記述言語：英語   出版者・発行元：Clinical Transplantation  

Introduction: Histopathological findings of chronic active T-cell-mediated rejection (CA-TCMR) have been reported to potentially improve with treatment. However, whether this improvement is associated with a better renal prognosis remains unclear. This study was performed to analyze the impact of the histological response to therapy on kidney allograft survival in patients with CA-TCMR. Methods: The data of patients diagnosed with CA-TCMR between January 2018 and May 2023 were retrospectively reviewed. A composite graft endpoint was defined as a two-fold increase in the serum creatinine level or the development of end-stage kidney disease. Results: Thirty-seven patients with CA-TCMR underwent 46 follow-up biopsies. Eleven patients who were diagnosed with CA-TCMR at the last biopsy were classified as the persistent group, while the remaining 26 patients were classified as the transient group. Both before and after treatment, there were no significant changes in serum creatinine, estimated glomerular filtration rate, or proteinuria in either group. However, the transient group showed a significant reduction in interstitial fibrosis and tubular atrophy without a specific etiology (IFTA). This improvement was attributed to better histopathological Banff scores after treatment. Patients with persistent CA-TCMR had significantly worse graft survival than those with transient CA-TCMR (p = 0.002), even after adjusting for significant clinical factors (hazard ratio: 11.4; 95% CI: 1.1–120.0; p = 0.043). Conclusion: Our findings suggest that the persistence of histopathologic evidence of CA-TCMR after treatment is a significant risk factor for allograft loss compared with transient CA-TCMR.

DOI： 10.1111/ctr.70011

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記述言語：英語   出版者・発行元：一般社団法人 日本動脈硬化学会  

Aims: Diabetic kidney disease is a major vascular complication in patients with diabetes mellitus (DM). However, the association between the hemoglobin (Hb)A1c levels, notably the prediabetic levels, and renal pathological changes remains unclear. We investigated the association between the HbA1c levels and renal arteriolar lesions in subjects without any apparent kidney dysfunction using a living kidney donor cohort. Methods: Between January 2006 and May 2016, 393 living kidney donors underwent a "zero-time" biopsy at Kyushu University Hospital. The patients were divided into four groups (HbA1c levels ＜5.6%, 5.6%–5.7%, 5.8%–6.4%, and ≥ 6.5%, or diagnosed with DM [DM group]). Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading. We then investigated the association between the HbA1c levels and renal pathological changes. Results: 158 (40.2%) patients had arteriolar hyalinization and 148 (37.6%) showed wall thickening. A significant correlation was observed between the HbA1c levels and wall thickening (p for trend ＜0.001). An elevated HbA1c level was significantly associated with wall thickening according to a multivariable logistic analysis in subjects with HbA1c levels of 5.6%–5.7% and 5.8%–6.4%, and the DM group, compared with those with HbA1c levels of ＜5.6% (odds ratio [OR], 1.91; 95% confidence interval [CI]: [1.03–3.54] for 5.6%–5.7%, OR, 1.96; 95% CI: [1.09–3.53] for 5.8%–6.4%, and OR, 2.86; 95% CI: [0.91–9.01] for the DM group), whereas arteriolar hyalinization did not increase within the nondiabetic HbA1c levels. Conclusions: Elevated high-normal HbA1c levels are considered to be independent risk factors for arteriolar wall thickening. Subclinical renal arteriolar sclerosis may develop in patients with prediabetic HbA1c levels.

DOI： 10.5551/jat.64236

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記述言語：英語   出版者・発行元：(一社)日本動脈硬化学会  

ヘモグロビン(Hb)A1cの高値が糖尿病性血管合併症と関連するとの報告を背景として、生体腎ドナーを対象に、HbA1c値と腎細動脈病変との関連性について検討した。2006年1月～2016年5月に当院でゼロ時間生検を受けた生体腎ドナー393名(年齢20～79歳、男性131名)をHbA1c値により4グループに分けた。158名(40.2%)に細動脈ヒアリン化が、148名(37.6%)に壁肥厚が認められた。HbA1c値と壁肥厚に有意な相関が認められた(傾向に関するp<0.001)。年齢、性別、肥満、高血圧、脂質異常症、喫煙習慣、eGFRおよび血清尿酸値について調整した多変量ロジスティック解析の結果、HbA1c値が5.6～5.7%および5.8～6.4%の被験者、ならびに糖尿病群で、HbA1c値<5.6%の被験者と比較して壁肥厚が有意に増加していた(オッズ比および95%CIはそれぞれ1.91[1.03～3.54]、1.96[1.09～3.53]、2.86[0.91～9.01])。細動脈ヒアリン化とHbA1c値に相関は認められなかった。以上の結果から、明らかな腎機能障害のない被験者において正常高値のHbA1cは細動脈壁肥厚の独立したリスク因子であることが示唆された。

記述言語：英語   出版者・発行元：Clinical Kidney Journal  

Background. Phospholipase A2 receptor (PLA2R) is a major target antigen in idiopathic membranous nephropathy (MN). Anti-PLA2R antibodies are mainly of the immunoglobulin G (IgG) subclass IgG4, although other IgG subclass depositions in glomeruli may also be detected. However, the importance of the subclass of the IgG deposit has not been proven. Thus we investigated clinical findings from patients with idiopathic MN in relation to glomerular PLA2R deposition and IgG subclass. Methods. We enrolled 132 Japanese patients with biopsy-proven idiopathic MN in a multicentre retrospective observational study. We investigated the complete remission rate as the primary outcome and the development of end-stage kidney disease (ESKD) as the secondary outcome in relation to glomerular PLA2R deposition. Moreover, we evaluated prognostic factors, including glomerular IgG subclass, in the PLA2R-positive group. Results. The percentage of cases with glomerular PLA2R deposition was 76.5% (n = 101). The first complete remission rate of the PLA2R-positive group was worse than that of the PLA2R-negative group (logrank test P < .001). ESKD incidence did not significantly differ between the glomerular PLA2R-negative and PLA2R-positive MN groups (logrank test P = .608). In the PLA2R-positive group, higher PLA2R intensities and IgG2 staining were associated with a poorer first complete remission rate (logrank test P < .001 and P = .032, respectively). Cox proportional hazards analysis also showed that strong PLA2R deposition and positive IgG2 staining were significantly associated with a failure to reach complete remission [hazard ratio 2.09 (P = .004) and 1.78 (P = .030), respectively]. Conclusions. Our results suggest that intense glomerular PLA2R and IgG2 positivity predict a poor proteinuria remission rate in idiopathic MN.

DOI： 10.1093/ckj/sfae104

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記述言語：英語   出版者・発行元：Transplantation Proceedings  

Background: This study aimed to examine the outcomes of kidney retransplantation in patients with allograft failure at Kyushu University. Methods: We reviewed data from 1043 consecutive patients (including 1001 in a first kidney transplantation [KT] group and 42 in a second KT group) who had undergone KT alone at our institution between January 2008 and September 2022. We also studied immunologic risks and outcomes of patients who had undergone preoperative testing for KT at Kyushu University during the same period. Results: No patient received more than 2 transplants. Donor-specific anti-HLA antibody (DSA) had been detected in a greater percentage of patients in the second KT group than in the first (31% vs 11%, respectively; P < .001). There were no significant differences in 5-year death-censored/overall graft survival rates, rates of surgical complications, or incidence of delayed graft function between the groups. During the study period, significantly more candidates for second than first KT were rejected for this procedure because of their high immunologic risk (20% vs 2%, P < 001). Seven of the 42 patients in the second KT group required the removal of the primary graft during the second transplantation. Conclusion: There is a higher percentage of patients whose DSA has been detected among patients undergoing retransplantation after allograft failure than among those receiving first KTs, which often leads to remaining on the waiting list in the former group. However, if the immunologic risk is within acceptable limits, the graft survival for retransplantation is not inferior to that of a first KT.

DOI： 10.1016/j.transproceed.2024.01.053

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記述言語：英語   出版者・発行元：Transplantation Proceedings  

Background: Perivascular aggregates (PVAs) often occur in kidney allografts; however, their significance needs to be re-evaluated in light of changes in the concept and criteria of allograft rejection. Methods: We reviewed 1-year protocol biopsies in 258 patients with kidney transplants to identify PVAs and concurrent pathology based on the Banff 2017 classification, including revised criteria for chronic active T-cell mediated rejection (CA-TCMR). We investigated the incidence of PVA, concurrent allograft lesions, diagnosis, and graft survival. No prisoners were used in this study, and no participants were coerced or paid. Results: We identified PVA in 81 biopsies (31.4%). The incidence of previous rejection (32.1% vs 12.4%, P= .0003) and total inflammation (1.3 ± 0.8 vs 0.6 ± 0.8, P < .0001), inflammation (0.7 ± 0.8 vs 0.2 ± 0.5, P < .0001), inflammation in the area of interstitial fibrosis and tubular atrophy (1.3 ± 1.2 vs 0.7 ± 0.9, P < .0001), tubulitis (1.4 ± 1.1 vs 0.6 ± 0.9, P < .0001), and interstitial fibrosis scores (1.2 ± 0.9 vs 0.9 ± 0.9, P= .01) were higher in PVA-positive compared with patients with PVA-negative. Diagnoses in the PVA-positive group revealed no rejection in 49.4%, CA-TCMR in 21.0%, borderline changes in 18.5%, and acute TCMR in 6.2%. CA-TCMR was more frequent in patients with PVA-positive (21.0% vs 4.0%, P < .0001). Graft survival was similar in both groups among all patients, no-rejection, any type of rejection, and CA-TCMR subgroups. Conclusions: PVAs occur heterogeneously and are associated with previous rejection or concurrent CA-TCMR. The prognostic significance of PVAs in kidney transplantation is inconclusive, and further investigations are needed.

DOI： 10.1016/j.transproceed.2024.01.012

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記述言語：英語   出版者・発行元：Cancer Science  

The Japan Diabetes Society and the Japan Cancer Association launched a joint committee and published their “First Joint Committee Report on Diabetes and Cancer” in 2013, compiling recommendations for physicians and health-care providers as well as for the general population. In 2016, the “Second Joint Committee Report on Diabetes and Cancer” summarized the current evidence on glycemic control and cancer risk in patients with diabetes. The current “Third Joint Committee Report on Diabetes and Cancer”, for which the joint committee also enlisted the assistance of the Japanese Society of Clinical Oncology and the Japanese Society of Medical Oncology, reports on the results from the questionnaire survey, “Diabetes Management in Patients Receiving Cancer Therapy,” which targeted oncologists responsible for cancer management and diabetologists in charge of glycemic control in cancer patients. The results of the current survey indicated that there is a general consensus among oncologists and diabetologists with regard to the need for guidelines on glycemic control goals, the relevance of glycemic control, and glycemic control during cancer therapy in cancer patients.

DOI： 10.1111/cas.15975

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記述言語：英語   出版者・発行元：Diabetology International  

The Japan Diabetes Society (JDS) and the Japan Cancer Association (JCA) launched a joint committee and published their “First Joint Committee Report on Diabetes and Cancer” in 2013, compiling recommendations for physicians and healthcare providers as well as for the general population. In 2016, the “Second Joint Committee Report on Diabetes and Cancer” summarized the current evidence on glycemic control and cancer risk in patients with diabetes. The current “Third Joint Committee Report on Diabetes and Cancer”, for which the joint committee also enlisted the assistance of the Japanese Society of Clinical Oncology (JSCO) and the Japanese Society of Medical Oncology (JSMO), reports on the results from the questionnaire survey, “Diabetes Management in Patients Receiving Cancer Therapy,” which targeted oncologists responsible for cancer management and diabetologists in charge of glycemic control in cancer patients. The results of the current survey demonstrated that there is a general consensus among oncologists and diabetologists with regard to the need for guidelines on glycemic control goals, the relevance of glycemic control, and glycemic control during cancer therapy in cancer patients.

DOI： 10.1007/s13340-023-00672-8

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記述言語：英語   出版者・発行元：Nephrology Dialysis Transplantation  

Background: Epidemiological studies have identified smoking as an independent risk factor for development of chronic kidney disease. However, the early renal pathological lesions have not been clearly elucidated. Methods: We investigated time-zero biopsy specimens from 547 living kidney donors and evaluated the relationships between smoking and renal histological changes, including arteriolar hyalinization, intimal thickening of small-medium arteries, global glomerulosclerosis, and interstitial fibrosis and tubular atrophy (IF/TA). Results: A total of 199 subjects (36.4%) had smoking history; 92 (16.8%) and 107 (19.6%) subjects had <20 pack-years and ≥20 pack-years of smoking, respectively. Cumulative smoking dose was significantly associated with prevalence of arteriolar hyalinization: the multivariable-adjusted odds ratio (OR) per 20 pack-year increase was 1.50 (95% confidence interval 1.15-1.97). The ORs for smokers with <20 pack-years and ≥20 pack-years versus never-smokers were 1.76 (1.01-3.09) and 2.56 (1.48-4.44), respectively. Smoking was also associated with prevalence of >10% global glomerulosclerosis: the OR per 20 pack-year increase was 1.24 (0.96-1.59). The ORs for smokers with <20 pack-years and ≥20 pack-years versus never-smokers were 1.50 (0.98-2.78) and 2.11 (1.18-3.79), respectively. The ORs for these pathological changes increased significantly depending on cumulative smoking dose. Intimal thickening of small-medium arteries and IF/TA were not associated with smoking status. The prevalence of arteriolar hyalinization remained higher in patients with ≥10 years since smoking cessation than in never-smokers [OR 2.23 (1.03-4.83)]. Conclusions: Subclinical pathological injury caused by smoking is potentially associated with renal arteriolar hyalinization and glomerular ischaemia.

DOI： 10.1093/ndt/gfad124

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出版者・発行元：Hypertension Research  

Intensive antihypertensive treatment decreases cardiovascular disease and mortality risks in chronic kidney disease (CKD), whereas extremely low systolic blood pressure (SBP) is associated with worsening kidney function and poor prognosis. Although the SBP variation is particularly large in patients with CKD, the optimal lower limit of SBP target is unclear. In a nationwide, multicenter cohort study of patients with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2, we evaluated the association between the eGFR slopes and the lower limit of SBP target at ≥110 mmHg using a linear mixed-effects model and an instrumental variable method. The instrumental variable was calculated as the facility-level percentage of nephrologists who answered in the survey that their lower limit of SBP target was 110 mmHg or higher. A total of 1320 patients (mean age 70 years; 66% men) were included. The mean eGFR slope ± standard deviation over the four years to baseline was –2.48 ± 2.15 mL/min/1.73 m2/year. The instrumental variable for the lower limit of SBP target at ≥110 mmHg (vs. ≤100 mmHg) was associated with less eGFR decline (coefficient: +1.05 mL/min/1.73 m2/year; 95% confidence interval: 0.33–1.77), while unassociated with a history of cardiovascular disease. The renoprotective effect was particularly larger in the subgroups of the elderly and those with a history of cardiovascular disease. In conclusion, the lower limit of SBP target at 110 mmHg or higher was associated with improved eGFR slope, suggesting the importance of aiming at avoiding excessively low SBP in patients with advanced CKD. [Figure not available: see fulltext.]

DOI： 10.1038/s41440-023-01358-z

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記述言語：英語   出版者・発行元：JCI Insight  

Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes are interacting comorbidities of obesity, and increased hepatic de novo lipogenesis (DNL), driven by hyperinsulinemia and carbohydrate overload, contributes to their pathogenesis. Fatty acid synthase (FASN), a key enzyme of hepatic DNL, is upregulated in association with insulin resistance. However, the therapeutic potential of targeting FASN in hepatocytes for obesity-associated metabolic diseases is unknown. Here, we show that hepatic FASN deficiency differentially affects NAFLD and diabetes depending on the etiology of obesity. Hepatocyte-specific ablation of FASN ameliorated NAFLD and diabetes in melanocortin 4 receptor–deficient mice but not in mice with diet-induced obesity. In leptin-deficient mice, FASN ablation alleviated hepatic steatosis and improved glucose tolerance but exacerbated fed hyperglycemia and liver dysfunction. The beneficial effects of hepatic FASN deficiency on NAFLD and glucose metabolism were associated with suppression of DNL and attenuation of gluconeogenesis and fatty acid oxidation, respectively. The exacerbation of fed hyperglycemia by FASN ablation in leptin-deficient mice appeared attributable to impairment of hepatic glucose uptake triggered by glycogen accumulation and citrate-mediated inhibition of glycolysis. Further investigation of the therapeutic potential of hepatic FASN inhibition for NAFLD and diabetes in humans should thus consider the etiology of obesity.

DOI： 10.1172/jci.insight.161282

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

症例は40歳男性。4年半前に母親をドナーとした生体腎移植を施行、腎移植の4年後にクローン病と診断されてインフリキシマブを開始していた。急性腎障害を発症して入院となり、解熱後も膀胱刺激症状と肉眼的血尿が持続したことから、アデノウイルス腎炎が出血性膀胱炎と急性腎障害の原因と推測された。移植腎生検標本のアデノウイルス免疫組織染色と尿検体を用いたPCR検査から、アデノウイルス腎炎の診断が確定した。インフリキシマブを中止、免疫抑制薬を減量し、さらに免疫グロブリン静注を開始したところ、移植腎障害、膀胱刺激症状、肉眼的血尿は改善した。インフリキシマブ中止後のクローン病の増悪に対しては、代替薬としてベドリズマブを投与した。

記述言語：英語   出版者・発行元：CEN case reports  

Excessive immunosuppression after kidney transplantation (KT) is often encountered in patients undergoing therapy for anti-rejection or autoimmune disease that requires further treatment using immunosuppressive medications (IMs), including biologic agents. We report a novel case wherein a kidney transplant recipient developed severe acute allograft injury and hemorrhagic cystitis at 4.5 years after KT due to adenovirus nephritis after treatment with infliximab for Crohn's disease. The diagnosis was made based on adenovirus immunohistochemistry staining and urine polymerase chain reaction tests. The patient was successfully treated by reducing IMs and administration of immunoglobulin even though allograft function was eventually partially recovered. When new immunosuppressive agents, particularly biologic agents, are initiated for other diseases in addition to maintenance IMs, the following points need to be regarded: (1) pay attention to opportunistic infections even in the late phase of KT, and (2) maintain communication with other specialists who prescribe biologics to ensure appropriate administration of IMs.

DOI： 10.1007/s13730-022-00756-5

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記述言語：英語   出版者・発行元：Stroke  

Background: It remains unclear how chronic kidney disease and its underlying pathological conditions, kidney dysfunction, and kidney damage, are associated with cardiovascular outcomes. This study aimed to determine whether kidney dysfunction (ie, decreased estimated glomerular filtration rate), kidney damage (ie, proteinuria), or both are associated with the long-term outcomes after ischemic stroke. Methods: A total of 12 576 patients (mean age, 73.0±12.6 years; 41.3% women) with ischemic stroke who were registered in a hospital-based multicenter registry, Fukuoka Stroke Registry, between June 2007 and September 2019, were prospectively followed up after stroke onset. Kidney function was assessed by estimated glomerular filtration rate and categorized into G1: ≥60 mL/(min·1.73 m2), G2: 45-59 mL/(min·1.73 m2), and G3: <45 mL/(min·1.73 m2). Kidney damage was evaluated by proteinuria using a urine dipstick test and classified into P1: -, P2: ±/1+, and P3: ≥2+. Hazard ratios and 95% CI for events of interest were estimated by a Cox proportional hazards model. Long-term outcomes included recurrence of stroke and all-cause death. Results: During the median follow-up of 4.3 years (interquartile range, 2.1-7.3 years), 2481 patients had recurrent stroke (48.0/1000 patient-years) and 4032 patients died (67.3/1000 patient-years). Chronic kidney disease was independently associated with increased risks of stroke recurrence and all-cause death even after adjustment for multiple confounding factors, including traditional cardiovascular risk factors. Both estimated glomerular filtration rate and proteinuria were independently associated with increased risks of stroke recurrence (multivariable-adjusted hazard ratio [95% CI], G3: 1.22 [1.09-1.37] versus G1, P3: 1.25 [1.07-1.46] versus P1) and death (G3: 1.45 [1.33-1.57] versus G1, P3: 1.62 [1.45-1.81] versus P1). In subgroup analyses, effect modifications were found in the association of proteinuria with death by age and stroke subtype. Conclusions: Kidney dysfunction and kidney damage were independently, but differently, associated with increased risks of recurrent stroke and all-cause death.

DOI： 10.1161/STROKEAHA.122.040958

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>【背景】腎移植後の慢性活動性T細胞性拒絶反応（CA-TCMR）は腎予後が不良だと考えられている。一方で治療によりその病理所見が改善する可能性についてはすでに報告した。しかし、病理所見の改善が腎予後の改善につながるかは不明であった。【対象・方法】2018年から2022年2月までに生検でCA-TCMRと診断され、治療後確認生検をおこなった32例を検討した。【結果】32例のうち病理所見上、B/CまたはNormalまで改善したものをResponder群（n=20）、そうでないものをNon-responder群（n=12）とした。Responder群ではti, i-IFTA, t-IFTAのスコアは治療前と比べ有意に改善していたのに対しNon-responder群では改善は見られなかった。血清クレアチニンの倍加、末期腎不全を複合アウトカムとした場合、Non-responder群に観察期間中に3例認めたのに対して、Responder群では認めず二群間の累積発症率に有意差を認めた（P＝0.019）。またeGFRの低下率もNon-responder群では-6.5％/年に対して、Responder群では-0.2％/年と有意差を認めた(Ｐ＜0.001)。一方で治療の前後では二群間で腎機能（eGFR）に変化を認めなかった。【結語】腎移植後CA-TCMRを発症しても治療を行い病理学的にB/CまたはNormalまで改善したものは、腎予後も良好であることが示唆された。一方で病理学的所見上の改善と治療前後の臨床所見は相関せず、確認生検が必要であると思われた。</p>

DOI： 10.11386/jst.58.supplement_s331_1

CiNii Research

出版者・発行元：Journal of the Japan Diabetes Society  

The Japan Diabetes Society (JDS) and the Japan Cancer Association (JCA) launched a joint committee and published their “First Joint Committee Report on Diabetes and Cancer” in 2013, compiling recommendations for physicians and healthcare providers as well as for the general population. In 2016, the “Second Joint Committee Report on Diabetes and Cancer” summarized the current evidence on glycemic control and cancer risk in patients with diabetes. The current “Third Joint Committee Report on Diabetes and Cancer”, for which the joint committee also enlisted the assistance of the Japanese Society of Clinical Oncology (JSCO) and the Japanese Society of Medical Oncology (JSMO), reports on the results from the questionnaire survey, “Diabetes Management in Patients Receiving Cancer Therapy,” which targeted oncologists responsible for cancer management and diabetologists in charge of glycemic control in cancer patients. The results of the current survey demonstrated that there is a general consensus among oncologists and diabetologists with regard to the need for guidelines on glycemic control goals, the relevance of glycemic control, and glycemic control during cancer therapy in cancer patients.

DOI： 10.11213/tonyobyo.66.705

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記述言語：英語   出版者・発行元：Bioorganic and Medicinal Chemistry  

Mincle, a C-type lectin receptor (CLR), activates the innate immune system by recognizing certain complex lipid compounds. In this study, we designed and synthesized trehalose disteate (TDS) and dibehenate (TDB), containing a polar-functional group in the middle of fatty acid moieties, based on a model of the Mincle–glycolipids interaction. The modified fatty acids were prepared using hydroxy fatty acids as common intermediates, and conjugated with an appropriate trehalose moiety to synthesize the desired trehalose diesters. TDE derivatives containing the modified fatty acid have different Mincle-mediated signaling activities depending on the position of the functional group and the length of the lipids. The newly developed TDE derivatives exhibit signaling activity comparable or superior to that of TDS or TDB, and the results suggest that Mincle tolerates polar functional groups at a certain position of the lipid chain of TDE. The introduction of the polar functional groups into the lipid moiety of the glycolipids also resulted in improved solubility in polar solvents, which would be advantageous for various analyses and applications.

DOI： 10.1016/j.bmc.2022.117045

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

腎グラフト不全に対する透析導入後のアウトカムについて検討した。腎グラフト不全をきたして透析導入に至った52例(男性32例、女性20例、平均51.8±13.5歳)を対象に後ろ向きコホート研究を実施した。腎移植(KT)のタイプは生体KTが37例(71.2%)、ABO不適合KTが14例(26.9%)、先制KTが6例(11.5%)であり、透析タイプは大半の患者が血液透析(HD)で腹膜透析(PD)施行は2例のみであった。計画外の透析導入となったのは25例(48.1%)であり、うっ血性心不全が7例、尿毒症が9例、電解質異常が2例、その他が7例となっていた。累積生存率は3ヵ月が96.0%、1年が96.0%、3年が93.8%、5年が82.4%で、観察期間中の死亡は8例(感染症5例、癌1例、弁膜症1例、不明1例)、2例は透析導入後1年以内に死亡に至り、先制KT施行群に死亡例はなかった。多変量解析では透析導入後死亡の独立リスク因子として、長期透析および白血球数高値が抽出された。腎グラフト不全に対する透析導入後の予後は受容可能なものであるが、特に先制KT施行例には腎臓内科医の早期介入が必要と考えられた。

記述言語：英語   出版者・発行元：Therapeutic Apheresis and Dialysis  

Few studies have focused on the outcome of dialysis for kidney graft failure. We investigated the outcomes of dialysis for graft failure. We retrospectively studied 52 patients undergoing dialysis for graft failure at our facility from January 2004 to December 2018. The mean age at initiation of dialysis was 51.8 ± 13.5 years. The patient survival rates after initiation of dialysis at 1, 3, and 5 years were 96.0%, 93.8%, and 82.4%, respectively. The rate of unplanned initiation was 44.2%. In multivariate logistic analysis, lack of follow-up by nephrologists and pre-emptive kidney transplantation (PEKT) tended to be risk factors for unplanned initiation (P = 0.065 and P = 0.014, respectively). Our study suggests that the prognosis of patients with dialysis for graft failure is acceptable. Dialysis for graft failure, especially in patients with PEKT, tends to be unplanned, and for safe initiation, early involvement of nephrologists may be necessary.

DOI： 10.1111/1744-9987.13756

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PubMed

記述言語：英語   出版者・発行元：Nephrology  

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.

DOI： 10.1111/nep.14048

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

症例は44歳男性で、腹膜透析開始14日後にダイアライザー出口部で血糖高値を示し、発熱、透析排液混濁、白血球数増加をきたした。透析液漏出に起因する腹膜透析関連腹膜炎と診断し、バンコマイシン(1g/日)およびセフタジジム(1g/日)の腹腔内投与を開始したが、改善は認められなかった。腹腔内および出口部排液の培養検査にて黄色ブドウ球菌を検出し、薬剤感受性試験をもとにセファゾリン(1.5g/日)腹腔内投与を開始したが、排液細胞数は依然として高値を示した。セファゾリン(1g/日)静脈内投与を追加したところ、症状と排液混濁は改善し、排液細胞数は正常化した。腹膜透析開始2年後も透析液漏出または腹膜炎の再発は認めていない。

記述言語：英語   出版者・発行元：CEN case reports  

Dialysate leakage is one of the causes of peritoneal dialysis (PD)-related peritonitis. The rate of catheter removal in PD-related peritonitis caused by dialysate leakage (PDPDL) is high, and the correct treatment is unclear. We experienced a case of PDPDL that was treated with intravenous and intraperitoneal antibiotic therapy. A 44-year-old Japanese man had high glucose discharge from the exit site after 14 days of initiating PD, and he had a fever and cloudy effluent with a high white cell count. We diagnosed him with PDPDL and began to administer vancomycin and ceftazidime intraperitoneally. However, the peritonitis could not be ameliorated. A culture examination showed Staphylococcus aureus from the effluent of peritoneal cavity and exit site cultures. We began intraperitoneal cefazolin administration according to a drug susceptibility test, but the effluent cell count remained high. As we added intravenous cefazolin administration, his symptoms and cloudy effluent improved, and the effluent cell count normalized. He has not developed any recurrence of dialysate leakage or peritonitis. Our findings suggest that PD-related peritonitis accompanied by other infectious sites, such as PDPDL, should be treated with additional intravenous antibiotic therapy to taking effect on the infectious sites except for peritoneum and to keep plasma concentration of antibiotics sufficient especially in cases with preserved residual kidney function.

DOI： 10.1007/s13730-021-00644-4

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Experimental and Clinical Transplantation  

Objectives: In this study, our aim was to compare the outcomes of everolimus versus mycophenolate mofetil plus standard-dose tacrolimus immunosup-pression 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 throughout the first postoperative year, were significant risk factors for severity of interstitial fibrosis/tubular atrophy at the 1-year protocol biopsy (P = .004 and P < .001, respectively). 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.

DOI： 10.6002/ect.2022.0028

Web of Science

Scopus

PubMed

出版者・発行元：Diabetology International  

Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.

DOI： 10.1007/s13340-021-00551-0

Scopus

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>＜背景＞腎移植後早期の血圧管理には主にカルシウム拮抗薬が用いられ、早期からアンジオテンシンⅡ受容体拮抗薬(ARB)を使用することに関しての安全性や有効性は定かではない。＜方法＞2020年5月〜2022年3月に当科で行われた生体腎移植で、タクロリムス、ミコフェノール酸モフェチル、ステロイドの３剤で免疫抑制導入され、免疫学的低リスクの成人症例で、移植後3ヶ月に腎生検を実施した計78例について検討した。術後早期よりARBを開始した症例をARB群（27例）、それ以外をControl群（51例)とし、さらに逆確率重み付け（IPW）を用いて患者背景を２群間で調整し、3ヶ月後の腎機能および生検結果について比較した。＜結果＞術後3ヶ月時点での血清クレアチニン、推算糸球体濾過量、高K血症や血圧低下などの有害事象の出現頻度については二群間に有意差は認めなかった。尿蛋白/尿クレアチニン比(Up/Uc)はARB群でContorolに比べ低い傾向にあった（0.12 vs. 0.16 , <i>p</i>=0.176)。また術後3ヶ月目に行った腎生検結果では、ARB群ではIF/TAの出現率は低い傾向にあった（9.3% vs 17.6%, p=0.313）。＜結論＞低用量からARBを術後早期に始めることは安全であった。</p>

DOI： 10.11386/jst.57.supplement_s378_1

CiNii Research

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語