研究者詳細 - 芳川　豊史

論文 - 芳川　豊史

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ABO blood type incompatible lung transplantation 査読有り国際誌

Chen-Yoshikawa T.F.

Journal of Thoracic Disease 15 巻 ( 6 ) 頁： 3437 - 3442 2023年6月

担当区分：筆頭著者,　最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Thoracic Disease

ABO-incompatible transplantation has been successfully performed in the kidney and liver. However, lungs are subject to strong rejection and are vulnerable to infection because they are directly exposed to air. Therefore, lung transplantation from organs with incompatible blood types has been considered a significant challenge. Due to the severe shortage of donors, ABO-incompatible lung transplantation might be a viable method to save critically ill patients with end-stage respiratory diseases. Herein, we review the worldwide published reports about both minor and major ABO-incompatible lung transplantations. In North America, major ABO-incompatible lung transplants have been performed in cases with clerical errors in blood typing. But they were successful with additional treatments following the protocol for ABO-incompatible transplants in other organs (multiple plasma exchanges and additional immunosuppressive therapy such as anti-thymocyte globulin administration). In Japan, major ABO-incompatible living-donor lobar lung transplantations have also been performed successfully when the recipient does not have an ABO antibody against the donor. This unique situation sometimes occurs when the recipient undergoes hematopoietic stem cell transplantation before lung transplantation, in which the recipient’s blood type changes after hematopoietic stem cell transplantation. One infant and one adult had successful intentional major ABO-incompatible lung transplantation with both induction therapy and aggressive maintenance antibody-depletion therapy. Furthermore, an experimental antibody-depletion study has also been conducted to overcome ABO incompatibility. Even though intentional major ABO-incompatible lung transplantation has rarely been performed, several significant pieces of evidence have been accumulated to prepare for ABO-incompatible lung transplantation in selected cases. In the future, this challenge can potentially expand the donor organ pool and lead to improvements in the fairness of organ allocation.

DOI： 10.21037/jtd-23-48

Scopus

PubMed

Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1. 査読有り国際誌

Yuko Ohara, Yuka Kadomatsu, Toyone Kikumori, Toyofumi F Chen-Yoshikawa

Surgical case reports 9 巻 ( 1 ) 頁： 114 - 114 2023年6月

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Hyperparathyroidism in patients with multiple endocrine neoplasia 1 is attributed to the excessive secretion of parathyroid hormone (PTH) from multiple parathyroid glands. This can be successfully treated through complete resection of the parathyroid glands; however, subsequent surgery is often required because of the presence of supernumerary or ectopic parathyroid glands. Therefore, identifying the locations of all functional glands is crucial for precise resection. Here, we report a case of ectopic mediastinal parathyroid adenoma that was successfully resected using robot-assisted thoracoscopic surgery. CASE PRESENTATION: A 53-year-old woman underwent a total parathyroidectomy with autotransplantation for multiple endocrine neoplasia 1-associated primary hyperparathyroidism. The patient previously underwent laparoscopic distal pancreatectomy for a pancreatic neuroendocrine tumor. She also presented with a mediastinal tumor and nonfunctional pituitary adenoma that could be followed up. Blood tests before total parathyroidectomy showed high levels of intact PTH (183 pg/mL) and calcium (Ca; 10.3 mg/dL); however, postoperative blood tests still revealed high levels of intact PTH (103 pg/mL) and Ca (11.4 mg/dL). Computed tomography and magnetic resonance imaging revealed a 45-mm-sized mass in the right upper mediastinum as a well-defined solid and cystic lesion, whereas 99mTc-methoxyisobutylisonitrile scintigraphy indicated a strong accumulation of tracers, suggesting an ectopic lesion in the mediastinum. Persistent hyperparathyroidism after total parathyroidectomy via neck incision was attributed to an ectopic parathyroid tumor in the mediastinum. Thus, we decided to resect the tumor using robot-assisted thoracoscopic surgery to perform the procedure gently and carefully. During surgery, a mediastinal tumor was identified as it was detected radiographically. Because it did not invade the surrounding tissues, it could be completely resected without injuring the capsule. The patient was discharged without complications. Postoperatively, Ca and intact PTH levels decreased back to normal. The final pathological diagnosis confirmed that the mass was an ectopic mediastinal parathyroid adenoma. CONCLUSIONS: Minimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery.

DOI： 10.1186/s40792-023-01694-9

PubMed

シスプラチン投与困難な病理病期II-III期非小細胞肺癌症例の術後成績

則竹統, 中村彰太, 大原佑子, 岡戸翔嗣, 渡邉裕樹, 仲西慶太, 門松由佳, 上野陽史, 加藤毅人, 福本紘一, 芳川豊史

日本呼吸器外科学会雑誌 37 巻 ( 3 ) 頁： P4 - 6 2023年6月

遷延する左気胸で発覚した悪性胸膜中皮腫の一例

岡戸翔嗣, 芳川豊史, 福本紘一, 中村彰太, 加藤毅人, 上野陽史, 門松由佳, 仲西慶太, 則竹統, 渡邉裕樹, 大原佑子

日本呼吸器外科学会雑誌 37 巻 ( 3 ) 頁： P78 - 6 2023年6月

Development of panorama vision ring for thoracoscopy 査読有り国際誌

Kitasaka T., Nakamura S., Hayashi Y., Nakai T., Nakai Y., Mori K., Chen-Yoshikawa T.F.

International Journal of Computer Assisted Radiology and Surgery 18 巻 ( 5 ) 頁： 945 - 952 2023年5月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Computer Assisted Radiology and Surgery

Purpose: Minimally invasive surgery (MIS) using a thoraco- or laparoscope is becoming a more common surgical technique. In MIS, a magnified view from a thoracoscope helps surgeons conduct precise operations. However, there is a risk of the visible area becoming narrow. To confirm that the operation field is safe, the surgeon will draw the thoracoscope back to check the marginal area of the target and insert it again many times during MIS. To reduce the surgeon’s load, we aim to visualize the entire thoracic cavity using a newly developed device called “panorama vision ring” (PVR). Method: The PVR is used instead of a wound retractor or a trocar. It is a ring-type socket with one big hole for the thoracoscope and four small holes for tiny cameras placed around the big hole. The views from the tiny cameras are fused into one wider view that visualizes the entire thoracic cavity. A surgeon can proceed with an operation by checking what exists outside of the thoracoscopic view. Also, she/he can check whether or not bleeding has occurred from the image of the entire cavity. Results: We evaluated the view-expansion ability of the PVR by using a three-dimensional full-scale thoracic model. The experimental results showed that the entire thoracic cavity could be visible in a panoramic view generated by the PVR. We also demonstrated pulmonary lobectomy in virtual MIS using the PVR. Surgeons could perform a pulmonary lobectomy while checking the entire cavity. Conclusion: We developed the PVR, which uses tiny auxiliary cameras to create a panoramic view of the entire thoracic cavity during MIS. We aim to make MIS safer for patients and more comfortable for surgeons through the development of the PVR.

DOI： 10.1007/s11548-023-02859-5

Scopus

PubMed

Clinical application of resection process map as a novel surgical guide in thoracic surgery. 査読有り国際誌

Yuka Kadomatsu, Megumi Nakao, Harushi Ueno, Shota Nakamura, Koichi Fukumoto, Toyofumi Fengshi Chen-Yoshikawa

Interdisciplinary cardiovascular and thoracic surgery 36 巻 ( 4 ) 2023年4月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Resection Process Map (RPM) is a surgical simulation system that uses preoperative three-dimensional computed tomography. Unlike the usual static simulation, this system provides surgeons an individualized dynamic deformation of the lung parenchyma and vessels. RPM was first introduced in 2020. Although the intraoperative usefulness of this system has been evaluated experimentally, there have been no reports on its clinical use. Herein, we presented in detail the first experience on RPM during robot-assisted anatomical lung resection in the real clinical setting.

DOI： 10.1093/icvts/ivad059

PubMed

連載未来の専門医を育てる! 名古屋大学の呼吸器外科教育-理想と現実のはざまで考えること

芳川豊史

胸部外科 76 巻 ( 4 ) 頁： 313 - 315 2023年4月

Video-assisted thoracoscopic surgery for pleuroperitoneal communication 査読有り

Tsubouchi H., Nakamura S., Fukui T., Kadomatsu Y., Ueno H., Ozeki N., Fukumoto K., Mizuno M., Chen-Yoshikawa T.F.

Asian Journal of Endoscopic Surgery 16 巻 ( 2 ) 頁： 262 - 265 2023年4月

担当区分：最終著者,　責任著者記述言語：英語出版者・発行元：Asian Journal of Endoscopic Surgery

Here we report the cases of five patients on continuous ambulatory peritoneal dialysis (CAPD) who developed hydrothorax because of pleuroperitoneal communication. Preoperative computed tomography (CT) peritoneography revealed penetrated sites on the diaphragm in all patients. All patients underwent video-assisted thoracoscopic surgery (VATS), and a dialysate containing indigo carmine was injected intraperitoneally through a CAPD catheter to confirm the fistula. In all patients, a thinned bleb was found at the center of the diaphragmatic tendon consistent with that noted on preoperative CT peritoneography. The bleb was resected using a surgical stapler in four patients, and the pleuroperitoneal communication did not recur. However, in one patient, the bleb was only covered with reinforcement agents and the hydrothorax recurred after CAPD. This study demonstrates that VATS treatment for pleuroperitoneal communication is safe and effective but that lesion resection would be more useful for preventing hydrothorax recurrence in patients undergoing CAPD.

DOI： 10.1111/ases.13127

Scopus

PubMed

術前に加えて周術期における脊柱起立筋CT値の低下も予後不良因子である

大島洋平, 佐藤晋, 芳川豊史, 中島大輔, 栢分秀直, 田中里奈, 山田義人, 豊洋次郎, 濱路政嗣, 大角明宏, 伊達洋至, 松田秀一

移植 57 巻 ( 4 ) 頁： 335 - 335 2023年4月

生体肺移植後の健康関連QoLの実態調査脳死肺移植との比較

大島洋平, 佐藤晋, 芳川豊史, 中島大輔, 吉岡佑二, 濱田涼太, 梶本泰志, 太田垣あゆみ, 田中里奈, 山田義人, 豊洋次郎, 大角明宏, 濱路政嗣, 伊達洋至, 松田秀一

移植 57 巻 ( 4 ) 頁： 425 - 425 2023年4月

Enteral liquid ventilation oxygenates a hypoxic pig model 査読有り

Fujii T., Yoneyama Y., Kinebuchi A., Ozeki N., Maeda S., Saiki N., Chen-Yoshikawa T.F., Date H., Nishiwaki K., Takebe T.

iScience 26 巻 ( 3 ) 2023年3月

記述言語：英語出版者・発行元：iScience

The potential of extrapulmonary ventilation pathways remains largely unexplored. Here, we assessed the enteral ventilation approach in hypoxic porcine models under controlled mechanical ventilation. 20 mL/kg of oxygenated perfluorodecalin (O2-PFD) was intra-anally delivered by a rectal tube. We simultaneously monitored arterial and pulmonary arterial blood gases every 2 min up to 30 min to determine the gut-mediated systemic and venous oxygenation kinetics. Intrarectal O2-PFD administration significantly increased the partial pressure of oxygen in arterial blood from 54.5 ± 6.4 to 61.1 ± 6.2 mmHg (mean ± SD) and reduced the partial pressure of carbon dioxide from 38.0 ± 5.6 to 34.4 ± 5.9 mmHg. Early oxygen transfer dynamics inversely correlate with baseline oxygenation status. SvO2 dynamic monitoring data indicated that oxygenation likely originated from the venous outflow of the broad segment of large intestine including the inferior mesenteric vein route. Enteral ventilation pathway offers an effective means for systemic oxygenation, thus warranting further clinical development.

DOI： 10.1016/j.isci.2023.106142

Scopus

ASO Visual Abstract: Impact of Pleural Thickness on the Occurrence of Postoperative Complications in Patients with Malignant Pleural Mesothelioma

Ito T., Nakamura S., Kadomatsu Y., Ueno H., Kato T., Ozeki N., Fukumoto K., Chen-Yoshikawa T.F.

Annals of surgical oncology 30 巻 ( 3 ) 2023年3月

Impact of Pleural Thickness on Occurrence of Postoperative Complications in Patients with Malignant Pleural Mesothelioma 査読有り

Ito T., Nakamura S., Kadomatsu Y., Ueno H., Kato T., Ozeki N., Fukumoto K., Chen-Yoshikawa T.F.

Annals of Surgical Oncology 30 巻 ( 3 ) 頁： 1574 - 1583 2023年3月

担当区分：最終著者記述言語：英語出版者・発行元：Annals of Surgical Oncology

Objectives: The rates of postoperative mortality and morbidity are high in patients with malignant pleural mesothelioma (MPM). Therefore, it is important to identify variables that increase the risk of postoperative complications. Pleural thickness has recently been identified as a prognostic indicator in patients with MPM. The aim of this study was to investigate clinical variables, including pleural thickness, that contribute to postoperative complications in patients with MPM. Patients and Methods: A total of 47 patients who underwent surgical excision of MPM between 2005 and 2021 were enrolled in this study. Correlations between postoperative complications within 90 days of surgery and preoperative clinical factors were investigated. Results: A total of 27 patients underwent extrapleural pneumonectomy (EPP), and the remaining 20 underwent pleurectomy/decortication (P/D). Macroscopic complete resections were obtained in all but three patients. Of the 47 patients, 23 (49%) experienced postoperative complications of grade 3 or worse. The major complication in patients with EPP was respiratory failure (n = 6), whereas the major complication in patients with P/D was prolonged air leakage (n = 7). Univariate logistic regression analysis found a correlation between postoperative complications and age, surgical side, and pleural thickness, while multivariate logistic regression analysis found surgical side (p = 0.04, 95% Cl 1.10–21.71, OR 4.90) and pleural thickness (p = 0.03, 95% Cl 1.21–23.00, OR 5.26) to significantly influence the occurrence of postoperative complications. Conclusions: Pleural thickness has a significant effect on the occurrence of postoperative complications. Patients with thick pleura on the right side are at greater risk of postoperative complications.

DOI： 10.1245/s10434-022-12790-9

Scopus

ASO Author Reflections: Pleural Thickness in Patients with Malignant Pleural Mesothelioma

Nakamura S., Ito T., Chen-Yoshikawa T.F.

Annals of Surgical Oncology 30 巻 ( 3 ) 頁： 1584 - 1585 2023年3月

Real-world evidence of safety and influence for lung cancer surgery under COVID-19 pandemic in Japan 査読有り国際誌

Kato T., Katsuya R., Okado S., Sato K., Noritake O., Nakanishi K., Noguchi M., Kadomatsu Y., Ueno H., Ozeki N., Nakamura S., Fukumoto K., Chen-Yoshikawa T.F.

Journal of Thoracic Disease 15 巻 ( 2 ) 頁： 542 - 551 2023年2月

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Thoracic Disease

Background: The COVID-19 pandemic has affected the clinical practice of lung cancer surgery in Japan, but few studies have revealed the real situation of surgical practice for lung cancer in this country. This latest information will help us to decide the future direction of lung cancer surgery under pandemic circumstances. Methods: We collected data from patients with primary lung cancer who underwent thoracic surgery between 2018 and 2021. To investigate the impact of the COVID-19 pandemic on lung cancer surgery, we compared between 2018–2019 (prepandemic group) and 2020–2021 (pandemic group) in the respect of patient characteristics, pathological findings, and short-term outcome after lung cancer resection by Mann-Whitney and Fisher’s exact tests. Moreover, the monthly number of surgeries for lung cancer in our institution during 2020–2021 was compared with the number of newly diagnosed COVID-19 patients in Japan by Spearman correlation analysis. Results: From 2018 through 2021, 936 patients with primary lung cancer underwent surgical intervention in our institute and were included in this study. The number of surgeries did not decrease in the pandemic group (n=443) compared with that in the prepandemic group (n=493). Tumor and invasive size in stage I which was measured by pathologist were significantly larger in the pandemic group than in the prepandemic group (tumor size: P=0.031, invasive size: P<0.001). In terms of postoperative short-term outcome, the median hospital stay was 6 days, 30-day mortality was 2, and morbidity was around 20% in both groups. Only one patient suffered from COVID-19 infection 5 months after right upper lobectomy. An increased ratio of newly diagnosed COVID-19 cases in Japan was negatively correlated with the number of surgeries for lung cancer in our institution in the next month (r=−0.393, P=0.007), although there was no correlation in the present or the month after next. Conclusions: Even during the COVID-19 pandemic period, lung cancer surgery could be performed safely and in a sustainable manner. However, pathological findings of lung cancer tended to be progressive in early-stage lung cancer.

DOI： 10.21037/jtd-22-1289

Scopus

PubMed

肺癌治療における蛍光イメージングの応用と将来展望

芳川豊史

日本レーザー医学会誌 43 巻 ( 4 ) 頁： 302 - 307 2023年1月

記述言語：日本語出版者・発行元：特定非営利活動法人日本レーザー医学会

放射線画像の進歩とともに微小な肺結節がますます検出されるようになり，手術の低侵襲化とともに，胸腔鏡下手術の時代となった．さらに，微小結節の同定や区域切除にインドシアニングリーン（indocyanine green: ICG）などの蛍光色素が用いられている．そこで，今回，呼吸器外科手術の中心となる肺がん治療における蛍光イメージングについて，近年臨床応用が広まっているICGの利用を中心に概説する．

DOI： 10.2530/jslsm.jslsm-43_0012

CiNii Research

Dual inhibition of the MEK/ERK and PI3K/AKT pathways prevents pulmonary GVHD suppressing perivenulitis and bronchiolitis. 査読有り国際誌

Hiroyuki Muranushi, Takero Shindo, Toyofumi F Chen-Yoshikawa, Akihiko Yoshizawa, Huong Thi Ngo, Fumiaki Gochi, Hiroshi Date, Akifumi Takaori-Kondo

Blood advances 7 巻 ( 1 ) 頁： 106 - 121 2023年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Patients with pulmonary graft-versus-host disease (pGVHD) have a poor prognosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Furthermore, pGVHD pathogenesis is not fully elucidated in humans, and currently available immunosuppressants are inadequately effective. We performed pathologic evaluation of lung specimens from 45 allo-HSCT recipients with pGVHD who underwent lung transplantation. Patient pathology was characterized by bronchiolitis and subpleural perivascular inflammation, with B-cell, monocyte, and T-cell accumulation around bronchioles. Bronchiolitis, perivascular inflammation, and peribronchial macrophage aggregation were also identified in a murine pGVHD model after transplant of bone marrow cells and splenocytes from C57BL/6 to B10.BR mice. Among mitogen-activated protein kinase kinase (MEK) inhibitors, cobimetinib, but not trametinib, improved survival rates. Cobimetinib attenuated bronchiolitis, improved airway resistance and lung compliance in the mice, and suppressed activation of B cells and tumor necrosis factor α production by monocytes in vitro; these features were not suppressed by trametinib or tacrolimus. Furthermore, cobimetinib suppressed activation of phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling, resulting in B-cell and monocyte suppression. Dual inhibition of the MEK/extracellular signal-regulated kinase (ERK) and PI3K/AKT pathways using a combination of trametinib and the PI3K inhibitor taselisib strongly suppressed B-cell activation in vitro and improved mouse survival rates compared with vehicle or monotherapy with trametinib or taselisib. Imaging mass cytometry of human pGVHD revealed that T cells around bronchioles were positive for phosphorylated ERK, whereas B cells were positive for phosphorylated AKT. Thus, perivascular inflammation and bronchiolitis mediated by activation of the MEK/ERK and PI3K/AKT pathways are essential for pGVHD and represent a potential novel therapeutic target in humans.

DOI： 10.1182/bloodadvances.2021006678

PubMed

Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database 査読有り

Okumura M., Yoshino I., Funaki S., Okuda K., Watanabe S.i., Tsuboi M., Shimizu K., Date H., Chen-Yoshikawa T.F., Nakajima J., Toyooka S., Asamura H.

Surgery Today 2023年

記述言語：英語出版者・発行元：Surgery Today

Purpose: Patients with a thymic epithelial tumor (TET), comprising thymoma, thymic carcinoma (TC), and thymic neuroendocrine neoplasm (TNEN), are rarely encountered. The present study was conducted to determine the recent outcomes of surgical treatment for TET in Japan and clarify the significance of prognostic factors by analyzing a nationwide database created by the Japanese Association for Research on the Thymus (JART). Methods: The JART database includes records of 2471 thymoma, 285 TC, and 56 TNEN cases surgically treated between 1991 and 2010. At the time of the final follow-up examination, 439 patients had died, with tumor the cause of death in 188. The disease-specific survival was examined using the Kaplan–Meier method, with Cox’s proportional hazards model utilized to determine independent prognostic factors. Results: The 10-year survival rate according to TNM-based Stage I, II, IIIA, IIIB, IVA, and IVB classification was 98.7%, 76.8%, 85.0%, 68.9%, 66.2%, and 59.8%, respectively. The T factor, M factor, and tumor size were independent prognostic factors in both thymoma and thymic carcinoma cases, while the N factor had tendency to be a prognostic factor in thymoma but not in thymic carcinoma cases. The WHO histological type was an independent factor in thymoma cases. Conclusion: The significance of pathology and TNM classification as prognostic factors was confirmed.

DOI： 10.1007/s00595-023-02705-w

Scopus

Impact of perioperative airway pathogens on living-donor lobar lung transplantation outcomes 査読有り

Oda H., Tanaka S., Chen-Yoshikawa T.F., Morimura Y., Yamada Y., Yutaka Y., Nakajima D., Hamaji M., Ohsumi A., Menju T., Nagao M., Date H.

Surgery Today 2023年

記述言語：英語出版者・発行元：Surgery Today

Purpose: To elucidate the clinical impact of pathogenic organism (PO) positivity early after transplantation, we evaluated the impact of perioperative airway POs on outcomes after living-donor lobar lung transplantation (LDLLT), where the graft airway is supposed to be sterile from a healthy donor. Method: A retrospective review of 67 adult LDLLT procedures involving 132 living donors was performed. Presence of POs in the recipients’ airways was evaluated preoperatively and postoperatively in intensive-care units. Results: POs were detected preoperatively in 13 (19.4%) recipients. No POs were isolated from the donor airways at transplantation. POs were detected in 39 (58.2%) recipients postoperatively; most were different from the POs isolated preoperatively. Postoperative PO isolation was not associated with short-term outcomes other than prolonged postoperative ventilation. The 5-year overall survival was significantly better in the PO-negative group than in the PO-positive group (89.1% vs. 63.7%, P = 0.014). In the multivariate analysis, advanced age (hazard ratio [HR]: 1.041 per 1-year increase, P = 0.033) and posttransplant PO positivity in the airway (HR: 3.684, P = 0.019) significantly affected the survival. Conclusions: The airways of the living-donor grafts were microbiologically sterile. PO positivity in the airway early after transplantation negatively impacted long-term outcomes.

DOI： 10.1007/s00595-023-02730-9

Scopus

Effectiveness and safety of rituximab in desensitization and for treatment of antibody-mediated rejection in a multicenter prospective study assessing liver, pancreas, lung, and heart transplantation

EGAWA Hiroto, ITO Taihei, ONO Minoru, CHEN-YOSHIKAWA Toyofumi, HASEGAWA Kiyoshi, NUNODA Shinichi, DATE Hiroshi, FUKUSHIMA Norihide, EGUCHI Susumu, HIBI Taizo, OGURA Yasuhiro, MIYAGI Shigehito, AKAMATSU Nobuhisa, ICHIDA Akihiko, HAGA Hironori, TERAMUKAI Satoshi

Japanese Journal of Transplantation 58 巻 ( 1 ) 頁： 43 - 57 2023年

記述言語：英語出版者・発行元：The Japan Society for Transplantation

【Background】 Few studies have assessed donor-specific antibodies (DSA) and anti-human leucocyte antigen (HLA) antibodies associated with the transplantation (Tx) of organs other than kidney.【Methods】 A total of 31 institutions participated in the current study. Patients who satisfied the study criteria were enrolled prospectively, and rituximab was used according to each institution’s clinical protocol for desensitization before Tx when patients had preexisting DSA or anti-HLA antibodies (desensitization cohort) or to treat post-Tx antibody-mediated rejection (ABMR) (ABMR treatment cohort). The desensitization cohort comprised four liver transplants, four kidney-pancreas transplants, and one heart transplant, and the ABMR treatment cohort contained two liver transplants, two heart transplants, and one lung transplant. In the desensitization cohort, organs ultimately were not allocated for the patient awaiting a heart transplant and one patient awaiting a kidney-pancreas transplant.【Results】 In the desensitization cohort, DSA or anti-HLA antibodies decreased in the four liver Tx patients and three of the kidney-pancreas Tx patients. Although T-cell mediated rejection occurred in two patients, they did not develop ABMR. One pancreatic graft was lost due to post-transplantation thrombosis; all other grafts and all patients survived. In the ABMR treatment cohort, DSA decreased after ABMR treatment in one heart Tx patient and two liver Tx patients. Acute ABMR was eliminated completely only in the patient who developed the complication early after liver Tx.【Conclusion】 Rituximab was well-tolerated, both during desensitization and as part of ABMR treatment for Tx of organs other than kidney.

DOI： 10.11386/jst.58.1_43

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