著者

中川 由紀 野崎 大司 小笠 大起 知名 俊幸 河野 春奈 清水 史孝 磯谷 周二 永田 政義 武藤 智 堀江 重郎

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.56, no.Supplement, pp.s116, 2021 (Released:2022-05-12)

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はじめに: 近年糖尿病性腎症の腎不全の増加に伴い、腎移植を希望する患者も男性が多く占め、夫婦間腎移植も増加している。必然的にドナーの女性の占める割合も多くなる。腎移植における性差によっての予後の違いやリスク因子に性差の関連性について検討したので報告する。対象:2010年1月から2019年12月までに日本で行われた14604症例の生体腎移植にてついて解析した。結果: 血清Cr, eGFRは女性ドナーの方が良かった。男性ドナーは女性ドナーに比べ、Body mass index とBody Surface Area は優位に大きいが、喫煙者が多くなる、高血圧、糖尿病の割合が多く、ハリスククドナーが多かった。ドナーの性別によってのレシピエントの生存率、生着率ともに、男性ドナーの方が女性に比べ優位に予後が良かった。日本の生体腎移植の中で1年後のCrを確認できた7577症例の1年後eGFRが 30mi/min以下のCKDリスク因子について検討した。ドナー年齢、レシピエント年齢、ドナーのBody Surface Area 、ドナーの糖尿病の既往、ドナーの高血圧の既往、Baseline eGFR が有意なリスク因子であった。性差は有意なリスク因子とはならなかった。結語:本邦ではドナーの女性の占める割合が6割以上であった。男性ドナーの方がバックグラウンドは腎機能の予後不良リスク因子を多く占めていたが、移植腎生着率は良好である。移植腎の予後に、体格差が関与している可能性が高い。

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

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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

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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

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【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

上野 敦子 布田 伸一

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.54, no.6, pp.257-264, 2019 (Released:2020-04-02)

参考文献数

35

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In recent years, the waiting period until a heart transplant has been increasing. Therefore, the need for rehabilitation after heart transplantation to patients who had severe heart failure before transplantation has been widely recognized. Cardiac rehabilitation is a type of comprehensive disease management including exercise therapy, patient education and counseling. Several reports have shown that even if the left ventricular contractility of the transplanted heart is normal, exercise tolerance is hardly improved. This involves such factors as mechanisms of exercise intolerance in chronic heart failure and deconditioning, denervation of transplanted hearts, and immunosuppressants. It is important to perform rehabilitation after transplantation with understanding of the conditions before transplantation, the specificity of the transplanted heart, type of rejection, and immunosuppressive therapy. In practice, starting from the ambulation in the postoperative acute phase, exercise therapy is performed with the aim of acquiring daily activities equivalent to or greater than those before transplantation and improving exercise capacity. Furthermore, patient education by a multi-disciplinary team is required so that self-management centering on complications of medication, dietary guidance, and infection prevention can be performed. Such comprehensive management is expected to improve exercise tolerance, prognosis, and quality of life (QOL).

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)

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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

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

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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

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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

苛原 稔

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.23-29, 2022 (Released:2022-05-19)

参考文献数

9

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Since 2014, more countries have been doing uterine transplants after the world’s first report of a uterine transplant delivery by Professor Brännström’s team in Sweden. Even in Japan, although it has not been applied to humans, transplantation technology has reached a certain level and has reached the stage of preparing for clinical application.The target of uterine transplantation is a patient with a uterine defect disease who desires fertility treatment, and congenital uterine defect (Mayer-Rokitansky-Küster-Hauser syndrome) can be considered as a consensus. In actual practice, it is important to consider the following points.1. There are still unresolved issues to be considered and a clinical trial study should be conducted.2. The choice of donor should be careful. This is because it is necessary to perform highly invasive surgery on a healthy donor in order to perform this technique. Brain death transplantation is also possible, but the hurdles are high in Japan. Therefore, living body transplantation is the main focus.3. As for the conditions of the recipient, it is necessary to consider that the patient can obtain a pregnant egg, that she is of an age that allows pregnancy and delivery, and that she and her partner desire fertility treatment.4. In addition, it is necessary to consider the level of medical facilities and what to do about the necessary expenses.While solving these problems, it is necessary to carry out cross- medical society efforts and proceed with preparations.

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)

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【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

會田 直弘 伊藤 泰平 栗原 啓 剣持 敬

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.Supplement, pp.s154_2, 2022 (Released:2023-02-23)

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移植医療の進歩に伴い,移植後の生活の質は向上している.移植後に挙児を希望する患者も増加しており,すでに多くの患者が児をもうけている.男性移植患者に限ってみると,米国のNational Transplantation Pregnant Registryの報告では2015年までに879名の移植患者が児をもうけているとされる.心臓,肺,肝臓,小腸,膵臓,腎臓移植のいずれの男性移植患者でも報告があり,このうち43名は多臓器移植患者であった.このようにいずれの男性移植患者でも児をもうけることは可能である.移植後の妊娠・出産においては,主に女性を中心とした報告が注目を集めている.しかしながら,男性移植患者においても継続的な免疫抑制剤の内服が必要であり,薬剤の妊孕性への影響について移植医は十分に認識すべきである.多く使用されるカルシニューリン阻害薬は動物実験において精子数を減少させる可能性が指摘されており,mTOR形成阻害薬はテストステロンの低下,精子数の減少による受精能力の低下が指摘されている.一方でミコフェノール酸モフェチルは妊孕性への影響の報告はない.また、受精後の周産期合併症や胎児への影響についてはリスクが高いと示すものはなく、健常者と同等であると考えられる.男性移植患者の妊孕性や注意点についてガイドラインに基づき解説する.

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

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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)

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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

祝迫 惠子 坂口 志文

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.6, pp.483-488, 2017 (Released:2018-02-14)

参考文献数

19

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Organ transplantation remains the only fundamental treatment for end-stage organ failure. Immunosuppression therapy is the key to successful post-transplantation outcomes. Although the survival after organ transplantation has improved with the development of immunosuppressant, chronic rejection and side effects of long-term exposure to immunosuppression remain ongoing concerns. Immune tolerance is important for normal physiology, and occurs in two forms: central and peripheral. The regulatory T cell is the essential constituent in peripheral tolerance. Regulatory T cells specialize in suppressing immune responses, including autoimmune disease, allergy or alloreaction. Regulatory T-cell therapy in transplantation may be emerging as an alternative therapeutic choice.

著者

河本 宏 増田 喬子

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.52, no.6, pp.505-515, 2017 (Released:2018-02-14)

参考文献数

27

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HLA haplotype-homozygous (HLA-homo) induced pluripotent stem cells (iPSCs) are being prepared as a national initiative referred to as the “iPSC Stock Project”, to be used for allogeneic transplantation of regenerated tissue into recipients carrying an identical haplotype in one of the alleles (HLA-hetero). In this article, we address the issue whether NK cells play any roles in graft rejection in this homo-to-hetero transplantation setting, and show our recent finding that NK cells from an HLA-hetero person can kill the cells regenerated from HLA-homo iPSCs when the KIR-ligand is mismatched, by the mechanism of missing-self response. Such cytotoxicity was cancelled when target cells were regenerated from iPSCs transduced with the “missing” HLA gene, providing the basis for an approach to prevent such NK cell-mediated rejection responses. We further discuss the frequency of KIR-ligand mismatch cases occurring in the iPSC Stock Project.

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

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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

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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)

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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

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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)

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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.