFAs, to total CD4+ T cells in the peripheral blood and spleen was significantly greater (p=0.002 and p<0.001) in the Pg group by flowcytometry. Finally, oral administration of Pg significantly prolonged skin graft survival (p<0.001) and reduced pathological inflammation in transplanted skin grafts.
In conclusion, periodontal pathogen-induced intestinal dysbiosis may affect transplant immunity through increased levels of SCFAs and regulatory T cells.. |
