A Clinical Trial With Adoptive Transfer of Ex Vivo-induced, Donor-specific Immune-regulatory Cells in Kidney Transplantation-A Second Report.

Background: Although the outcome of kidney transplantation (KTx) has improved, various adverse effects of immunosuppressants and chronic rejection aggravate the long-term prognosis of patients. Therefore, the induction of immune tolerance may be an effective therapeutic strategy.

Methods: A clinical trial aiming at immune tolerance induction was conducted in kidney transplant recipients from HLA mismatched living donors by infusing autologous donor-specific regulatory T cells (Treg).

Low-dose In Situ Perfusion With Euro-Collins Solution Is Effective for the Procurement of Marginal Kidney Grafts From Donation After Circulatory Death Donors.

Unlabelled: We have adopted a modified method to resuscitate kidneys from donation after circulatory death (DCD) donors with the use of Euro-Collins (EC) solution instead of University of Wisconsin solution. This study aimed to evaluate kidney transplantation (KTx) outcomes of DCD procured with low-dose in situ perfusion using EC solution.

Patients And Methods: KTx was performed in 8 adults.

A case of cryopyrin-associated periodic syndrome with kidney transplant failure.

The cryopyrin-associated periodic syndrome (CAPS) is an autosomal dominant autoinflammatory disease characterized by fever, skin rash, and joint involvement with acute inflammatory response. The genetic defect involves the NLRP3 gene that encodes cryopyrin and leads to an abnormal production of interleukin-1 (IL-1). Therefore, anti-IL-1 treatment represents an effective therapy.

Efficacy and safety of concentration-controlled everolimus with reduced-dose cyclosporine in Japanese de novo renal transplant patients: 12-month results.

Background: No study to date has evaluated the efficacy and safety of everolimus with reduced-exposure cyclosporine in Japanese de-novo renal transplant (RTx) patients.

Methods: This 12-month, multicenter, open-label study randomized (1:1) 122 Japanese de-novo RTx patients to either an everolimus regimen (1.5 mg/day starting dose (target trough: 3 to 8 ng/ml) + reduced-dose cyclosporine) or a mycophenolate mofetil (MMF) regimen (2 g/day + standard dose cyclosporine).

Early histologic lesions and risk factors for recurrence of diabetic kidney disease after kidney transplantation.

Background: Recurrence of diabetic kidney disease (DKD) after diabetic kidney transplantation has been reported. The aim of this study was to determine the early histologic lesions, focusing especially on abnormal glomerular angiogenesis, and clinical risk factors of recurrent DKD after kidney transplantation.

Methods: The authors studied 34 renal transplant recipients with diabetes and 30 without diabetes.

Kidney transplantation restored uncoupled bone turnover in end-stage renal disease.

Background: While kidney transplantation (KTx) reverses many disorders associated with end-stage renal disease (ESRD), patients who have received KTx often have chronic kidney disease and bone and mineral disorder (CKD-MBD). However, it is unknown how bone metabolism changes by KTx.

Patients And Methods: Living donor-KTx recipients (n = 34) at Tokyo Women's Medical University were prospectively recruited and the levels of bone-specific alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of Type 1 collagen (NTX) were measured before, 6 and 12 months after transplantation.

Steroid-free living donor liver transplantation for HCV--a multicenter prospective cohort study in Japan.

This prospective, non-randomized, multicenter cohort study analyzed the safety and efficacy of a steroid-free immunosuppressive (IS) protocol for hepatitis C virus (HCV)-positive living donor liver transplant (LDLT) recipients in Japan. Of 68 patients enrolled from 13 transplant centers, 56 fulfilled the inclusion/exclusion criteria; 27 were assigned the steroid-free IS protocol (Fr group) and 29 the traditional steroid-containing IS protocol (St group). Serum HCV RNA levels increased over time and were higher in the St group until postoperative day 90 (POD 14, p=0.

Nine-yr experience of 700 hand-assisted laparoscopic donor nephrectomies in Japan.

Objective: We reviewed the introduction of a new, minimally invasive, live kidney donation program in our department.

Methods: The operating times of 700 consecutive hand-assisted laparoscopic donor nephrectomies (HALDN) conducted from February 2001 to April 2010 were examined. The risk factors for prolonging operating times were analyzed and major surgical barriers in HALDN investigated.

Acute kidney injury as defined by the RIFLE criteria is a risk factor for kidney transplant graft failure.

Acute kidney injury (AKI) is not recognized as a major complication at the maintenance phase after kidney transplantation (KTx). Moreover, it is not clear whether the onset of AKI leads to graft failure. We examined the incidence of AKI that developed three months or later after KTx at our institute.

Natural history of mineral and bone disorders after living-donor kidney transplantation: a one-year prospective observational study.

Mineral and bone disorders (MBD), including hypercalcemia and hypophosphatemia, are common complications after renal transplantation; however, the natural course of these disorders has not been well documented, and the pathogenesis of persistent post-transplant MBD still remains elusive. This study was carried out to show the natural history of mineral metabolism in recipients after living-donor kidney transplantation and also to clarify post-transplant risk factors of persistent hypercalcemia and/or hypophosphatemia at 12months after transplantation. Living-donor kidney transplant recipients (N=34) at Tokyo Women's Medical University were prospectively and consecutively recruited.

The relative role of fibroblast growth factor 23 and parathyroid hormone in predicting future hypophosphatemia and hypercalcemia after living donor kidney transplantation: a 1-year prospective observational study.

Background: Kidney transplantation (KTx) restores many of the disorders accompanying end-stage renal failure. However, hypercalcemia and hypophosphatemia are both common complications after renal transplantation. Prospective observation of these complications has not been well described and pre-transplant predictors also remain unknown.

The 5-year outcome of ABO-incompatible kidney transplantation with rituximab induction.

Background: In 2002, we introduced the anti-CD20 chimeric antibody, rituximab, for ABO-incompatible kidney transplantation (ABO-IKT). Here, we report the 5-year outcome obtained using rituximab as part of the preoperative regimen for ABO-IKT.

Methods: Between January 2002 and December 2008, 408 patients underwent living-related kidney transplantation at our department.

[Current status and issues of organ transplantation in Japan].

Since Organ Transplant Act was legislated and enforced in 1997, there reported to be 86 cases of organ donation from brain-dead donors, and 70 cases for heart transplantation, 67 for lung transplantation, 67 for liver transplantation, 64 for pancreas transplantation and 103 for kidney transplantation as of the end of May, 2010. The organ donation from brain-dead persons in Japan required the documented will of the deceased to accept brain death and to remove his/her organs for the purpose of transplantation, and the written consent of his/her family member to brain death diagnosis and organ donation. Furthermore enforcement regulations and related guideline too much restricted and limited the necessary conditions for the organ donation from brain-dead donors.

Medullary ray injury in renal allografts.

Non-immune injury leading to interstitial fibrosis and tubular atrophy (IF/TA) in renal allografts has various etiologies, but pathological means of verification have yet to be developed. Medullary ray injury (MRI) is a pathological feature of many non-immune injuries inducing IF/TA and pathological determination of calcineurin inhibitor (CNI) toxicity proceeding to striped fibrosis. We investigated the contribution of CNI toxicity to MRI and other non-immune etiologies related to IF/TA.

Renoprotective effect of erythropoietin against ischaemia-reperfusion injury in a non-human primate model.

Background: The renoprotective effect of erythropoietin (Epo) against ischaemia-reperfusion injury (IR/I) was evaluated in a non-human primate model.

Methods: Crab-eating macaques were divided into two groups: Control (n = 10), treated with saline, and EPO (n = 10), treated with Epo. Epo was injected intravenously at a dose of 12,000 units, 5 min before clamping the renal pedicle and 5 min before declamping.

Islet transplantation using donors after cardiac death: report of the Japan Islet Transplantation Registry.

Background: This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry.

Method: Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting.

Activation of the transcription factor c-Jun in acute cellular and antibody-mediated rejection after kidney transplantation.

c-Jun is a transcription factor that belongs to the activator protein-1 family of proteins. In human kidney disease, c-Jun is activated in glomerular and tubular cells and plays a major role in renal pathophysiology. However, the contribution of this pathway to renal allograft rejection has not been determined.

Very low but stable glomerular filtration rate after living kidney donation: is the concept of "chronic kidney disease" applicable to kidney donors?

Background: Renal prognosis and outcome of Japanese kidney donors, who have lower preoperative glomerular filtration rate (GFR) and are generally older than their counterparts abroad, have scarcely been investigated. Here, the longitudinal changes in renal function of Japanese kidney donors were studied to clarify the prevalence and consequences of low GFR.

Methods: We reviewed charts of the living kidney donors and followed renal function by estimated GFR (eGFR, ml/min/1.

De novo membranous nephropathy and antibody-mediated rejection in transplanted kidney.

Background: The etiology of de novo membranous nephropathy (MN) after kidney transplantation is still uncertain. Immunological response to various allograft antigens is speculated to be a candidate for the etiology.

Methods: Seventeen patients with post-transplant de novo MN were studied clinically and pathologically in comparison with control post-transplant patients without MN.

A long-term prevention of diabetic nephropathy in a patient with type 1 diabetes after simultaneous pancreas and kidney transplantation.

We report a case of type 1 diabetes mellitus who was successfully treated with simultaneous pancreas and kidney (SPK) transplantation and both grafts survived for 16 yr. A 30-yr-old woman underwent SPK transplantation from a non-heart-beating donor in January 1992. She was treated with combined immunosuppressive therapy consisting of cyclosporine, azathioprine, methylprednisolone, and anti-lymphocyte globulin.

Two cases of ANCA-associated vasculitis in post-transplant kidney: relapse and de novo.

Two cases of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (ANCA-V) occurred in the transplanted kidney were reported. Case 1 was a 57 yr-old female whose original disease was MPO-ANCA-V. A relapse of necrotizing crescentic glomerulonephritis occurred one year after transplantation with positive serum reaction for MPO-ANCA.

An experimental model of encapsulating peritoneal sclerosis.

In Japan, only about 3% of all patients with end-stage renal disease are maintained by continuous ambulatory peritoneal dialysis (CAPD). Although the reasons for the low proportion of patients receiving CAPD are multifactorial, encapsulating peritoneal sclerosis (EPS), a fatal complication of CAPD, is a major factor. In 1995 we developed a rat model of EPS, and in 2001 also developed an EPS model in mice.