Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
NOGUCHI HIROSHI Last modified date:2021.07.29

Assistant Professor / Kidney Care Unit / Kyushu University Hospital


Papers
1. Zhang, Mengyu MSc1,a; Tajima, Soichiro PhD2,a; Shigematsu, Tomohiro BSc1,2; Noguchi, Hiroshi MD, PhD3; Kaku, Keizo MD, PhD3; Tsuchimoto, Akihiro MD, PhD4; Okabe, Yasuhiro MD, PhD3; Egashira, Nobuaki PhD1,2; Ieiri, Ichiro PhD1,2, Development and Validation of an LC-MS/MS Method to Simultaneously Measure Tacrolimus and Everolimus Concentrations in Kidney Allograft Biopsies after Kidney Transplantation, Therapeutic Drug Monitoring, DOI: 10.1097/FTD.0000000000000912, in Press, 2021.07, Background: Therapeutic drug monitoring (TDM) is necessary for immunosuppressive therapy with tacrolimus and everolimus after kidney transplantation. Several studies have suggested that the concentrations of immunosuppressive agents in allografts may better reflect clinical outcomes than whole blood concentrations. This study aimed to develop a method for the simultaneous quantification of tacrolimus and everolimus concentrations in clinical biopsy samples and investigate their correlation with histopathological findings in kidney transplant recipients.

Methods: Fourteen biopsy samples were obtained from kidney transplant recipients at 3 months after transplantation. Kidney allograft concentrations (Ctissue) of tacrolimus and everolimus were measured by liquid chromatography tandem mass spectrometry (LC-MS/MS), and the corresponding whole blood trough concentrations (C0) were obtained from clinical records.

Results: The developed method was validated over a concentration range of 0.02[FIGURE DASH]2.0 ng/mL for tacrolimus and 0.04[FIGURE DASH]4.0 ng/mL for everolimus in kidney tissue homogenate. The Ctissue of tacrolimus and everolimus in kidney biopsies ranged from 21.0 to 86.7 pg/mg tissue and 33.5 to 105.0 pg/mg tissue, respectively. Dose-adjusted Ctissue of tacrolimus and everolimus was significantly correlated with the dose-adjusted C0 (P < 0.0001 and P = 0.0479, respectively). No significant association was observed between the Ctissue of tacrolimus and everolimus and the histopathologic outcomes at 3 months after transplantation.

Conclusions: This method could support further investigation of the clinical relevance of tacrolimus and everolimus allograft concentrations after kidney transplantation..
2. 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, Transplantation DIRECT, doi: 10.1097/TXD.0000000000001185, 7, 8, e728-e728, 2021.07.
3. 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, Journal of Endourology, 10.1089/end.2020.1181, 2021.04.
4. 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, Journal of Hepato-Biliary-Pancreatic Sciences, doi.org/10.1002/jhbp.895, 28, 4, 365-375, 2021.04, 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..
5. 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, 2021.04.
6. Takanori Mei, Hiroshi Noguchi, Kanae Otsu, Yu Hisadome, Yu Sato, 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, 2021.02.
7. 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, DOI: 10.1111/ases.12922, 2021.01.
8. Kenji Ueki1, Akihiro Tsuchimoto1, Yuta Matsukuma1, Kaneyasu Nakagawa1, Hiroaki Tsujikawa1, Kosuke Masutani2, Shigeru Tanaka1, Keizo Kaku3, Hiroshi Noguchi3, Yasuhiro Okabe3, Kohei Unagami4, Yoichi Kakuta5, Masayoshi Okumi5, Masafumi Nakamura3, Kazuhiko Tsuruya6, Toshiaki Nakano1, Kazunari Tanabe5, Takanari Kitazono1, and Japan Academic Consortium of Kidney Transplantation investigators, Development and validation of a risk score for the prediction of cardiovascular disease in living donor kidney transplant recipients, Nephrology Dialysis Transplantation, doi: 10.1093/ndt/gfaa275, 2020.12.
9. Hiroshi Noguchi, Kaneyasu Nakagawa, Kenji Ueki, Akihiro Tsuchimoto, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Response to treatment for chronic active T cell-mediated rejection in kidney transplantation: a report of three cases, Transplantation Direct, doi: 10.1097/TXD.0000000000001079, 6, 12, e628-e628, 2020.11.
10. Takanori Mei, M.D. Hiroshi Noguchi, MD, PhD Kimitaka Suetsugu, PhD Yu Hisadome, MD Keizo Kaku, MD, PhD Yasuhiro Okabe, MD, PhD Satohiro Masuda, PhD Masafumi Nakamura, MD,PhD, Effects of Concomitant Administration of Vonoprazan Fumarate on the Tacrolimus Blood Concentration in Kidney Transplant Recipients, Biological and Pharmaceutical Bulletin, https://www.jstage.jst.go.jp/article/bpb/43/10/43_b20-00361/_article/-char/en, 43, 10, 1600-1603, 2020.10.
11. Meier, Raphael P.H.; Noguchi, Hiroshi; Kelly, Yvonne M.; Sarwal, Minnie; Conti, Giulia; Ward, Casey; Halleluyan, Ran; Tavakol, Mehdi; Stock, Peter G.; Freise, Chris, Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study, Transplantation Direct, doi: 10.1097/TXD.0000000000001053, 6, 10, e610-e610, 2020.10.
12. Hiroshi Noguchi, Akihiro Tsuchimoto, Kenji Ueki, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, 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, in Press-in Press, 2020.05.
13. Hiroshi Noguchi, Akihiro Tsuchimoto, Kenji Ueki, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, One-year Outcome of Everolimus With Standard-dose Tacrolimus Immunosuppression in De Novo ABO-incompatible Living Donor Kidney Transplantation: A Retrospective, Single-center, Propensity Score Matching Comparison With Mycophenolate in 42 Transplants, Transplantation Direct, doi: 10.1097/TXD.0000000000000962, 6, 1, e514-e514, 2020.04.
14. Takanori Mei, Hiroshi Noguchi, Yu Hisadome, Keizo Kaku, Takehiro Nishiki, Yasuhiro Okabe, Masafumi Nakamura, 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, 10.1111/tid.13234, 2020.02.
15. Akihiro Tsuchimoto, Kosuke Masutani, Kenji Ueki, Kaneyasu Nakagawa, Yuta Matsukuma, Shigeru Tanaka, Kohei Unagami, Yoichi Kakuta, Masayoshi Okumi, Hiroshi Noguchi, Keizo Kaku, Yasuhiro Okabe, Toshiaki Nakano, Takanari Kitazono, Masafumi Nakamura, Hideki Ishida, Kazunari Tanabe, The Japan Academic Consortium of Kidney Transplantation (JACK) Investigators, Effect of renin–angiotensin system blockade on graft survival and cardiovascular disease in kidney transplant recipients: retrospective multicenter study in Japan, Clinical and Experimental Nephrology, doi.org/10.1007/s10157-019-01827-1, 24, 369-378, 2020.01.
16. Tomoyuki Araki, Hiroshi Noguchi, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura, Hand-assisted laparoscopic versus hand-assisted retroperitoneoscopic living-donor nephrectomy: a retrospective, single-center, propensity-score analysis of 840 transplants using two techniques, Transplantation Proceedings, in Press, 2020.01.
17. Yu Hisadome, Hiroshi Noguchi, Kukiko Sakihama, Yuki Nakafusa, Takanori Mei, Keizo Kaku, Yasuhiro Okabe, Kosuke Masutani, Yuki Ohara, Kazuyuki Ikeda, Yoshinao Oda, Masafumi Nakamura, Association of Pretransplant BK Polyomavirus Antibody Status with BK Polyomavirus Infection After Kidney Transplantation: A Prospective Cohort Pilot Study of 47 Transplants, Transplantation Proceedings, in Press, 2020.01.
18. Hiroshi Noguchi, Yoichi Kakuta, Masayoshi Okumi, Kazuya Omoto, Yasuhiro Okabe, Hideki Ishida, Masafumi Nakamura, Kazunari Tanabe, Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy
a retrospective cohort study of 1508 transplants from two centers, Surgical endoscopy, 10.1007/s00464-019-06697-y, 33, 12, 4038-4047, 2019.12, Background: Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. Methods: A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. Results: Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1–6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193). Conclusions: Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN..
19. Soichiro Tajima, Rao Fu, Tomohiro Shigematsu, Hiroshi Noguchi, Keizo Kaku, Akihiro Tsuchimoto, Yasuhiro Okabe, Satohiro Masuda, Urinary human epididymis secretory protein 4 as a useful biomarker for subclinical acute rejection three months after kidney transplantation, International journal of molecular sciences, 10.3390/ijms20194699, 20, 19, 2019.10, Kidney transplantation is the treatment of choice for patients with advanced chronic kidney disease (CKD) and end stage renal disease (ESRD). However, acute rejection (AR) is a common complication in kidney transplantation and is associated with reduced graft survival. Current diagnosis of AR relies mainly on clinical monitoring including serum creatinine, proteinuria, and confirmation by histopathologic assessment in the biopsy specimen of graft kidney. Although an early protocol biopsy is indispensable for depicting the severity of pathologic lesions in subclinical acute rejection (subAR), it is not acceptable in some cases and cannot be performed because of its invasive nature. Therefore, we examined the detection of noninvasive biomarkers that are closely related to the pathology of subAR in protocol biopsies three months after kidney transplantation. In this study, the urinary level of microtubule-associated protein 1 light chain 3 (LC3), monocyte chemotactic protein-1 (MCP-1), liver-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and human epididymis secretory protein 4 (HE4) were measured three months after kidney transplantation. Urine samples of 80 patients undergoing kidney transplantation between August 2014 to September 2016, were prospectively collected after three months. SubAR was observed in 11 patients (13.8%) in protocol biopsy. The urinary levels of LC3, MCP-1, NGAL, and HE4 were significantly higher in patients with subAR than in those without, while those of L-FABP did not differ between the two groups. Multivariate regression models, receiver-operating characteristics (ROC), and areas under ROC curves (AUC) were used to identify predicted values of subAR. Urinary HE4 levels were able to better identify subAR (AUC = 0.808) than the other four urinary biomarkers. In conclusion, urinary HE4 is increased in kidney transplant recipients of subAR three months after kidney transplantation, suggesting that HE4 has the potential to be used as a novel clinical biomarker for predicting subAR..
20. Yoshifumi Miura, Hiroshi Noguchi, Yasuhiro Okabe, Kosuke Masutani, Shoji Tokunaga, Masafumi Nakamura, Effects of telmisartan and candesartan on the metabolism of lipids and glucose in kidney transplant patients
A prospective, randomized crossover study, Transplantation Direct, 10.1097/TXD.0000000000000861, 5, 2, 2019.02, Background. The risk of cardiovascular events remains after kidney transplantation (KT). Abnormal glucose metabolism and hyperlipidemia contribute partly to this risk. Among angiotensin II type-1 receptor blockers, telmisartan alone has been shown to ameliorate these effects on glucose and lipid metabolism (GLM). We investigated the effects of telmisartan on GLM in KT patients. Methods. This trial had a crossover design. Forty-six KT patients with well-controlled hypertension under angiotensin II type-1 receptor blockers were randomized into telmisartan and candesartan groups. After a 12-week treatment, crossover was initiated, and additional 12-week treatment was administered without a washout period. We examined the laboratory parameters of GLM, blood pressure and graft function before and after each treatment period. Results. Forty patients completed the scheduled treatment regimen. Serum levels of triglyceride were significantly lower (114.3 ± 50.8 mg/dL vs 136.5 ± 66.8 mg/dL; P = 0.019), and the estimated glomerular filtration rate was significantly higher (50.4 ± 15.1 mL/min per 1.73 m 2 vs 48.5 ± 12.5 mL/min per 1.73 m 2 ; P = 0.038) after telmisartan treatment than after candesartan treatment. There were no significant differences between the 2 treatment groups with regard to the other parameters studied (including serum adiponectin levels and parameters of glucose metabolism). Conclusions. These data suggest that telmisartan can improve serum triglyceride levels and graft function for KT patients better than candesartan..
21. H. Noguchi, Y. Miyasaka, K. Kaku, K. Kurihara, U. Nakamura, Y. Okabe, T. Ohtsuka, K. Ishigami, M. Nakamura, Preoperative Muscle Volume Predicts Graft Survival After Pancreas Transplantation
A Retrospective Observational Cohort Study, Transplantation Proceedings, 10.1016/j.transproceed.2018.03.018, 50, 5, 1482-1488, 2018.06, 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 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 =.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 PMI (P =.0206). A multivariate Cox regression analysis revealed that a low PMI (P =.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 =.0025). Conclusions: Our data suggest that muscle volume could be a predictor of graft survival after PT..
22. S. Date, H. Noguchi, K. Kaku, K. Kurihara, Y. Miyasaka, Y. Okabe, U. Nakamura, T. Ohtsuka, M. Nakamura, Laparoscopy-Assisted Spleen-Preserving Distal Pancreatectomy for Living-Donor Pancreas Transplantation, Transplantation Proceedings, 10.1016/j.transproceed.2017.03.037, 49, 5, 1133-1137, 2017.06, 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 transplantation. 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..
23. K. Kaku, H. Kitada, H. Noguchi, K. Kurihara, S. Kawanami, U. Nakamura, M. Tanaka, Living donor kidney transplantation preceding pancreas transplantation reduces mortality in type 1 diabetics with end-stage renal disease, Transplantation Proceedings, 10.1016/j.transproceed.2014.12.048, 47, 3, 733-737, 2015.04, Background Simultaneous pancreas-kidney transplantation (SPK) is a definitive treatment for type 1 diabetics with end-stage renal disease (ESRD). Because of the shortage 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 the benefit 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-six patients underwent SPK, 15 underwent LDK, and 30 were waiting for SPK. Their cumulative patient and graft survival rates were retrospectively evaluated. Risk factors contributing to mortality in patients with type 1 diabetes awaiting SPK were evaluated with the use of a Cox proportional hazards model. Results The 5-year cumulative patient survival rates in the SPK and LDK groups were 100% and 93.3%, respectively (P =.19), and 5-year kidney graft survival rates were 95.7% and 100% (P =.46), respectively. The cumulative survival rate in patients awaiting SPK was 77.7% at 5 years after registration. Duration of dialysis was the only factor significantly associated with patient and graft survivals according to both univariate and multivariate 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 was an independent risk factor for patient and graft survival. LDK preceding pancreas transplantation may be an effective therapeutic option for patients with type 1 diabetes and ESRD..
24. H. Noguchi, H. Kitada, K. Kaku, K. Kurihara, S. Kawanami, A. Tsuchimoto, K. Masutani, U. Nakamura, M. Tanaka, Outcome of renal transplantation in patients with type 2 diabetic nephropathy
A single-center experience, Transplantation Proceedings, 10.1016/j.transproceed.2014.12.047, 47, 3, 608-611, 2015.04, Background Renal transplantation has been established as a treatment for end-stage renal disease (ESRD) due to diabetic nephropathy. However, few studies have focused on the outcome 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. This study aimed to compare the outcome of renal transplantation for type 2 diabetic nephropathy 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 living-donor renal transplantation at our facility from February 2008 to March 2013. We compared the 2 groups retrospectively. Results In the DM and NDM groups, the 5-year patient survival rates were 96.6% and 98.7%, and the 5-year graft survival rates were 96.8% and 98.0%, respectively, with no significant differences between the groups. There were no significant differences in the rates of surgical complications, rejection, and infection. The cumulative incidence of postoperative cardiovascular events was higher in the DM group than in the NDM group (8.5% vs 0.49% at 5 years; P =.002). Conclusions Patient and graft survival rates after renal transplantation for type 2 diabetic nephropathy are not inferior to those for recipients without diabetic nephropathy. Considering the poor prognosis of patients with diabetic nephropathy on dialysis, renal transplantation can provide significant benefits for these patients..
25. Soushi Terasaka, Hidehisa Kitada, Yasuhiro Okabe, Sayako Kawanami, Hiroshi Noguchi, Kyoko Miyamoto, Akihiro Tsuchimoto, Kousuke Masutani, Masao Tanaka, Living-donor kidney transplant in T-cell and B-cell flow cytometry crossmatch-positive patients, Experimental and Clinical Transplantation, 10.6002/ect.2013.0163, 12, 3, 227-232, 2014.06, Objectives: Complement-dependent cytotoxic crossmatch is an important indicator for kidney transplant. However, there is controversy about treatment for flow cytometry crossmatch-positive cases. Materials and Methods: This was a retrospective study of 127 living-donor kidney transplant recipients from May 2007 to July 2011. We divided patients into 115 flow cytometry crossmatch T-cell and B-cell- negative cases, and 12 T-cell and B-cell-positive cases. Both groups were given 20 mg basiliximab the day of surgery and 4 days after surgery. Common oral immunosuppressive agents used were tacrolimus, mycophenolate mofetil, and methylprednisolone. Flow cytometry crossmatch T-cell and B-cell-negative recipients started immunosuppression 7 days before surgery, T-cell and B-cell-positive recipients started immunosuppression 14 days before surgery. T-cell and B-cell-positive patients also received 200 mg rituximab 1 week before surgery, had 3 plasma exchange sessions before transplant, and received intravenous immunoglobulin 20 g/day during surgery and after surgery for 5 days. We measured flow-panel reactive antibodies of T-cell and B-cell-positive patients just before surgery to check desensitization efficiency. We evaluated patient survival, graft survival, graft function, and frequency of rejection and infectious diseases. Results: Patient survival and graft survival were 100% in both groups. Flow cytometry crossmatch T-cell and B-cell-positive cases had no rejection events, but T-cell and B-cell-negative groups developed rejection. There was no statistical difference in the incidence of infection and graft function. Flow-panel reactive antibody demonstrated improvement in all T-cell and B-cell-positive cases. Conclusions: In living-donor kidney transplant, flow cytometry crossmatch T-cell and B-cell-positive patients are still considered to be at high risk. Although this is a short-term outcome, all T-cell and B-cell-positive patients in this study achieved excellent results with appropriate preoperative and postoperative treatment..
26. Yasuhiro Okabe, Hidehisa Kitada, Yoshifumi Miura, Takehiro Nishiki, Kei Kurihara, Sayako Kawanami, Soshi Terasaka, Keizo Kaku, Hiroshi Noguchi, Atsushi Sugitani, Masao Tanaka, Pancreas transplantation
A single-institution experience in Japan, Surgery today, 10.1007/s00595-013-0516-6, 43, 12, 1406-1411, 2013.02, Purpose: We herein report our experience with pancreas transplantation in 26 patients at a single institution in Japan between August 2001 and December 2011. Methods: We reviewed the medical records of 26 pancreas transplantations performed in our institute. Results: The early complications (within 2 weeks) included one graft venous thrombosis, one arterial thrombosis, and two reoperations for bleeding. Of the 26 pancreas transplant recipients, five lost pancreas graft function. Of 24 simultaneous pancreas-kidney recipients, three lost kidney graft function due to noncompliance. The patient, pancreas, and kidney survival rates were 100, 96 and 93 % at 1 year; 100, 80 and 93 % at 5 years; and 100, 67 and 68 % at 10 years, respectively. Of all these complications, venous thrombosis after pancreas transplantation was the most critical. Conclusions: As the largest series of pancreas transplantations in a single institution in Japan, our series yielded better results than the worldwide data recorded by the International Pancreas Transplant Registry. Routine postoperative anticoagulation therapy is not necessary for the prevention of graft thrombosis if sufficient fluid infusion is strictly controlled and the graft blood flow is frequently monitored. When graft thrombosis occurs, both early detection and appropriate intervention are extremely important if the pancreas graft is to survive..