著者

大城 吉則 安次嶺 聡 木村 隆 宮城 亮太 玉城 由光 仲西 昌太郎 松村 英理 大城 琢磨 宮里 実 呉屋 真人 斎藤 誠一

出版者

一般社団法人 日本移植学会

雑誌

移植 (ISSN:05787947)

巻号頁・発行日

vol.51, no.1, pp.40-47, 2016

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【Objective】Good long-term kidney graft function and graft survival depend on multiple factors. This study aimed to assess the impact of donor and recipient clinical factors on 20-year graft survival after kidney transplantation (KT).<br/>【Material and Methods】From 1987-1994, twenty-five KTs (14 living and 11 deceased donors) were performed at Ryukyu University Hospital, and 24 of these cases were followed for more than 20 years after the KTs and reviewed. Ten patients had 20 years of graft survival, and 14 experienced graft failure for some reason within 20 years after KTs. Retrospective analyses were performed to elucidate the difference in donor and recipient factors among these patients.<br/>【Results】The death censored graft survival rates at 5, 10, 15, and 20 years were 92.0%, 83.0%, 67.0%, and 67.0% in living-donor KTs and 73.0%, 62.0%, 62.0%, and 31.0% in deceased-donor KTs, respectively. The overall graft survival rates at 5, 10, 15, and 20 years were 85.0%, 77.0%, 62.0%, and 54.0% in living-donor KTs and 63.0%, 55.0%, 45.0%, and 27.0% in deceased-donor KTs, respectively. Comparison of clinical factors between the ≥ 20-year graft survivor group (10 cases) and <20-year graft survivor group (14 cases) revealed no differences in, for example, recipient age, duration of dialysis, donor age, donor type, number of human leukocyte antigen mismatches, and occurrence of acute rejections within 1 year of KTs. However, among 13 cases of living-donor KTs, the overall graft survivals after KTs from donors older than 50 years were worse than those after KTs from donors younger than 50 years. Also, the death-censored graft survivals after KTs from donors older than 60 years were worse than those after KTs from donors younger than 60 years. Moreover, graft survivals after KTs from maternal donors were worse than those after KTs from nonmaternal living donors, and there were no 20-year graft survivors after KTs from maternal donors.<br/>【Conclusion】Our results suggest that the principal risk factors associated with <20-year graft survival after living-donor KTs are the presence of donors older than 50 or 60 years and a maternal donor.

著者

松岡 崇志 井上 幸治 水野 桂 北 悠希 仲西 昌太郎 浅井 聖史 田岡 利宜也 宗田 武 寺井 章人

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.58, no.5, pp.223-226, 2012-05

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Anticoagulant and antiplatelet medications are commonly used for the treatment and prevention of cardiovascular diseases. We studied 84 patients who received heparin as a bridging anticoagulant and antiplatelet therapy during the perioperative period. Hospitalization was extended for adjusting anticoagulant and antiplatelet drugs and also bleeding complications in the perioperative period. There were 25 instances of bleeding complications (29.7%) in this study. These complications mainly occurred when anticoagulant and antiplatelet medications were restarted in the postoperative period. In transurethral surgery, patients taking warfarin and antiplatelet drugs (aspirin or ticlopidine) had a statistically significant increase in bleeding complications compared to patients taking warfarin alone. We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. The heparinization group had a statistically significant longer hospitalization period and an increase in bleeding complications. There was one instance of thromboembolism (1.2%) in our series. This involved stent thrombosis of a patient who had drug-eluting stent in the left anterior descending coronary artery. She died three days postoperatively. The number of patients taking anticoagulant and/or antiplatelet drugs is predicted to increase in the future due to aging of the population. Guidelines for the management of anticoagulant and antiplatelet therapy in the urological period are considered necessary.