Renal Transplantation In Japan Research Articles

260.5: Current status of ABO incompatible kidney transplantation in Japan: Based on statistical data of renal transplantation in Japan.

260.5: Current status of ABO incompatible kidney transplantation in Japan: Based on statistical data of renal transplantation in Japan.

Introduction.

We are pleased to bring you this supplement to Nephrology, which contains the proceedings of the 20th and 21st Japanese Clinicopathological Conference on Renal Allograft Pathology, held on 16 July 2016 in Tokyo and on 15 July 2017 in Nagoya, Japan, respectively. The conference is held annually, with clinical nephrologists, transplant surgeons, urologists and renal pathologists meeting to discuss the issues in cases and topics concerning renal transplantation. The conference has made a great contribution to the field of renal transplantation in Japan. Each year, we set several topics for detailed discussion at the conference. In 2016, the 20th conference consisted of one educational lecture, two special lectures, 18 oral presentations and 15 poster presentations, which focused on graft dysfunction in the chronic phase, recurrent kidney disease and infection. The educational lecture titled ‘Post-transplant immunoglobulin A deposition and nephropathy in allografts’ was presented by Dr. Tadashi Sofue and is published in this supplement. Mr. Shigeru Horita discussed ‘Usefulness of immunofluorescence technique in transplant kidney biopsy’ in one of the special lectures, and the other, ‘Essence of the Banff 2015 meeting’, was delivered by Dr. Sigeo Hara. In 2017, the 21st conference comprised two educational lectures, two special lectures, 15 oral presentations and eight poster presentations. An overview of the educational lecture ‘Recurrence of native kidney disease after kidney transplantation’, which was presented by Dr. Izumi Yamamoto, is published in this supplement. Also, Professor Ken Sakai spoke about ‘Protocol graft biopsy in kidney transplantation’. The special lecture titled ‘Viral infections directly involve in kidney allograft function’ was presented by Dr. Kosuke Masutani, and is published in this supplement as a mini review. In addition, Dr. Shigeo Hara discussed ‘Cell-mediated rejection revisited: past, current, and future direction’. We believe that the reports in this supplement address recent important issues in the field of renal transplantation. The guest editors thank all authors and participants for their contributions. Finally, we would like to express our sincere appreciation to Dr. Morozumi and Dr. Yamaguchi for their dedication to these conferences. The authors have no conflicts of interest to declare.

New Registry and Tracking System for Renal Transplantation in Japan

Following The Declaration of Istanbul 2008, a registration committees of The Japan Society for Transplantation and The Japanese Society for Clinical Renal Transplantation planned to establish a new registry and tracking system for renal transplant recipients and donors supported by a Health Labor Sciences Research Grant by The Ministry of Health Labour and Welfare. In place of the previous paper-based system, we established the new registry and tracking system, JARTRE (Japan Renal Transplantation Registry), using USB memory in 2009. Recipient and donor data were inputted into the USB memory at the transplantation centers. The memory was reviewed a yearly by committees. The recipient and donor registration included details from both. The tracking is performed centrally 3 months, 1 year, and every year after the operation. The advantages of this system are the ease of input, adequacy of the data, and rapid statistical processing. In 2009, we registered 97.9% of new renal transplantation recipients and donors; in 2008 it was more than 81.9% of all past renal transplantation recipients in Japan.

Association of treatment with 15‐deoxyspergualin and BK virus nephropathy in kidney allograft recipients

BK virus nephropathy (BKVN) has been proposed as an important cause of allograft dysfunction and loss in kidney allograft recipient over the last decade. Intense immunosuppression and tubular injury have been shown to promote the replication of polyomavirus. 15-deoxyspergualin (DSG), an effective immunosuppressive agent, is used as a rescue drug for acute rejection in clinical renal transplantation in Japan. To determine whether DSG is a risk factor for BKVN and outline the relationship among BKVN, DSG, and other risk factors, we analyzed 88 patients who received living-related renal transplantation between January 1999 and April 2003. A total of 114 biopsy specimens from 88 living-related kidney transplantation recipients (performed between January 1999 to April 2003) were retrospectively analyzed. Patients received immunosuppression therapy based on calcineurin inhibitors and corticosteroid [tacrolimus (TAC) 33 and cyclosporin (CyA) 55]. Additionally, mycophenolate mofeteil (MMF) was used in 21 patients; DSG was used in seven patients; and anti-CD3 monoclonal antibody was used in 16 patients. We analyzed the degree of donor/recipient human leucocyte antigen (HLA) compatibility assessed by the number of HLA-A, -B, and -DR-mismatched antigens in 88 patients. The diagnosis of BKVN was made by the light microscopic examination and a positive immunohistochemical staining of anti-40 antibody in biopsy specimens. Patients were divided into two groups of group A (mild histological change) and group B (moderate or severe histological change) to determine the risk factors in different histological staging. The clinical course of two typical patients in different histological stage is described briefly to outline the risk factors of BKVN. We identified seven cases of BKVN (8.0%) from 88 transplanted patients. Significantly higher incidence of combination regimen consisting of TAC and MMF in BKVN group was noticed compared with non-BKVN group (57.1% vs. 9.9%; p = 0.003). BKVN was associated with a significantly higher incidence of DSG administration compared with non-BKVN group (57.1% vs. 3.7%; p </= 0.001). No difference was found in HLA mismatch between BKVN and non-BKVN group. Additionally, a significantly higher incidence of acute rejection episode prior to BKVN diagnosis was found in group B compared with group A (100% vs. 0%; p = 0.002), and the same statistical difference was shown in the number of anti-rejection therapy between group B and group A (100% vs. 0%; p = 0.002). We recognized a significant difference between group B and group A in terms of the combine regimen therapy of TAC with MMF (p = 0.002) and no difference in graft loss rate (p = 0.092), even though it was 50% in group B and was 0% in group A. In this study, our data indicated excessive intense immunosuppression with TAC-MMF is related to the development of BKVN. In addition, we found that anti-rejection therapy, especially with DSG, may accelerate the development of BKVN.

Basiliximab: economic advantage for renal transplantation in Japan

Basiliximab: economic advantage for renal transplantation in Japan

Basiliximab: economic advantage for renal transplantation in Japan

Basiliximab: economic advantage for renal transplantation in Japan

Factors contributing to long graft survival in non-heart-beating cadaveric renal transplantation in Japan: a single-center study at Kitasato University.

A total of 107 cadaveric kidneys from non-heart-beating donors (NHBDs) have been transplanted between 1974 and 2000 at Kitasato University Hospital, Sagamihara, Japan. The patient survival of the 107 recipients of cadaveric renal transplants at 1, 5 and 10 yr was 0.857, 0.770 and 0.746, respectively. The 50% graft survival was 3.8 yr. The 5 and 10-yr graft survival was 0.457 and 0.337, respectively. Twenty of the 107 recipients of non-heart-beating cadaveric renal transplantation had graft survival longer than 10 yr. Of these 20 patients, 14 survivors still maintain functioning renal grafts and two died with functioning graft, although the remaining four reverted to dialysis because of chronic rejection and nephropathy. The average graft survival of these 20 patients at the time of study was 13.3 yr and the longest was 21.4 yr. The average serum creatinine level at 10 yr after transplantation was 1.63 mg/dL, almost identical to that at 5 yr post-transplant. The donors aged on average 40.2 yr; 13 were male and seven were female. The youngest donor was 9-yr-old and the oldest was 66. The graft survival was significantly better in the group with donor age younger than 55 yr (Log-rank: p=0.007). The average weight of the renal graft was not different between the long and shorter graft survival groups. The average warm ischemic time and total ischemic time were 9.7 and 539.7 min, respectively. The duration of post-transplant acute tubular necrosis averaged 9.2 days. These parameters tended to be shorter than those in recipients with graft survival >10 yr, but with no statistical significance. The mean numbers of acute rejection (AR) episode within 3 months after transplantation were 0.25 +/- 0.66 and 0.92 +/- 0.90 (p=0.020) in long survival and shorter survival groups, respectively. Long survivors had a significantly lower incidence of AR. Two of 20 cases received conventional immunosuppression with prednisolone, azathioprine and mizoribin, and 18 had prednisolone and calcineurin inhibitor (CNI). Kaplan-Meier analysis showed a significant contribution of CNI to graft survival (p=0.036). However, the graft survival reduction rate after 1 yr post-transplant did not differ between conventional and CNI immunosuppression. These data suggest that renal grafts retrieved with proper organ procurement procedures from NHBDs may survive long-term and help to overcome donor shortage.

Safety analysis following tacrolimus immunosuppression in renal transplant recipients in Japan: 3-year results in over 1000 patients

TTACROLIMUS is a potent immunosuppressant that is now well established for primary immunosuppression in kidney transplantation as well as in other solid organ transplantations, with long-term clinical experience accumulating. In Japan, tacrolimus was approved for the prevention of allograft rejection in patients receiving kidney transplants in April 1996. Since then, it has been used widely in various recipient and donor conditions. This paper summarizes the results of a 3-year experience with tacrolimus at 35 leading institutions for renal transplantation in Japan, focusing on safety data for tacrolimus with special attention to its effects on cardiovascular risk factors.

Lymphoproliferative disorders in renal transplant patients in Japan.

Post-transplantation lymphoproliferative disorders (PT-LPD) are characterized by a clinically and morphologically heterogeneous group of lymphoid proliferation occurring after organ or bone marrow transplantation. The immunodeficient state provides a basis for lymphomagenesis probably through activation of oncogenic viruses. Twenty-four patients in whom PT-LPD developed after renal transplantation in Japan were analyzed. They received hemodialysis for 4 to 226 (median 13) months before transplantation. In situ hybridization was performed to detect Epstein-Barr virus (EBV). Polymerase chain reaction and Southern hybridization with primers in the tax and pol regions of human T-cell leukemia virus type I (HTLV-1) were performed on DNA extracted from paraffin-embedded specimens. Immunohistochemical analysis revealed that 12 cases were B-cell type, 10 cases (42%) T-cell type and 2 NK-cell type. Five of the T-cell cases were classified as adult T-cell lymphoma with proven HTLV-1 genome in the tumor and seropositivity for the virus. These cases were classified as adult T-cell lymphoma (ALT). More than 80% of B-cell, 30% of T-cell and both NK/T-cell lymphomas were EBV-positive. Co-infection of EBV and HTLV-1 was found in 2 cases with ATL. These findings showed that ATL is common among Japanese renal transplant patients, which might be due to transmission of HTLV-1 via blood transfusion during hemodialysis.

Health-related quality of life among renal-transplant recipients in Japan.

This study had four goals: (1) to evaluate an index of health-related quality of life (HQOL) among renal-transplant recipients in Japan, (2) to compare HQOL of renal-transplant recipients with that of the Japanese population as a whole, and (3,4) to study associations of HQOL with renal function and with the time since transplantation. Questionnaires were distributed to 570 subjects. All were outpatients, were 16 years old or older, and were studied at least 1 year after they had received their latest renal transplant. HQOL was assessed with the Short Form 36-item health survey. Subjects' physicians provided data on renal function. Associations of HQOL with serum creatinine concentration and with the time since transplantation were evaluated by logistic regression. The response rate was 83%. Data from patients with diabetes and from those who had had at least two renal transplants were excluded; data from 395 recipients were analyzed. On the physical functioning, general health perception, vitality, and social functioning scales, the patients' scores were significantly lower than the Japanese national-norm scores. General health perception was particularly low. Serum creatinine concentrations were associated with general health perception, vitality, and social functioning. Longer times since transplantation were associated with better social functioning. Although social and physical functioning may improve after transplant surgery, a low self-rating of general health seemed to remain. The rarity of renal transplantation in Japan and other psychosocial factors may explain the low self-rating of general health in Japanese renal-transplant recipients.

The beneficial effects of FK 506 on living-related renal transplantation in presensitized recipients

IT HAS been recognized that recipient lymphocytotoxic antibodies directed to organ donor lymphocytes are frequently associated with hyperacute rejection. Therefore, for many years it has been standard practice to perform a crossmatch test against donor lymphocytes before transplantation. We previously reported that double-filtration plasmapheresis (DFPP) was effective in removing preformed antibodies and led to encouraging results in presensitized patients. However, with cyclosporine A (CyA), the graft survival rate was lower in presensitized patients than in sero-negative patients. From May 1996, FK 506 (tacrolimus, Prograf) has been commercially available for renal transplantation in Japan. In this study, we analyzed the effects of FK 506 on the clinical course of transplantation in presensitized recipients.

Cancer risk after renal transplantation in Japan.

Excess of cancer in patients receiving renal transplantation is well-known in Western countries, but information in Japan remains limited. Our study examined whether excess risk is found in patients receiving renal transplantation in Japan. Between 1970 and 1995, 1155 males and 589 females underwent renal transplantation in 6 hospitals, and a total of 12,982 person-years of observation was accumulated. Malignancies developed in 2.6% of patients; O/E ratio was 2.78. Median interval from renal transplantation to tumor development was 58 months. The interval in the patients receiving medication with cyclosporine-A (CyA) (median, 42.5 months) was significantly shorter than that with non-CyA (median, 95.5 months). Median age at the diagnosis of malignancy was 40 years, which is much younger than that in the general population. Relative risk was highest in renal cancer, followed by thyroid cancer, malignant lymphoma and uterine cancer. A distribution of malignancies was different from that reported from Western countries. These findings showed the excess risk of malignancies in Japan with renal transplants, especially in male patients, similar to that observed in Western countries, though the types of malignancy were different.

Renal transplantation in Japan

Renal transplantation in Japan

Cadaveric Renal Transplantation in Japan

Cadaveric Renal Transplantation in Japan