移植
Online ISSN : 2188-0034
Print ISSN : 0578-7947
ISSN-L : 0578-7947
50 巻, 1 号
選択された号の論文の14件中1~14を表示しています
特集 移植医療の未来像―次の半世紀へ向けて―
  • 島津 元秀
    2015 年 50 巻 1 号 p. 001-005
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Even after the revision of the Organ Transplant Law, organ transplantation continues to be mired in a dire situation. The causes of this situation must be understood when taking steps to reverse it; in fact, these causes have been partially discussed in the past. Issues include both hard and soft aspects, such as institutional issues not solved by legal revision alone, prejudice, and misunderstandings of transplantation rooted in a cultural/historical background.
    Potential measures for improving the situation include: revision of the transplantation system (enhancement of in-hospital coordinators, simplification of transplantation suitability assessments, saving labor in organ donation verification) ; administrative reform (organ procurement organizations, brain death notification system, opting out) ; revision of the health insurance system (insurance coverage of brain death determination, various additional fees adjustment factor) ; and educational/public awareness activities (secondary education, media cooperation, participation by recipients and others).
    The time has come to investigate methods to increasing organ donations as a national project.
  • 光法 雄介, 落合 高徳, 伊藤 浩光, 松村 聡, 藍原 有弘, 伴 大輔, 工藤 篤, 田中 真二, 田邉 稔
    2015 年 50 巻 1 号 p. 006-010
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Organ shortage worldwide is a major limiting factor to transplantations. In Japan, most liver transplants have been performed using living donors because of the severe shortage of cadaveric organ donors. The shortage of donor organs has led to the consideration of organs from marginal donors. We describe innovative medical strategies to increase the donor pool in liver transplantation.
  • 清野 研一郎
    2015 年 50 巻 1 号 p. 011-015
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Transplantation has been developed based on the progress of immunosuppression. During the past half-century, various excellent immunosuppressants have been developed. Furthermore, the induction of immunological tolerance has been investigated to improve the outcome, and it has already been applied clinically. Turning our attention to the future, an age of cellular transplantation using pluripotent stem cells would be realistic. Even in this age, when other-derived pluripotent stem cells as the source of transplantation are used, the idea of immune regulation is important. The investigation of immune regulation using pluripotent stem cells has already been started.
  • 佐原 寿史, 関島 光裕, 山田 和彦
    2015 年 50 巻 1 号 p. 016-023
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Although improvements in operative techniques and immunosuppressions have paved the way for increases in the organ donor pool through living donor kidney donations, a vast disparity remains between the number of organs available for transplantation and the demand. Indeed, though progress has been made in the fields of regenerative medicine and stem cell technologies, neither de novo nor regenerated tissues are currently capable of sustaining life in animal models. Xenotransplantation would provide an inexhaustible supply of donor organs. Although there have been reports of severe immunologic response between swine and humans, much progress has been made in the past decade largely because of advances in our understanding of the xenoimmunobiology of pig-to-nonhuman primate transplantation as well as the availability of pigs that have undergone genetic modifications, including the alpha 1,3-galactosyltransferase gene knockout (GalT-KO) swine. The results of preclinical transplantation studies with pig organs or cells have been encouraging when co-stimulatory blockade or more-advanced tolerance-inducing treatment strategies were used. In these studies, the survival times for heterotopic heart grafts were more than a year, for life-supporting kidneys it was approximately three months, and for islets, six months. In this review, we summarize recent progress in the field and discuss strategies for successful clinical trials of xenotransplantation.
  • 谷口 英樹, 武部 貴則
    2015 年 50 巻 1 号 p. 024-030
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Organ transplantation is the only curative method for treating end-stage organ failure. Over the past decade, there has been increased demand for organ transplantations throughout the world because of the increased incidence of organ failure. A critical shortage of donor organs highlights the urgent need for generating organs from human pluripotent stem cells (iPSCs) for transplantation of organ buds created in vitro. Human vasculatures in iPSC-organ bud transplants became functional by connecting to the recipient's vessels. The formation of functional vasculatures stimulated the maturation of iPSC-organ bud into tissue resembling the adult organ. This method is the alternative way to the generation of functional human organs from pluripotent stem cells. Although efforts must ensue to translate these techniques to treatments for patients, this proof-of-concept demonstration of organ-bud transplantation provides a promising new approach to a critical shortage of donor organs for treating end-stage organ failures.
  • 塚田 敬義
    2015 年 50 巻 1 号 p. 031-036
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    There is a kidney that provides less current from cardiac arrest donors. One of the causes is considered to be in the excessively heavy burden of hospital staffs. In the future, it will become necessary to examine the policy to increase organ donations. Disability injuries to further joining by living donors will also be required.
特集 各臓器の悪性腫瘍の発生(調査)-Ⅱ
  • 宮崎 拓郎, 三好 新一郎, 奥村 明之進, 伊達 洋至, 白石 武史, 近藤 丘, 千田 雅之, 永安 武
    2015 年 50 巻 1 号 p. 037-044
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    The number of organ transplants in Japan is now increasing following revision of the brain death law in 2010. However, de novo malignancies after lung transplantations have become obstacles to long-term survival. The purpose of this study was to analyze the incidence of de novo malignancies after lung transplantations in Japan. A total of 179 cases were performed by seven institutions in Japan from 2001 to 2010, and de novo malignancies had occurred in 18 patients (10.1%). The most common tumors were lymphoproliferative malignancies (12 cases, including 1 double de novo cancer), following cervical cancer (4 cases), breast cancer (2 cases), and tongue cancer (1 case). The mean time of occurrence after transplantation was 37.8 months (range 4 to 148). Reduction and/or withdrawal of immunosuppressions were seen in 14 cases. The 5-year survival of lymphoproliferative malignancies was not significantly different from other malignancies (47.6% and 62.5%, respectively, p=0.33). Death resulting from cancer occurred in 6 cases. This is the first nationwide survey of the incidence of various malignancies after lung transplantation in Japan. Further detailed surveys, follow-up, and establishment of screening algorithms for malignancies after lung transplantation in Japan are required to improve the rate of survival.
  • 熱田 由子, 小寺 良尚
    2015 年 50 巻 1 号 p. 045-048
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Secondary malignancies are an important late complication after hematopoietic stem cell transplantation. Several studies have reported that survivors of HSCT have a 2―3-fold increased risk of developing new solid cancers compared with an age‐, sex‐, region‐, and calendar-year-adjusted population. We analyzed the incidence of, risk compared with that in the general population, and risk factors for secondary solid cancers among 17,545 adult recipients of a first allogeneic stem cell transplantation between 1990 and 2007 in Japan. A total of 269 secondary solid cancers were identified. The cumulative incidence was 0.7% at 5 years and 1.7% at 10 years after transplant. The risk was significantly higher than that in the general population (standard incidence ratio [SIR]=1). Risk was higher for oral cancer (SIR=15.7), esophageal cancer (SIR=8.5), colon cancer (SIR=1.9), skin cancer (SIR=7.2), and brain/nervous system cancer (SIR=4.1). The risk of developing oral, esophageal, or skin cancer was higher at all times after 1-year posttransplant. Extensive-type chronic graft-versus-host disease (GVHD) was a significant risk factor for the development of oral (RR=2.9, p<0.001) and esophageal (RR=5.3, p<0.001) cancers. Recipients of allogeneic HSCT had a significantly higher risk of developing secondary solid cancers than the general population. Lifelong screening for high-risk organ sites, especially oral and esophageal cancers, is important for recipients with active, or a history of, chronic GVHD.
原著
  • 古澤 美由紀, 石田 英樹, 清水 朋一, 尾本 和也, 奥見 雅由, 天野 裕之, 田邉 一成
    2015 年 50 巻 1 号 p. 049-054
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Tacrolimus, an immunosuppressive drug has been used for many indications, including posttransplant immunosuppression and autoimmune diseases. Because of the increasing number of patients in whom the blood tacrolimus level needs to be maintained at low concentrations, we changed the assay method to chemiluminescent immunoassay (CLIA). For evaluating this assay method, we examined the correlations among results obtained by three methods, enzyme multiplied immunoassay technique (EMIT), CLIA (two instruments), and electro-chemi luminescence immunoassay (ECLIA), and assessed the precision of each method. Satisfactory results in regard to the within-run reproducibility, between-run reproducibility, specimen stability, and dilution linearity were obtained for all three methods. In regard to correlations among the results, no clear correlations were obtained, presumably because of the differences in the measurable range among the methods. From the regression equation, a tendency toward providing higher values was observed for EMIT as compared to the other methods. Instruments can have various characteristics, such as a tendency toward providing higher values and a possibility of being affected by cross reactivity. We wish to contribute to improvement of the treatment results by improving the sensitivity, accuracy, and precision while taking these characteristics into consideration.
  • 三浦 昌朋, 増田 智先, 江川 裕人, 湯沢 賢治, 松原 和夫
    2015 年 50 巻 1 号 p. 055-061
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    Objective】Five current immunoassay methods (chemiluminescent enzyme immunoassay [CLIA], affinity column mediated immune assay [ACMIA], enzyme multiplied immunoassay technique [EMIT], electro-chemi luminescence immunoassay [ECLIA], and enzyme-linked immunosorbent assay [ELISA]) in Japan were used there to monitor tacrolimus concentrations in the whole blood. The aim of this study was to assess interhospital laboratory variability (coefficient of variation: CV) for each of the 5 methods, the comparability of control samples, and the results obtained by immunoassay measurements (accuracy).
    Design and Methods】A total of 100 laboratories routinely performing therapeutic drug monitoring (TDM) of tacrolimus participated. Reports of 67, 19, 8, 5, and 1 laboratories reported showed results using, respectively, CLIA, ACMIA, EMIT, ECLIA, and ELISA merhods for the tacrolimus assay. In iMPT2014, four spiked samples (0, mean 1.7, 4.8, and 14.4 ng/ml for LC-MS) were sent to each hospital.
    Results】CVs for CLIA, ACMIA, EMIT, and ECLIA assays at a concentration of 4.8 and 14.4 ng/ml were less than 18.3%. Especially, CV values at 1.7 ng/ml for ECLIA were 8.9%. Accuracies for the EMIT assay at a concentration range of 1.7―14.4 ng/ml were 24.8% to 31.2%, whereas those for CLIA, ACMIA, and ECLIA were within ±16.9% at the same concentration range.
    Conclusion】The interlaboratory mean CVs at a target concentration of 5 ng/ml ranging from 6.8% to 18.3%, according to the immunoassay method. Higher interlaboratory variability mainly depends on the difference between analytical methods. Clinicians need to understand the precision and accuracy of using a tacrolimus assay well and should carry out a TDM.
  • 江川 裕人, 尾形 哲, 山本 雅一, 高原 武志, 若林 剛, 藤山 泰二, 高田 泰次, 保田 裕子, 八木 孝仁, 岡島 英明, 海道 ...
    2015 年 50 巻 1 号 p. 062-077
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    【Objective】To estimate a standard dosage of rituximab prophylaxis for ABO incompatible living donor liver transplantation (ABO-I LDLT), we retrospectively investigated rituximab dosage, efficacy and safety in 37 patients including 4 children undergoing ABO-I LDLT with rituximab prophylaxis in 15 centers in 2013.
    【Methods】We analyzed the data collected by questionnaire that were sent to registered surgeons or hepatologists of the Japanese Liver Transplantation Society.
    【Results】Doses of rituximab in adult patients were 500 mg/body in 16 cases (48%), 375 mg/m2 in 12 cases (36%) and 300 mg/body or 100 mg/body in 5 cases. The number of administration was one in 29 cases (89%). The scheduled timing of initial administration was 2 weeks of operation or earlier in 14 centers (93%), and the median of actual timing was 14 days prior to transplantation. One-year patient survival rate was 82%, and the incidence of antibody-mediated rejection (AMR) was 9%. Patients with a standard regimen consisting of 500 mg/body or 375 mg /m2 rituximab 2 weeks before operation or earlier had significantly better one-year survival rate compared to a non-standard regimen consisting of 100mg/body or 300mg/body rituximab later than 2 weeks (100% vs. 70%, p = 0.009) and a lower incidence of AMR (0% vs. 15%, p=0.074). ABO-I LDLT with rituximab prophylaxis was well tolerated.
    【Conclusion】The recommended regimen for rituximab prophylaxis is a single dose of 375 mg/m2 body surface area 2 weeks before transplantation or earlier. The dose should be reduced carefully according to patient condition.
症例報告
  • 安井 稔博, 宇賀 菜緒子, 直江 篤樹, 渡邉 俊介, 原 普二夫, 鈴木 達也
    2015 年 50 巻 1 号 p. 078-084
    発行日: 2015/03/10
    公開日: 2015/03/31
    ジャーナル フリー
    A portosystemic shunt remaining after a living-donor liver transplantation sometimes causes a postoperative portal venous flow drop. It is diagnosed with Doppler ultrasound, angiography, contrast-enhanced computed tomography or magnetic resonance angiography. We report a case in which a contrast-enhanced ultrasound was useful to find out a portosystemic shunt. The patient is an 8-year-old girl who had undergone a portoenterostomy for biliary atresia and a living-donor liver transplantation for a hepatopulmonary syndrome at that age of 8 years. Because of an ABO incompatible transplant, a catheter was inserted into the portal vein for local infusion therapy. At first, a Doppler ultrasound showed a normal portal venous flow. On the next day of removal of the portal venous catheter, however, her portal venous flow was not able to be confirmed. We supposed a portal thrombosis, but we were unable to confirm it by the contrast-enhanced CT scan. After a contrast-enhanced ultrasound was performed, we could confirm the portal venous flow and the steal of the portal blood through the remaining portosystemic shunt. In conclusion, a contrast-enhanced ultrasound is useful for the blood flow evaluation after a living-donor liver transplantation.
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