129 129 12 0 OA 子宮移植の現状

著者
木須 伊織 阪埜 浩司 青木 大輔
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.57, no.1, pp.9-22, 2022 (Released:2022-05-19)
参考文献数
31

A new medical technique called uterus transplantation has been considered as an option for raising children of women with uterine factor infertility. Clinical studies have already begun overseas, and 87 uterus transplantations have been performed so far, and 49 babies have been born. Uterus transplantation, like other assisted reproductive technology, involves many medical, ethical, and social challenges that must be carefully considered for clinical application. However, uterus transplantation is highly expected to bring the gospel to women with uterine factor infertility who were previously unable to raise children.
著者
飯野 正光
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.57, no.1, pp.1-7, 2022 (Released:2022-05-19)
参考文献数
7

The Japanese Association of Medical Sciences established a Uterus Transplantation (UTx) Ethics Review Committee to examine, from the standpoint of medical, ethical, legal, and social perspectives, whether UTx can be performed in Japan. The Committee concluded that carefully designed clinical research studies with a small number of live-donor UTx cases may be conducted. At the same time, comprehensive measures regarding diagnosis, treatment, and care of patients with congenital deficiency in the uterus should be established, and it should be requested to include the uterus in the list of legally transplantable organs from deceased donors. Furthermore, an inspection committee jointly formed by the Japanese Society of Transplantation and the Japanese Society of Obstetrics and Gynecology should be implemented to oversee individual UTx cases.
著者
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 利実 上本 伸二 伊藤 孝司 吉村 了勇 吉住 朋晴 調 憲 前原 喜彦 阪本 靖介 猪股 裕紀洋 篠田 昌宏 板野 理 北川 雄光 川岸 直樹 石山 宏平 井手 健太郎 大段 秀樹 水野 修吾 伊佐地 秀司 浅岡 忠史 永野 浩昭 梅下 浩司 日髙 匡章 江口 晋 小倉 靖弘
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.50, no.1, pp.062-077, 2015-03-10 (Released:2015-03-31)
参考文献数
12

【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.
著者
和田 啓伸 坂入 祐一 吉野 一郎
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.52, no.1, pp.031-037, 2017-03-10 (Released:2017-04-04)
参考文献数
44

Human lungs are generally not believed to repair or regenerate, and regenerative medicine in the field of respiratory organs, especially lungs, is far behind in comparison with those of other organs. Regenerative medicine is defined as medicine that replaces or regenerates human cells, tissue, or organs to restore or establish normal functions. On the other hand, lung transplantation is a last resort for patients suffering from end-stage lung diseases, and more than 4,000 cases have been performed worldwide. However, the number of patients on the waiting list largely exceeds the number of available transplantable lungs because of a severe short supply of organ donors. Lung regenerative medicine may be a solution for the serious issue to restore injured lungs or to supply transplantable functional lungs. We herein describe lung restoration, lung growth, and lung regeneration, which are related to lung transplantation.
著者
高島 響子
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.57, no.1, pp.37-43, 2022 (Released:2022-05-19)
参考文献数
23

Uterus transplantation (UTx) has become a new potential option for women with absolute uterine factor infertility (UFI), who desire to give birth to their own children. In UTx, organ transplantation from living or deceased donors is used under the goal of assisted reproductive technology. In July of 2021, the commission for ethical issues on UTx under the Japanese Association of Medical Sciences published the report, and allowed the conducting of clinical research on UTx with a limited number of patients. This article discusses bioethical considerations of UTx. Transplantation from a living donor is an exceptional procedure which does not fulfill ethical principles of non-maleficence nor justice. Autonomy is also affected because the national guideline requires that a donor should primarily be a family member of the recipient and it raises a concern whether both a donor and a recipient feel pressure. Transplantation from a living donor is accepted because beneficence (saving a patient’s life) surpasses the other principles. This formula cannot be applied to UTx from living donors because the uterus is not a vital organ, and it is difficult to ethically justify such a transplantation. The interest of children is another important ethical issue. From a research ethics perspective, UTx is an unproven intervention to achieve the clinical goal for UFI women. Implementing UTx not as treatment but as clinical research first is supported by the standard of research ethics today. However, allowing clinical research embraces the practice of UTx itself, while unresolved ethical considerations are left behind. Continuous discussion open to public, review of institutional systems including legislation reform, and wholistic care and support for UFI women are needed.
著者
福田 将一 高橋 一広 金子 修三 臼井 丈一 小関 美華 小田 竜也 山縣 邦弘
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.55, no.Supplement, pp.375_3, 2020 (Released:2021-09-18)

【目的】夫婦間生体腎移植の実施数は全国的に増加傾向にあり、当院でも生体腎移植の約4割を占める。手術に伴う生活環境などの変化が予測される症例も経験することが多くなっており、当人以外の治療参加も求められる。今回、ドナー・レシピエント夫婦がほかの家族に相談なく移植を受けようとし、家族と医療者間の調整を必要とした症例を経験したので報告する。学会発表にあたり、患者本人から同意を得た。【症例】A氏、60歳代、男性、糖尿病性腎症により生体腎移植を希望した。ドナーは妻であり、通院はドナー・レシピエント夫婦のみであった。術前検査を進め手術入院を控えていたが、同居する30代長女からの連絡で妻以外の家族には相談せず話を進めていたことがわかった。家族は患者の病気や自己管理能力に不安を抱いていたが、患者から説明を受けていないということで、移植に対して反対の意見を持たれていた。反対の理由や疑問点・患者への思いを確認し、主治医との面談を調整した。主治医より患者夫婦に家族を加えて説明が行われ、移植手術を行うことに同意された。【考察】家族は患者を心配する気持ちを抱いていたが、家族へ相談なく進めていたため治療方針の確認やその後のフォローアップなど、理解する機会を得たかったのではないかと考える。【まとめ】患者・家族の関係性を理解し、コンフリクトが生じていないか評価する必要がある。
著者
日本臨床腎移植学会・日本移植学会
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.55, no.3, pp.225-243, 2020 (Released:2020-12-08)

A total of 2,057 kidney transplants including 1,827 from living donors, 54 from non-heart-beating donors and 176 from heart-beating donors were performed in 2019 in Japan.The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, status of viral antigens and antibodies, pretransplant complications, causes of death of deceased donors, ischemic time and histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed.We also report the results of follow-up survey for recipients and living donors.
著者
日本臨床腎移植学会・日本移植学会
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.56, no.3, pp.195-216, 2021 (Released:2021-12-25)

A total of 1,711 kidney transplants including 1,570 from living donors, 17 from non-heart-beating donors and 124 from heart-beating donors were performed in 2020 in Japan. The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, status of viral antigens and antibodies, pretransplant complications, causes of death of deceased donors, ischemic time and histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed. We also report the results of a follow-up survey for recipients and living donors.
著者
佐原 寿史 関島 光裕 山田 和彦
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.50, no.1, pp.016-023, 2015-03-10 (Released:2015-03-31)
参考文献数
49

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.
著者
両角 國男 武田 朝美
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.49, no.1, pp.001-005, 2014-03-10 (Released:2014-05-12)
参考文献数
7

Standardization of renal allograft biopsy interpretation is necessary to guide therapy. This manuscript describes milestones of the Banff classification for renal allograft pathology developed by an international investigators conference.From small beginnings in 1991, the Banff working classification of renal allograft pathology has grown to be a major force for setting standards in renal transplant pathology. The meeting, classification, and consensus process have a unique history.Semiquantitative scorings of key lesions, such as tubulitis, interstitial inflammation, capillaritis, arteritis, and others, make a central core of the Banff scheme. The Banff classification proposed many new concepts related to pathogenesis of rejection. There are many important issues, including T-lymphocyte related rejaction, antibody-mediated rejection (ABMR), chronic active rejection, and C4d negative antibody-mediated rejection. ABMR is associated with heterogeneous phenotypes even within the same type of transplant.The willingness of the Banff process to continually adapt in response to new research and to improve potential weaknesses led to the implementation of six working groups in the following areas: isolated v-lesion, fibrosis scoring, glomerular lesions, molecular pathology, polyomavirus nephropathy, and quality assurance. Furthermore, compelling molecular research data led to the discussion of incorporation of omics technologies and the discovery of new tissue markers with the goal of soon combining histopathology and molecular parameters within the Banff working classification.
著者
日本臨床腎移植学会・日本移植学会
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.53, no.2-3, pp.89-108, 2018 (Released:2018-11-07)

A total of 1,742 kidney transplants including 1,544 from living donors, 65 from non-heart-beating donors and 133 from heart-beating donors were performed in 2017 in Japan.The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, the status of viral antigens and antibodies, pretransplant complications, the causes of death of deceased donors, ischemic time and histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed.We also report the results of a follow-up survey for recipients and living donors.
著者
村上 穣 池添 正哉 大沢 紘介 佐々本 格 降籏 俊一 石田 英樹 田邉 一成
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.2-3, pp.207-210, 2016-06-10 (Released:2016-08-12)
参考文献数
14

We report the case of a kidney transplant recipient who was himself a nephrologist and first author of this report, and who found a sense of purpose in life despite his disease. At age 7, the patient was diagnosed with chronic kidney disease resulting from vesicoureteral reflux. After undergoing surgery, he had to maintain a strict diet along with medication to control disease progression. Two years after becoming a licensed nephrologist, he received a living donor kidney transplantation from his mother. He used his position as a nephrologist and a kidney transplant recipient to educate medical and nursing students on organ donations and transplantations and to promote deceased organ donations. However, despite his successes the patient suffered psychological issues throughout his life because of his disease. First, he experienced depression from learning the poor prognosis of chronic kidney disease patients. Second, he was bothered by fears of having to undergo dialysis therapy and dying. Third, he struggled with guilt after his successful kidney transplantation, knowing about the many dialysis patients who were forced to wait long periods for donor organs. Nevertheless, he was eventually able to accept his disease and discovered a sense of purpose in life by promoting deceased organ donations. Our observations suggest the importance of treating patients with chronic kidney disease not only physically, but also by caring for them psychologically.
著者
日本移植学会・日本臨床腎移植学会
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.50, no.2-3, pp.138-155, 2015-07-31 (Released:2015-08-07)

A number of 1,598 kidney transplants including 1,471 from living donors, 42 from non-heart-beating donors and 85 from heart-beating donors were performed in 2014 in Japan. The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, the status of viral antigens and antibodies, pretransplant complications, the causes of death of deceased donors, ischemic time and the histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed. We also reported the results of follow-up survey for living donors.
著者
剣持 敬 福嶌 教偉 肥沼 幸 牛込 秀隆 久保 正二
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.49, no.6, pp.393-401, 2014-12-10 (Released:2014-12-26)
参考文献数
21

The number of organ transplantations from donation from brain-dead (DBD) donors has recently increased because of the enforcement of the revised Organ Transplantation Law in 2010 in Japan. More than 500 kidney transplant recipients, more than 30 liver transplant recipients, and two recipients of simultaneous pancreas and kidney transplantations have already experienced pregnancy and childbirth in our country. Along with the increase of DBD donors, pregnancy and childbirth must be an important issue for the recipients of heart and lung transplantations as well as kidney and liver transplantations. The Japan Society for Transplantation has decided to make a guideline for pregnancy and childbirth in patients after organ transplantation.The contents of this guideline are planned to be classified into two chapters. One concerns common problems after organ transplantations, such as the use of drugs, including immunosuppressive agents and vaccines. The second chapter is planned to focus on problems particular to reach organ transplantation. Furthermore, this guideline will include the problems of living donors for kidney and liver transplantations and male recipients who underwent organ transplantations.
著者
日本移植学会・日本臨床腎移植学会
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.49, no.2-3, pp.240-260, 2014-06-10 (Released:2014-07-18)

A number of 1,586 kidney transplants including 1,431 from living donors, 67 from non-heart-beating donors and 88 from heart-beating donors were performed in 2013 in Japan. The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, the status of viral antigens and antibodies, pretransplant complications, the causes of death of deceased donors, ischemic time and the histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed. We also reported the results of follow-up survey for all recipients and donors of the transplants from living donors.
著者
日本移植学会登録委員会
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.49, no.2-3, pp.235-239, 2014-06-10 (Released:2014-07-18)

After the enforcement in Japan of the amended Act on Organ Transplantation in July 2010, the number of brain-dead donors vastly increased. But the total numbers of the deceased donors for organ transplantation were almost the same in 2010, 2011 and 2012. The percentage of the brain-dead donors increased, but the total numbers of cardiac-arrested donors decreased. Unexpectedly, in 2013, the total number of the deceased donors decreased to 84. The numbers of brain-dead and cardiac-arrested donors were 47 and 37. The organ transplantations from the deceased donors are realized with the efforts of the procurement teams. This is a report on organ procurement from the deceased donors for organ transplantations in Japan in 2013.

1 1 0 0 OA 子宮移植と法

著者
丸山 英二
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.57, no.1, pp.45-49, 2022 (Released:2022-05-19)

On July 14, 2021, a committee created by the Japanese Association of Medical Sciences for studying ethical issues of uterus transplantation released a report allowing the transplant to be performed as clinical research. The author, who was a member of the committee, explains the legal background to and implications of the report.
著者
湯沢 賢治
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.57, no.1, pp.31-35, 2022 (Released:2022-05-19)
参考文献数
9

As a transplantation surgeon, I celebrate and admire the success of uterus transplantation and birth after uterus transplantation. It was brought about by the scientific achievement in organ transplantation. But, as the history of uterus transplantation is short, many key issues on it remain unresolved. Living donor or cadaveric donor, age of donor, operation for hysterectomy in living or cadaveric donor, preservation time of uterus, histocompatibility, immunosuppressive drugs, diagnosis and treatment of rejection, problems in the newborn baby, medical cost and comparison with surrogate conception are discussed.
著者
日本心臓移植研究会
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.56, no.3, pp.235-244, 2021 (Released:2021-12-25)
参考文献数
4

Since the Organ Transplantation Law was passed in October 1997, a total of 566 heart transplantations (HTx) had been performed in Japan as of December, 2020. Of those, 597 HTx were performed after activation of a revised Transplant Act, and 84 were performed in 2019, but the number fell to 54 due to the COVID-19 pandemic. Most recipients had dilated cardiomyopathy; and the waiting condition of all patients was status 1 at HTx. The mean waiting time as status 1 continually increased to 1,625 days in 2020 from 892 days in 2014 in adults. After approval of the use of an implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) since 2011, BTT, especially using the cf-LVAD increased. In 2020, 46 of 49 adult cases were supported by several types of cf-LVADs. Fifty-five children underwent HTx and 42 (76%) of them were BTT cases (8 in Nipro VAD, 17 in EXCOR VAD, 9 in Jarvik 2000 and 8 in other cf-VADs). Most patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with a calcineurin inhibitor (cyclosporine or tacrolimus), mycophenolate mofetil, and a steroid as an initial immunosuppressive regimen. Patient survival at 5, 10 and 20 years was 90.5%, 79.5% and 75.5%, respectively, which is superior to that of the international registry. This surveillance documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.
著者
西 慎一
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.49, no.6, pp.417-422, 2014-12-10 (Released:2014-12-26)
参考文献数
17

Many medical complications, including hypertension, diabetes, and dyslipidemia, appear after kidney transplantation. These complications significantly affect the grafts and the patient survivals; thus the control of posttransplant medical complications is absolutely essential. Unfortunately, steroid and immunosuppressive agents induce or impair the medical complications, which are a special condition after kidney transplantation.The Japanese Society of Clinical Renal Transplantation (JSCRT) has already published "Guidelines for medical and pediatric complications after kidney transplantation" in 2011. Earlier, in 2009, "KDIGO Clinical Practice Guidelines for Kidney Disease" for the care of kidney transplant patients was published in the American Journal of Transplantation. The contents of recommendations are not always the same between two guidelines. Referring to these two guidelines, the author summarized the points and problems and posttransplant hypertension, posttransplant diabetes, and post transplant dyslipidemia.