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Hiramitsu T, Himeno T, Hasegawa Y, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Impact of Age 70 years or Older on Donors for Living-Donor Kidney Transplantation. Kidney Int Rep 2024; 9:1321-1332. [PMID: 38707796 PMCID: PMC11069014 DOI: 10.1016/j.ekir.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kidney transplantation (KT) involving elderly living kidney donors (LKDs) is becoming more frequent because of a profound organ shortage. The efficacy of KT involving grafts obtained from LKDs aged 70 years or older has been reported. However, the safety of donor nephrectomy in LKDs aged 70 years or older, including that associated with changes in the estimated glomerular filtration rate (eGFR), has not been investigated. This study investigated the outcomes of LKDs aged 70 years or older after donor nephrectomy. Methods This single-center, retrospective cohort study included 1226 LKDs who underwent donor nephrectomy between January 2008 and December 2020. LKDs were stratified into the following age groups: 30 to 49 years (244 LKDs), 50 to 69 years (803 LKDs), and 70 to 89 years (179 LKDs). Surgical outcomes, postoperative eGFR changes, end-stage renal disease (ESRD) rates, and mortality rates were compared among these groups. Results No significant difference in surgical outcomes was identified among the groups. LKDs aged 70 to 89 years experienced the lowest eGFR changes at all time points and the lowest eGFR improvement; however, ESRD was not identified in any group during the observation period. Mortality was the highest among LKDs aged 70 to 89 years compared to the other age groups. Conclusion Surgical outcomes, eGFR changes, and ESRD incidences can support the safety of donor nephrectomy in LKDs aged 70 years or older. Considering the advanced age, the high mortality rates in LKDs aged 70 years or older could be considered acceptable.
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Affiliation(s)
- Takahisa Hiramitsu
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Tomoki Himeno
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yuki Hasegawa
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Manabu Okada
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
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Shindo T, Hashimoto K, Takahashi A, Miyamoto S, Kunishima Y, Sato S, Fukuta F, Hiyama Y, Takayanagi A, Kato R, Wanifuchi A, Ueki Y, Okada M, Adachi H, Kobayashi KO, Tanaka T, Masumori N. Comparison of Oncological Outcomes of Pembrolizumab as Second-line Therapy and Maintenance Avelumab Therapy in Advanced Urothelial Carcinoma After Platinum-based Chemotherapy. Anticancer Res 2024; 44:1271-1279. [PMID: 38423657 DOI: 10.21873/anticanres.16922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND/AIM Sequential therapy using chemotherapy and subsequent immune checkpoint inhibitor (ICI) treatment prolongs the survival of patients with advanced urothelial carcinoma (UC). However, no comparison data for oncological outcome between pembrolizumab and avelumab has been reported. Thus, we compared oncological outcomes between pembrolizumab as second-line therapy and maintenance avelumab therapy in patients with advanced UC. PATIENTS AND METHODS We retrospectively evaluated patients with advanced UC treated with pembrolizumab or avelumab between January 2018 and February 2023. We compared oncological outcomes after adjusting for patient characteristics. Immune-related adverse events (AEs) in each group were evaluated using the Common Terminology Criteria for Adverse Events. RESULTS There were 186 and 44 patients in the pembrolizumab- and avelumab-treated cohorts, respectively. After propensity score matching, 43 patients from each group were selected and analyzed. Median progression-free survival from the initiation of pembrolizumab and avelumab treatments was 126 and 139 days, respectively (log-rank test, p=0.625). Median overall survival in the pembrolizumab and avelumab cohorts were 658 days and not reached, respectively (log-rank test, p=0.249). Thirty-eight (20.4%) and 14 (31.8%) all-grade immune-related AEs were observed in 186 pembrolizumab- and 44 avelumab-treated patients, respectively (chi-squared test, p=0.112). Regarding endocrine-related AEs, 12 (6.5%) and none (0%) were observed in pembrolizumab- and avelumab-treated patients, respectively (Fisher's exact probability test, p=0.129). CONCLUSION Pembrolizumab and maintenance avelumab therapy provide equivalent oncological outcomes in patients with advanced UC. Although no significant difference was observed, there might be a potential risk of higher endocrine-related AEs due to pembrolizumab compared to avelumab maintenance therapy.
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Affiliation(s)
- Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan;
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Shintaro Miyamoto
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | - Shunsuke Sato
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Fumimasa Fukuta
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Yoshiki Hiyama
- Department of Urology, NTT Medical Center Sapporo, Sapporo, Japan
| | - Akio Takayanagi
- Department of Urology, Japan Community Healthcare Organization Hokkaido Hospital, Sapporo, Japan
| | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Atsushi Wanifuchi
- Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan
| | - Yohei Ueki
- Department of Urology, Takikawa Municipal Hospital, Takikawa, Japan
| | - Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Hideki Adachi
- Department of Urology, Saiseikai Otaru Hospital, Otaru, Japan
| | - K O Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Fujihara C, Murakami K, Magi S, Motooka D, Nantakeeratipat T, Canela A, Tanaka RJ, Okada M, Murakami S. Omics-Based Mathematical Modeling Unveils Pathogenesis of Periodontitis in an Experimental Murine Model. J Dent Res 2023; 102:1468-1477. [PMID: 37800405 DOI: 10.1177/00220345231196530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Periodontitis is a multifactorial disease that progresses via dynamic interaction between bacterial and host-derived genetic factors. The recent trend of omics analyses has discovered many periodontitis-related risk factors. However, how much the individual factor affects the pathogenesis of periodontitis is still unknown. This article aims to identify multiple key factors related to the pathogenesis of periodontitis and quantitatively predict the influence of each factor on alveolar bone resorption by omics analysis and mathematical modeling. First, we induced periodontitis in mice (n = 3 or 4 at each time point) by tooth ligation. Next, we assessed alveolar bone resorption by micro-computed tomography, alterations in the gene expression by RNA sequencing, and the microbiome of the gingivae by 16S ribosomal RNA sequencing during disease pathogenesis. Omics data analysis identified key players (bacteria and molecules) involved in the pathogenesis of periodontitis. We then constructed a mathematical model of the pathogenesis of periodontitis by employing ordinary differential equations that described the dynamic regulatory interplay between the key players and predicted the alveolar bone integrity as output. Finally, we estimated the model parameters using our dynamic experimental data and validated the model prediction of influence on alveolar bone resorption by in vivo experiments. The model predictions and experimental results revealed that monocyte recruitment induced by bacteria-mediated Toll-like receptor activation was the principal reaction regulating alveolar bone resorption in a periodontitis condition. On the other hand, osteoblast-mediated osteoclast differentiation had less impact on bone integrity in a periodontitis condition.
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Affiliation(s)
- C Fujihara
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - K Murakami
- Laboratory of Cell Systems, Institute for Protein Research, Osaka University, Suita, Osaka, Japan
| | - S Magi
- Department of Physiology, Division of Cell Physiology, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - D Motooka
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - T Nantakeeratipat
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
- Department of Conservative Dentistry and Prothodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - A Canela
- The Hakubi Center for Advanced Research, Radiation Biology Center, Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - R J Tanaka
- Department of Bioengineering, Imperial College London, London, UK
| | - M Okada
- Laboratory of Cell Systems, Institute for Protein Research, Osaka University, Suita, Osaka, Japan
- Human Metaverse Medicine (WPI-PRIMe), Osaka University, Suita, Osaka, Japan
| | - S Murakami
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Ueda H, Katakami S, Okada M, Yoshida S, Nakai Y, Mito T, Mizumaki M. Efficient NMR measurement and data analysis supported by the Bayesian inference: The case of the heavy fermion compound YbCo 2Zn 20. J Magn Reson 2023; 357:107585. [PMID: 37952430 DOI: 10.1016/j.jmr.2023.107585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
We propose a data-driven technique to infer microscopic physical quantities from nuclear magnetic resonance (NMR) spectra, in which the data size and quality required for the Bayesian inference are investigated. The 59Co-NMR measurement of YbCo2Zn20 single crystal generates complex spectra with 28 peaks. By exploiting the site symmetry in the crystal structure, the isotropic Knight shift Kiso and nuclear quadrupole resonance (NQR) frequency νQ were respectively estimated to be Kiso=0.7822±0.0090% and νQ=2.008±0.016 MHz (T=20 K and H≃10.2 T) by analyzing only 30 data points from one spectrum. The estimated νQ is consistent with the precise value obtained in the NQR experiment. Our method can significantly reduce the measurement time and the computational cost of data analysis in NMR experiments.
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Affiliation(s)
- H Ueda
- Department of Complexity Science and Engineering, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277-8561, Japan
| | - S Katakami
- Department of Complexity Science and Engineering, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277-8561, Japan
| | - M Okada
- Department of Complexity Science and Engineering, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277-8561, Japan.
| | - S Yoshida
- Department of Material Science, Graduate School of Science, University of Hyogo, Ako-gun, Hyogo, 678-1297, Japan
| | - Y Nakai
- Department of Material Science, Graduate School of Science, University of Hyogo, Ako-gun, Hyogo, 678-1297, Japan
| | - T Mito
- Department of Material Science, Graduate School of Science, University of Hyogo, Ako-gun, Hyogo, 678-1297, Japan
| | - M Mizumaki
- Faculty of Science, Course for Physical Sciences, Kumamoto University, Kurokami, Kumamoto 860-8555, Japan
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Okada M, Shindo T, Fujino K, Maeda T, Ito N, Takahashi A, Hotta H, Kunishima Y, Matsukawa M, Takayanagi A, Wanifuchi A, Nofuji S, Kato R, Fukuta F, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. Prevention of local symptoms in muscle invasive bladder cancer patients: clinical significance of local radiation therapy. Support Care Cancer 2023; 31:607. [PMID: 37787829 DOI: 10.1007/s00520-023-08087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To evaluate the significance of local radiation therapy (LRT) for prevention of local symptoms (LSs) caused by muscle-invasive bladder cancer (MIBC). METHODS We retrospectively reviewed the clinical records of 133 patients from 13 hospitals. MIBC patients with or without metastases who were treated with LRT alone from January 2015 through December 2020 were enrolled. Exclusion criteria were urinary diversion (UD) prior to LRT, non-MIBC, or lack of clinical information. LSs were defined as hematuria requiring invasive treatment or transfusion, UD after LRT, bladder tamponade, and opioid use for bladder pain. RESULTS One hundred fourteen patients were finally enrolled in the study. During the median follow-up period of 13.5 months, 30 patients (26.3%) had LSs. Risk factors of LSs in multivariate analysis were a prior history of non-MIBC (NMIBC) (hazard ratio [HR] 2.99; 95% confidence interval [CI], 1.36 to 6.56; P < 0.01), radiation dose of less than 50 Gray (Gy) (HR 3.99; 95% CI, 1.80 to 8.82; P < 0.01), and tumor stage 3 or more (HR 2.43; 95% CI, 1.14 to 5.21; P = 0.02). Risk factors of overall survival (OS) in multivariate analysis were being female (HR 3.32; 95% CI, 1.68 to 6.58; P < 0.01), an age-adjusted Charlson Comorbidity index of 6 or more (HR 2.19; 95% CI, 1.18 to 4.10; P = 0.01), distant metastases (HR 3.20; 95% CI, 1.39 to 6.58; P < 0.01), and tumor size of 40 mm or more (HR 2.38; 95% CI, 1.34 to 4.52; P < 0.01). Toxicity (all grades) occurred in 40.4% of the patients, 4.8% with grade 3 or more and 95.2% with lower grades. CONCLUSIONS We determined the risk factors for LSs in MIBC patients treated with LRT alone. An escalated-dose of 50 Gy or more may contribute to prevention of LSs caused by MIBC. Thus, dose-escalated LRT for MIBC patients who can expect favorable survival may be a good option to avoid future annoying LSs.
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Affiliation(s)
- Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan.
| | - Keiko Fujino
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Toshihiro Maeda
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Naoki Ito
- Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Hiroshi Hotta
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | | | - Akio Takayanagi
- Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan
| | - Atsushi Wanifuchi
- Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan
| | - Seisuke Nofuji
- Department of Urology, Hokkaido Medical Center, Sapporo, Japan
| | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Fumimasa Fukuta
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
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Okada M, Sato T, Hasegawa Y, Futamura K, Hiramitsu T, Ichimori T, Goto N, Narumi S, Takeda A, Watarai Y. Persistent hyperparathyroidism after preemptive kidney transplantation. Clin Exp Nephrol 2023; 27:882-889. [PMID: 37351681 PMCID: PMC10504143 DOI: 10.1007/s10157-023-02371-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Long-term dialysis vintage is a predictor of persistent hyperparathyroidism (HPT) after kidney transplantation (KTx). Recently, preemptive kidney transplantation (PKT) has increased. However, the incidence, predictors, and clinical implications of HPT after PKT are unclear. Here, we aimed to elucidate these considerations. METHODS In this retrospective cohort study, we enrolled patients who underwent PKT between 2000 and 2016. Those who lost their graft within 1 year posttransplant were excluded. HPT was defined as an intact parathyroid hormone (PTH) level exceeding 80 pg/mL or hypercalcemia unexplained by causes other than HPT. Patients were divided into two groups based on the presence of HPT 1 year after PKT. The primary outcome was the predictors of HPT after PKT, and the secondary outcome was graft survival. RESULTS Among the 340 consecutive patients who underwent PKT, 188 did not have HPT (HPT-free group) and 152 had HPT (HPT group). Multivariate logistic regression analysis revealed that pretransplant PTH level (P < 0.001; odds ratio [OR], 5.480; 95% confidence interval [CI], 2.070-14.50) and preoperative donor-estimated glomerular filtration rate (P = 0.033; OR, 0.978; 95% CI, 0.957-0.998) were independent predictors of HPT after PKT. Death-censored graft survival was significantly lower in the HPT group than that in the HPT-free group (90.4% vs. 96.4% at 10 years, P = 0.009). CONCLUSIONS Pretransplant PTH levels and donor kidney function were independent predictors of HPT after PKT. In addition, HPT was associated with worse graft outcomes even after PKT.
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Affiliation(s)
- Manabu Okada
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan.
| | - Tetsuhiko Sato
- Department of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Yuki Hasegawa
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Kenta Futamura
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Toshihiro Ichimori
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Norihiko Goto
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Shunji Narumi
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery and Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
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Sato T, Azuma Y, Ozone C, Okazaki M, Takeda A, Okada M, Futamura K, Hiramitsu T, Goto N, Narumi S, Watarai Y. Possible Advantage of Glucagon-Like Peptide 1 Receptor Agonists for Kidney Transplant Recipients With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:2597-2603. [PMID: 36974363 DOI: 10.1210/clinem/dgad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
CONTEXT Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have the potential to improve native kidney function. OBJECTIVE This work aimed to elucidate the possible protective effects of GLP-1 RAs on kidney graft function after successful kidney transplantation (KTX). METHODS This retrospective cohort study included all KTX recipients (KTRs) at our facility with type 2 diabetes who were followed up from 1 month post-transplantation for 24 months or longer as of December 31, 2020. We investigated associations between the use of GLP-1 RAs and other antidiabetic medications (non-GLP-1 RAs) and the risk of sustained estimated glomerular filtration rate (eGFR) reduction (40% reduction compared with baseline for 4 months) for KTRs with type 2 diabetes. We calculated the propensity score of initiating GLP-1 RAs compared with that of initiating non-GLP-1 RAs as a function of baseline covariates using logistic regression. The inverse probability of the treatment-weighted odds ratio was estimated to control for baseline confounding variables. Sodium-glucose cotransporter 2 inhibitor use was a competing event. The primary outcome was sustained eGFR reduction of at least 40% from baseline for 4 months post-transplantation. RESULTS Seventy-three patients were GLP-1 RA users and 73 were non-GLP-1 RA users. Six patients and 1 patient in the non-GLP-1 RA and GLP-1 RA groups had sustained eGFR reduction. GLP-1 RA use after KTX was associated with a lower risk of sustained eGFR reduction. CONCLUSION GLP-1 RAs resulted in lower eGFR reduction compared with non-GLP-1 RAs and may contribute to better kidney graft survival after KTX.
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Affiliation(s)
- Tetsuhiko Sato
- Division of Integrated Strategic Medicine, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
- Division of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Yoshinori Azuma
- Division of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Chikafumi Ozone
- Division of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Mikako Okazaki
- Division of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Manabu Okada
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Kenta Futamura
- Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Norihiko Goto
- Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Shunji Narumi
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Prediction models for the recipients' ideal perioperative estimated glomerular filtration rates for predicting graft survival after adult living-donor kidney transplantation. Front Med (Lausanne) 2023; 10:1187777. [PMID: 37720509 PMCID: PMC10501755 DOI: 10.3389/fmed.2023.1187777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The impact of the perioperative estimated glomerular filtration rate (eGFR) on graft survival in kidney transplant recipients is yet to be evaluated. In this study, we developed prediction models for the ideal perioperative eGFRs in recipients. Methods We evaluated the impact of perioperative predicted ideal and actual eGFRs on graft survival by including 1,174 consecutive adult patients who underwent living-donor kidney transplantation (LDKT) between January 2008 and December 2020. Prediction models for the ideal perioperative eGFR were developed for 676 recipients who were randomly assigned to the training and validation sets (ratio: 7:3). The prediction models for the ideal best eGFR within 3 weeks and those at 1, 2, and 3 weeks after LDKT in 474 recipients were developed using 10-fold validation and stepwise multiple regression model analyzes. The developed prediction models were validated in 202 recipients. Finally, the impact of perioperative predicted ideal eGFRs/actual eGFRs on graft survival was investigated using Fine-Gray regression analysis. Results The correlation coefficients of the predicted ideal best eGFR within 3 weeks and the predicted ideal eGFRs at 1, 2, and 3 weeks after LDKT were 0.651, 0.600, 0.598, and 0.617, respectively. Multivariate analyzes for graft loss demonstrated significant differences in the predicted ideal best eGFR/actual best eGFR within 3 weeks and the predicted ideal eGFRs/actual eGFRs at 1, 2, and 3 weeks after LDKT. Discussion The predicted ideal best eGFR/actual best eGFR within 3 weeks and the predicted ideal eGFRs/actual eGFRs at 1, 2, and 3 weeks after LDKT were independent prognostic factors for graft loss. Therefore, the perioperative predicted ideal eGFR/actual eGFR may be useful for predicting graft survival after adult LDKT.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yuki Hasegawa
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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9
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1175237. [PMID: 37396185 PMCID: PMC10311438 DOI: 10.3389/fendo.2023.1175237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Following total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx. Methods A total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy-defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1-between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft. Results Univariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (P=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992-0.999) and the maximum diameter of the PTG for autograft (P=0.046; HR, 1.107; 95% CI, 1.002-1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551-0.705). Conclusions The dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft.
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10
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Treatment for secondary hyperparathyroidism focusing on parathyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1169793. [PMID: 37152972 PMCID: PMC10159274 DOI: 10.3389/fendo.2023.1169793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients' need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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11
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Kyoda Y, Hashimoto K, Takahashi A, Maehana T, Tachikawa K, Muranaka T, Kato S, Kurisu T, Fukuta F, Kirisawa T, Okada M, Kobayashi K, Tanaka T, Hinotsu S, Masumori N. Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy? Curr Urol 2023. [DOI: 10.1097/cu9.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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12
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Kobayashi A, Takeda A, Shinjo H, Iguchi D, Ito C, Okada E, Goto N, Futamura K, Okada M, Hiramitsu T, Narumi S, Watarai Y. Light Chain Deposition Disease Recurrence in Renal Allograft after Long-Term Remission. Nephron Clin Pract 2023; 147 Suppl 1:96-100. [PMID: 36809757 DOI: 10.1159/000529776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Light chain deposition disease (LCDD) is a rare manifestation of monoclonal gammopathy, which can lead to renal failure. We previously reported a detailed recurrence process in a case of LCDD after renal transplantation. To the best of our knowledge, no report has described the long-term clinical course and renal pathology findings of recurrent LCDD in patients after renal transplantation. In this case report, we describe the long-term clinical presentation and changes in renal pathology of the same patient after early LCDD relapse in a renal allograft. A 54-year-old woman with recurrent immunoglobulin A λ-type LCDD in an allograft was admitted 1 year post-transplant for bortezomib and dexamethasone therapy. At 2 years post-transplantation, a graft biopsy performed after complete remission was achieved, showing some glomeruli with residual nodular lesions similar to the pre-treatment renal biopsy findings. However, the enlarged subendothelial space disappeared. She remained in complete remission serologically for 6 years. Subsequently, the ratio of serum κ/λ-free light chains decreased gradually. She underwent a transplant biopsy approximately 12 years after renal transplantation due to increased proteinuria and decreased renal function. Compared with the previous graft biopsy, almost all glomeruli showed advanced nodule formation and subendothelial expansion. Because the LCDD case relapsed after long-term remission following renal transplantation, protocol biopsy monitoring might be necessary.
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Affiliation(s)
- Azusa Kobayashi
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Asami Takeda
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hibiki Shinjo
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Daiki Iguchi
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Chiharu Ito
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Eriko Okada
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Norihiko Goto
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Syunji Narumi
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Kidney Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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13
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Okada M, Narumi S, Hasegawa Y, Futamura K, Hiramitsu T, Ichimori T, Goto N, Kobayashi T, Uchida K, Takeda A, Watarai Y. Optimal dose of rituximab in ABO-incompatible kidney transplantation in patients with low anti-A/B antibody titers: A single-center retrospective cohort study. Clin Transplant 2023; 37:e14915. [PMID: 36634703 DOI: 10.1111/ctr.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/28/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND The clinical outcomes of ABO-incompatible (ABOi) kidney transplantation have improved with the introduction of desensitization therapy with rituximab. However, rituximab prevents not only antibody-mediated rejection (AMR) but also increases the risk of adverse events, such as infection. For ABOi kidney transplantation in patients with low anti-A/B antibody titers, we previously used a rituximab-free desensitization protocol and then initiated a single dose of 100 mg rituximab in 2016. We retrospectively compared the outcomes of ABOi kidney transplantation in patients with low anti-A/B antibody titers before and after the introduction of rituximab. METHODS ABOi kidney transplantations (n = 142) in patients with low anti-A/B antibody titers between 2007 and 2021 were included. Patients were divided into two groups (with and without rituximab) for desensitization. The primary outcomes were the incidence of acute AMR and infection. RESULTS Sixty-six patients were desensitized without rituximab (rituximab-free group), and 76 were pretreated with 100 mg rituximab (rituximab group) before transplantation. The incidence of acute AMR was significantly lower in the rituximab group than in the rituximab-free group (.0% [0/76] vs. 7.6% [5/66], respectively; p = .047). Post-transplantation anti-A/B antibody titers were also lower in the rituximab group than in the rituximab-free group. There was no significant difference in the incidence of adverse events, including infections, between the two groups. CONCLUSION In ABOi kidney transplantation patients with low anti-A/B antibody titers, the desensitization protocol with a single dose of 100 mg rituximab was effective in preventing acute AMR without increasing the risk of other adverse events.
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Affiliation(s)
- Manabu Okada
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yuki Hasegawa
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Transplant Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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14
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Fukuhara H, Nawano T, Kanda A, Tomosugi T, Okada M, Futamura K, Hiramitsu T, Takeda A, Tsuchiya N, Goto N, Narumi S, Watarai Y. Short-term outcomes of second kidney transplantation compared with those of first transplantation in Japanese patients: a single-center, retrospective, observational study. Clin Exp Nephrol 2023; 27:188-196. [PMID: 36318396 DOI: 10.1007/s10157-022-02290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Among patients who undergo kidney transplantation, a subsequent second kidney transplantation (TX2) is often necessary. The TX2 outcomes remain controversial, however, and only limited data are available on clinical outcomes of TX2 in Japanese patients. This study aimed to assess graft and patient survival rates of TX2 and compared these rates with those of first kidney transplantation (TX1) in Japanese patients. METHODS Of the 898 kidney transplantations performed between 2010 and 2019 at our institution, 33 were TX2. We performed survival analysis using weighted Kaplan-Meier analysis and Cox proportional hazards analysis with propensity score matching, specifically inverse probability of treatment weighting (IPTW). RESULTS Death-censored graft survival (DCGS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.3, 97.9, and 95.0% versus 100, 96.0, and 91.2%, respectively. Overall survival (OS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.4, 98.9, and 97.8% versus 100, 100, and 94.4%, respectively. Using the log-rank test, IPTW-weighted Kaplan-Meier curves showed no significant differences for TX1 versus TX2 in DCGS (p = 0.535) and OS (p = 0.302). On Cox proportional hazards analysis for TX2 versus TX1, the IPTW-adjusted hazard ratio (HR) for DCGS was 1.75 (95% CI, 0.28-10.9; p = 0.550) and for OS was 2.71 (95% CI, 0.40-18.55; p = 0.311). CONCLUSIONS For patients who require TX2, this treatment is an acceptable option based on the short-term outcomes data for DCGS and OS.
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Affiliation(s)
- Hiroki Fukuhara
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan. .,Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan.
| | - Takaaki Nawano
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Akiko Kanda
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Toshihide Tomosugi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Manabu Okada
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Kenta Futamura
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Takahisa Hiramitsu
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan
| | - Norihiko Goto
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Shunji Narumi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Yoshihiko Watarai
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
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15
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Yonishi H, Nishizawa K, Futamura K, Goto N, Nishikawa T, Nobata M, Imai M, Hasegawa Y, Tanaka K, Okada M, Hiramitsu T, Ichimori T, Narumi S, Watarai Y. Collaboration with surrounding medical institutions in the treatment of severe acute respiratory syndrome coronavirus-2-infected kidney transplant recipients using a smartphone application. Transpl Infect Dis 2022; 24:e13992. [PMID: 36349713 PMCID: PMC9877781 DOI: 10.1111/tid.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroaki Yonishi
- Department of Transplant NephrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Keitaro Nishizawa
- Department of Transplant NephrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Kenta Futamura
- Department of Transplant NephrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Norihiko Goto
- Department of Transplant NephrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Tomoko Nishikawa
- Department of NursingJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Mayumi Nobata
- Department of NursingJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Mitoko Imai
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Yuki Hasegawa
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Kei Tanaka
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Manabu Okada
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Takahisa Hiramitsu
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Toshihiro Ichimori
- Department of Endocrine SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Shunji Narumi
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Yoshihiko Watarai
- Department of Transplant SurgeryJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
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16
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Ogasa T, Nakagawa Y, Isotani S, Futamura K, Okada M, Hiramitsu T, Goto N, Narumi S, Watarai Y. Angioplasty or sacrifice is better in multiple renal artery grafts: a computed tomography image analysis study. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-4242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Taiki Ogasa
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Kenta Futamura
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplantation Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
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17
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Intraoperative intact parathyroid hormone monitoring and frozen section diagnosis are essential for successful parathyroidectomy in secondary hyperparathyroidism. Front Med (Lausanne) 2022; 9:1007887. [PMID: 36419788 PMCID: PMC9676982 DOI: 10.3389/fmed.2022.1007887] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/25/2022] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Total parathyroidectomy (PTx) is often performed to treat secondary hyperparathyroidism (SHPT). Successful PTx is essential to prevent recurrent and persistent SHPT because remnant parathyroid glands (PTGs) in the neck can be stimulated and may secrete excessive parathyroid hormone (PTH) in end-stage renal disease. However, to date, few studies have investigated factors contributing to successful PTx before the completion of surgery. MATERIALS AND METHODS Between August 2010 and February 2020, 344 patients underwent total PTx, transcervical thymectomy, and forearm autograft for SHPT at our institute. Factors contributing to successful PTx before the completion of surgery were investigated. Preoperative imaging diagnoses, including computed tomography, ultrasonography, technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy, intraoperative intact PTH (IOIPTH) monitoring, and frozen section histologic diagnosis, were performed. Successful PTx was defined as intact PTH level < 60 pg/mL on postoperative day 1. A sufficient decrease in IOIPTH level was defined as > 70% decrease in intact PTH levels measured 10 min after total PTx and transcervical thymectomy compared to intact PTH levels measured before skin incision. Logistic regression analysis was conducted to investigate factors contributing to PTx success. RESULTS Univariate analysis showed that the number of all PTGs identified preoperatively by imaging modalities and the specimens submitted for frozen section diagnosis, which surgeon presumed to be PTGs, were not significant factors contributing to successful PTx. However, multivariate analysis revealed that the number of PTGs identified by frozen section diagnosis (P < 0.001, odds ratio [OR] 4.356, 95% confidence interval [CI] 2.499-7.592) and sufficient decrease in IOIPTH levels (P = 0.001, OR 7.847, 95% CI 2.443-25.204) significantly contributed to successful PTx. CONCLUSION Sufficient intact PTH level decrease observed on IOIPTH monitoring and the number of PTGs identified by frozen section diagnosis contributed to successful PTx for SHPT. IOIPTH monitoring and frozen section diagnosis are essential for achieving successful PTx for SHPT.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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18
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Higuchi Y, Tomosugi T, Futamura K, Okada M, Kusano T, Sawada H, Kobayashi K, Narumi S, Watarai Y, Goto N, Ando T, Sato K. Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients. J Bone Miner Metab 2022; 40:968-973. [PMID: 36001151 DOI: 10.1007/s00774-022-01360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/11/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Risk factors associated with subchondral insufficiency fracture (SIF) of the femoral head have not been established. The aim of the present study was to determine the incidence and risk factors for SIF of the femoral head following renal transplantation (RT). MATERIALS AND METHODS We analyzed the cases of 681 RT patients (mean age at surgery: 49.5 ± 13.6 years, 249 women, 432 men) to determine the incidence of SIF. Hip magnetic resonance imaging (MRI) was performed 6 months post-RT. The following potential predictors of SIF were evaluated: (1) patient's condition at RT: bone mineral density (BMD), pre-RT laboratory values including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone; the patient and donor's blood relationship; and mismatching number of human leukocyte antigens (HLAs), and (2) post-RT dosage(s) of steroid(s), the immunosuppressive regimen, and the incidence of acute rejection. RESULTS SIF was observed in 15 hips (13 patients, 1.9%). We successfully matched 39 patients without SIF. A multivariate logistic regression analysis adjusted for cumulative dosages of steroids, revealed the following were risk factors for SIF: osteoporosis (OR: 11.4, p = 0.046), lumbar BMD (OR: 0.003, p = 0.038), pre-RT serum P (OR 2.68, p = 0.004), and pre-RT serum Ca × P (OR: 1.11, p = 0.005). CONCLUSION Since osteoporosis, the lumbar BMD, serum P, and serum Ca × P were identified as risk factors for a post-RT SIF, these factors should be evaluated before RT for the prediction of the SIF risk.
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Affiliation(s)
- Yoshitoshi Higuchi
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan.
| | - Toshihide Tomosugi
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Kenta Futamura
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Manabu Okada
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Taiki Kusano
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Hideyoshi Sawada
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Kazuyoshi Kobayashi
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Shunji Narumi
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Yoshihiko Watarai
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Norihiko Goto
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Toshihiro Ando
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Koji Sato
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
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19
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Natsumeda M, Matsuzawa H, Watanabe M, Motohashi K, Gabdulkhaev R, Tsukamoto Y, Kanemaru Y, Watanabe J, Ogura R, Okada M, Kurabe S, Okamoto K, Kakita A, Igarashi H, Fujii Y. SWI by 7T MR Imaging for the Microscopic Imaging Diagnosis of Astrocytic and Oligodendroglial Tumors. AJNR Am J Neuroradiol 2022; 43:1575-1581. [PMID: 36229164 PMCID: PMC9731250 DOI: 10.3174/ajnr.a7666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Despite advances in molecular imaging, preoperative diagnosis of astrocytomas and oligodendrogliomas can be challenging. In the present study, we assessed whether 7T SWI can be used to distinguish astrocytomas and oligodendrogliomas and whether malignant grading of gliomas is possible. MATERIALS AND METHODS 7T SWI was performed on 21 patients with gliomas before surgery with optimization for sharp visualization of the corticomedullary junction. Scoring for cortical thickening and displacement of medullary vessels, characteristic of oligodendroglial tumors, and cortical tapering, characteristic of astrocytic tumors, was performed. Additionally, characteristics of malignancy, including thickening of the medullary veins, the presence of microbleeds, and/or necrosis were scored. RESULTS Scoring for oligodendroglial (highest possible score, +3) and astrocytic (lowest score possible, -3) characteristics yielded a significant difference between astrocytomas and oligodendrogliomas (mean, -1.93 versus +1.71, P < .01). Scoring for malignancy was significantly different among the World Health Organization grade II (n = 10), grade III (n = 4), and grade IV (n = 7) tumors (mean, 0.20 versus 1.38 versus 2.79). Cortical thickening was observed significantly more frequently in oligodendrogliomas (P < .02), with a sensitivity of 71.4% and specificity of 85.7%; observation of tapering of the cortex was higher in astrocytomas (P < .01) with a sensitivity of 85.7% and specificity of 100%. CONCLUSIONS Visualization of the corticomedullary junction by 7T SWI was useful in distinguishing astrocytomas and oligodendrogliomas. Observation of tapering of the cortex was most sensitive and specific for diagnosing astrocytomas. Reliably predicting malignant grade was also possible by 7T SWI.
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Affiliation(s)
- M Natsumeda
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - H Matsuzawa
- Center for Integrated Human Brain Science (H.M., M.W., H.I.)
| | - M Watanabe
- Center for Integrated Human Brain Science (H.M., M.W., H.I.)
| | - K Motohashi
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | | | - Y Tsukamoto
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - Y Kanemaru
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - J Watanabe
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - R Ogura
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - M Okada
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - S Kurabe
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
| | - K Okamoto
- Department of Translational Research (K.O.), Brain Research Institute, Niigata University, Niigata, Japan
| | - A Kakita
- Department of Pathology (R.G., A.K.)
| | - H Igarashi
- Center for Integrated Human Brain Science (H.M., M.W., H.I.)
| | - Y Fujii
- From the Department of Neurosurgery (M.N., K.M., Y.T., Y.K., J.W., R.O., M.O., S.K., Y.F.)
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20
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Hiramitsu T, Tomosugi T, Futamura K, Okada M, Goto N, Ichimori T, Narumi S, Uchida K, Watarai Y. Hand port-site infection after hand-assisted laparoscopic donor nephrectomy for living-donor kidney transplantation: a retrospective cohort study. PeerJ 2022; 10:e14215. [PMID: 36275464 PMCID: PMC9583851 DOI: 10.7717/peerj.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Hand-assisted laparoscopic donor nephrectomy (HALDN) is widely performed to minimize burden on living kidney donors. However, hand port-site infections after HALDN may occur. This study aimed to assess the impact of donor characteristics including preoperative comorbidities and operative factors on hand port-site infection after HALDN. Methods In this single-center, retrospective cohort study, 1,260 consecutive HALDNs for living-donor kidney transplantation performed between January 2008 and December 2021 were evaluated. All living donors met the living kidney donor guidelines in Japan. Hand port-site infections were identified in 88 HALDN cases (7.0%). To investigate risk factors for hand port-site infection, donor characteristics including preoperative comorbidities such as hypertension, glucose intolerance, dyslipidemia, obesity, and operative factors such as operative duration, blood loss, preoperative antibiotic prophylaxis, and prophylactic subcutaneous suction drain placement at the hand port-site were analyzed using logistic regression analysis. Results In the multivariate analysis, significant differences were identified regarding sex (P = 0.021; odds ratio [OR], 1.971; 95% confidence interval [CI], 1.108-3.507), preoperative antibiotic prophylaxis (P < 0.001; OR, 0.037; 95% CI [0.011-0.127]), and prophylactic subcutaneous suction drain placement at the hand port-site (P = 0.041; OR, 2.005; 95% CI [1.029-3.907]). However, a significant difference was not identified regarding glucose intolerance (P = 0.572; OR, 1.148; 95% CI [0.711-1.856]). Preoperative comorbidities may not cause hand port-site infections within the donors who meet the living kidney donor guidelines. Preoperative antibiotic prophylaxis is crucial in preventing hand port-site infection, whereas prophylactic subcutaneous suction drain placement may increase the risk of hand port-site infection.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
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21
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Oka T, Koyama Y, Inoue K, Tanaka N, Tanaka K, Hirao Y, Okada M, Okamura A, Iwakura K, Fujii K, Masuda M, Watanabe T, Sunaga A, Hikoso S, Sakata Y. Extensive ablation strategy for persistent atrial fibrillation impairs left atrial function but reduces recurrence rate. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In catheter ablation for persistent atrial fibrillation (AF), extensive ablation strategy, such as linear ablation and/or complex fractionated atrial electrogram (CFAE) ablation in addition to pulmonary vein isolation (PVI-plus), might impair left atrial function more severely than PVI-alone strategy.
Purpose
The aim of this study is to investigate the impact of extensive ablation strategy on LA function and assess the relationship between post-ablation LA function and recurrence.
Methods
This study is a post-hoc subanalysis of the EARNEST-PVI randomized controlled trial, which investigated the efficacy of the PVI-alone strategy in comparison with PVI-plus strategy for persistent AF. From the 497 participants of EARNEST-PVI trial, we enrolled 191 patients with full datasets of pre- and post-ablation cardiac computed tomography (CT) at our Hospital. Patients were divided into PVI-alone and PVI-plus groups. Within one month before and 3 months after ablation, LA volume index (LAVI) and LA emptying fraction (LAEF) were calculated by using the Comprehensive Cardiac Analysis software on the Extended Brilliance Workspace. We assessed i) post-ablation LA function, ii) AF/atrial tachycardia (AT) -free rate after single and final session, and iii) relationship between post-ablation LAEF and ablation success in each group.
Results
The indices of baseline LA remodeling were not different between PVI-alone (N=96) and PVI-plus groups (N=95) [LAVI: 71.4 (57.8, 82.0) vs. 68.7 (61.0, 78.1), P=0.92, LAEF: 13.7 (10.0, 17.4) vs. 13.0 (10.0, 16.9), PVI-alone vs. PVI-plus, P=0.78]. In overall patients, post-ablation LAEF did not differ among them [34.4 (26.1, 40.7) vs. 31.6 (26.0, 37.4), P=0.13]. In the analysis of patients showing sinus rhythm during the CT study, LAEF was significantly higher in PVI-alone (N=87) than in PVI-plus group (N=93) [35.7 (29.0, 41.0) vs. 31.7 (26.1, 37.5), P=0.011] (Figure 1A). AF/AT-free survival rate during median follow-up of 44 months was not different after first session (63.5% vs. 68.4%, P=0.33), while PVI-plus had a tendency towards higher success rate after final session (72.9% vs. 84.2%, P=0.053) (Figure 2). In receiver operating characteristics analysis for recurrence after first session, post-ablation decreased LAEF had significantly related to recurrence after PVI-alone (AUC: 0.733, P<0.0001), but not after PVI-plus (AUC: 0.567, P=0.31) (Figure 1B, C).
Conclusion
Compared with PVI-alone strategy, PVI-plus strategy damaged LA function more severely, but tended to be related to higher success rate. Post-ablation LA function was related to recurrence in PVI-alone, but not in PVI-plus. Extensive ablation might have additional anti-arrhythmic effect regardless of iatrogenic myocardial damage. Myocardial injury by extensive ablation may less attribute to recurrence than intrinsic damage of LA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Oka
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Inoue
- National Hospital Organization Osaka National Hospital , Osaka , Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - M Masuda
- Kansai Rosai Hospital , Amagasaki , Japan
| | - T Watanabe
- Osaka General Medical Center , Osaka , Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
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22
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Iwakura K, Onishi T, Okamura A, Koyama Y, Hirao Y, Tanaka K, Iwamoto M, Tanaka N, Okada M, Watanabe H, Nakatani D, Hikoso S, Sakata Y, Sakata Y. Development of the new risk score to predict occurrence of atrial fibrillation early after acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
New onset of atrial fibrillation (AF) is associated with adverse short- and long-term outcomes after acute myocardial infarction (AMI), and its prediction is relevant for the risk stratification in patients with AMI. Although several risk scores were developed for AF in the general population, there is no established risk score for AF occurrence after AMI.
Purpose
To develop a risk score to predict occurrence of AF early after AMI.
Methods
We enrolled consecutive 751 patients with AMI who admitted to our hospital between April 2006 and September 2012 for the present study. New occurrence of AF was defined as AF detected during hospital stay in a patient showing normal regular sinus rhythm at admission. Parameters relevant to the occurrence of AF was selected from the clinical characteristics, physical status and blood test data at admission, and peak CK/CK-MB, by stepwise logistic regression analysis. We constructed a risk score model to predict the new occurrence of AF, using selected parameters and their logistic regression coefficients. C-statistics was determined by constructing a receiver operating characteristic curve to evaluate the accuracy of the risk score for prediction of AF occurrence.
Results
We excluded 48 patients (6.4%) who had AF at admission, and 208 patients without sufficient data at admission, and thus, the study group consisted of 459 patients (age; 65±13 years, male gender; 79.6%). New AF occurrence was observed in 72 patients (14.5%). The following 7 parameters was selected as parameters related with AF (as p<0.1); Inferior/posterior AMI, use of β blockers, use of diuretics, single vessel disease, absence of reperfusion therapy, systolic blood pressure (sBP) at admission, and smoking. One point was given to sBP>128mmHg, 2 points to absence of reperfusion, and one point to other parameters. Sum of these points was calculated as the AF risk score (Table 1). AF occurred in 27.1% of patients with ≥5 points whereas it was observed 5.2% of those with <5 points. C-statistics of the risk score was 0.75 (95% CI 0.68–0.83).
Conclusion
We developed a novel risk score to estimate the risk of AF occurrence early after AMI, which can be a useful tool for the risk stratification after AMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Iwakura
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - M Iwamoto
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - H Watanabe
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - Y Sakata
- National Cerebral and Cardiovascular Center Hospital, Department of Clinical Medicine and Development , Osaka , Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
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23
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Suetani Y, Iida Y, Hirose K, Shichijo K, Yamamoto S, Fukui T, Kuramoto M, Arita Y, Saeki H, Miyoshi M, Okada M, Ogasawara N. Urine osmolality predicts worsening renal function and poor prognosis in acute decompensated heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Purpose
Worsening renal function (WRF) can sometimes occur in the patients with acute decompensated heart failure (ADHF) and increase the risk of morbidity and mortality (1). In a previous study, it was reported that fractional excretion of sodium (FENa) reflects net sodium reabsorption from nephron segments and predicts WRF during treating ADHF (2). On the other hand, recently the new drugs which approach urine concentration mechanism and affect urine osmolality (U-OSM), such as tolvaptan and sodium-glucose cotransporter-2 inhibitor, have begun to be widely used as treatment of heart failure. Thus, we focused on U-OSM, which reflects not only sodium handling but also water excretion controlled by the collecting duct, and evaluated the association between WRF and U-OSM. Moreover, previous studies have demonstrated that FENa, fractional excretion of urea nitrogen and transtubular potassium concentration gradient are markers for long-term prognosis in patients with ADHF (3–5). Therefore, we also studied whether U-OSM can predict prognosis in ADHF.
Methods
A total of 157 patients admitted to our hospital because of a primary diagnosis of ADHF from February 2020 through July 2021 were retrospectively reviewed. U-OSM in the spot urinary samples were examined within 72 hours after admission. U-OSM was calculated based on the following validated formula (6): U-OSM = 1.07 × {2 × [urine sodium (mEq/L)] + [urine urea nitrogen (mg/dL)]/2.8 + [urine creatinine (mg/dl)] × 2/3} + 16.2. The primary outcome was the occurrence of WRF during hospitalization. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline (7). The secondary outcome was the occurrence of ADHF readmission and all-cause death within 180 days after discharge.
Results
Primary Outcome. WRF developed in 46% of all patients. In the patients that developed WRF during hospitalization, U-OSM was significantly lower than in the patients without WRF (366±106 mOsm/L versus 430±128 mOsm/L; P<0.001). Receiver operating characteristic curve analysis revealed the optimal cutoff values of U-OSM was 403 mOsm/L (AUC 0.64; 95% CI: 0.56–0.72; P<0.001) to predict the WRF (Figure 1). On multivariable logistic regression analysis, U-OSM (OR, 1.99, 95% CI: 1.27–3.12; p=0.003) and serum creatinine (OR, 1.00, 95% CI: 0.99–1.00; P=0.009) were independent predictors of WRF.
Secondary Outcome. There were 34 patients (22%) readmitted and 9 patients (6%) died within 180 days after discharge. ROC curve analysis revealed the optimal cutoff values of U-OSM as 349 mOsm/L (C-statistic 0.74; 95% CI: 0.65–0.83; P<0.001) to predict ADHF readmission and all-cause death within 180 days (Figure 2A). On Kaplan-Meier analysis, the secondary outcome was significantly higher in patients with U-OSM<349 mOsm/L (u-OSM≥349, 57%, U-OSM<349, 43%; HR, 0.99; 95% CI: 0.99–1.00, P<0.001) (Figure 2B).
Conclusion
U-OSM on admission may be a predictor of WRF and a prognostic marker in ADHF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Suetani
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - Y Iida
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - K Hirose
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - K Shichijo
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - S Yamamoto
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - T Fukui
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Kuramoto
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - Y Arita
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - H Saeki
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Miyoshi
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Okada
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - N Ogasawara
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
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24
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Tanaka N, Okada M, Tanaka K, Harada S, Kawahira M, Hirao Y, Onishi T, Koyama Y, Fujii K, Watanabe H, Okamura A, Iwakura K. Untreated sleep apnea and left atrial dilatation in patients with atrial fibrillation prior to catheter ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sleep apnea and left atrial dilatation are both risk factors for an arrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF). Negative intrathoracic pressure fluctuations during an obstructive apnea episode may cause the left atrium to distend and stretch its wall. Whether sleep apnea is associated with left atrial dilatation in patients receiving CA of AF remains unknown.
Purpose
We sought to elucidate whether moderate or severe untreated sleep apnea was associated with left atrial dilatation in patients with AF before CA.
Methods
This study was conducted under a retrospective, single-center, observational design. The data were derived from screening tests for sleep apnea, which were routinely performed in patients scheduled to receive CA of AF in our institution. After excluding patients who were already diagnosed with sleep apnea, we enrolled 1265 consecutive patients (age 65±11 years, 27.8% females, and 46.2% of non-paroxysmal AF) who underwent both home sleep apnea testing and multidetector computed tomography (MDCT) before the CA of AF. The severity of the sleep apnea was evaluated by the apnea-hypopnea index (AHI) using a watch-type peripheral arterial tonometry. Left atrial dilatation was evaluated by the left atrial maximum volume (LA max V) using 256-slice MDCT.
Results
The age was 65±11 years, 27.8% were females, and 46.2% had non-paroxysmal AF. The mean AHI was 20.3±15.3 and LA max V 105±34 ml (R2=0.075, p<0.0001). LA dilatation was defined by larger than mean LA max V (LA max V≥105 ml). We examined an LA max V≥105 ml as a predictor. After an adjustment by an advanced age (≥65 years), non-paroxysmal AF, male sex, obesity, hypertension, and congestive heart failure, all of which were significant predictors of an LA max V≥105ml in the univariate analysis, moderate or severe sleep apnea (AHI≥15) was a significant predictor of an LA max V≥105 ml (odds ratio 1.63, 95% confidence interval 1.24–2.14, p=0.0005).
Conclusion
Among the patients scheduled to receive catheter ablation of AF, moderate or severe sleep apnea was independently associated with left atrial dilatation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - S Harada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - M Kawahira
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - H Watanabe
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
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25
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Tanaka N, Inoue K, Hirao Y, Koyama Y, Okamura A, Iwakura K, Okada M, Tanaka K, Kobori A, Kaitani K, Morimoto T, Morishima I, Kusano K, Kimura T, Shizuta S. Sex differences in terms of recurrent atrial fibrillation after catheter ablation according to the history of heart failure: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There are significant differences in the prevalence and prognosis of cardiovascular diseases between male and female. We previously reported that catheter ablation (CA) of atrial fibrillation (AF) was less effective in female than male, but whether their history of heart failure influence the recurrence after CA of AF remains still unknown.
Purpose
We sought to clarify sex differences in terms of AF recurrence after RFCA of AF according to the history of heart failure.
Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.
Results
Fourteen % of female had a history of heart failure prior to CA, while 12.8% of male had a history of heart failure at baseline (p=0.29). The 3-year cumulative incidence of AF recurrence after a single procedure was 43.3% in female and 39.0% in male (log rank P=0.0046). In patients with the history of heart failure, AF recurrence rates were 42.2% in female and 45.8% in male (log rank P=0.51). On the other hand, in patients without history of heart failure, more females experienced AF recurrence (female vs. male, 43.5% vs. 38.0%, log rank P=0.001).
The rate of AF recurrence after multiple procedures was higher in female (24.2% vs. 19.6%, log rank P<0.0001). AF recurrence rates were similar between sexes in patients with history of heart failure (female vs. male, 26.0% vs. 26.7%, log rank P=0.86), while AF recurrence rates were higher in female without history of heart failure than those in male (females vs. males, 23.9% vs. 18.5%, log rank P<0.0001).
Conclusion
The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the AF recurrence after CA of AF. Females had higher recurrence rates compared with males in patients without history of heart failure, while recurrence rates were similar between sexes in patients with history of heart failure.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Kobori
- Kobe City Medical Center General Hospital , Kobe , Japan
| | - K Kaitani
- Japanese Red Cross Otsu Hospital , Otsu , Japan
| | - T Morimoto
- Hyogo Medical University , Nishinomiya , Japan
| | | | - K Kusano
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine , Kyoto , Japan
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26
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Hiramitsu T, Tomosugi T, Okada M, Futamura K, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Preservation of the nonrecurrent laryngeal nerve using intraoperative nerve monitoring during endoscopic thyroidectomy. Asian J Endosc Surg 2022; 15:828-831. [PMID: 35570683 DOI: 10.1111/ases.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
A 40-year-old woman underwent right lobe thyroidectomy for thyroid nodules that increased in size from 17 mm to 33.5 mm within 1 year. Identification of arteria lusoria using computed tomography suggested the presence of a right nonrecurrent laryngeal nerve (RNRLN). Endoscopic thyroidectomy was performed under general anesthesia. The right vagal nerve was first identified between the common carotid artery and jugular vein. A positive response was confirmed via intraoperative neuromonitoring (IONM), implying that the RNRLN did not branch from the central side of the stimulated point of the vagal nerve. The RNRLN was confirmed using IONM around the middle to lower pole of the right thyroid gland. The right thyroid lobe was successfully removed, with meticulous preservation of the RNRLN. The motion of the vocal cord, examined by an ear-nose-throat doctor postoperatively, was intact. We demonstrated the efficacy of IONM in patients with RNRLN who underwent endoscopic thyroidectomy.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
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27
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Kyoda Y, Kimura M, Shimizu T, Miyao N, Ogasawara T, Shimizu T, Iwasawa A, Yorozuya W, Hashimoto J, Ichihara K, Takei F, Uchida K, Kouzen N, Suzuki N, Tachikawa K, Shibuya A, Muranaka I, Okada M, Igarashi M, Shibamori K, Nofuji S, Fujino K, Toyota T, Ito Y, Shinkai N, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. Efficacy and safety of desmopressin orally disintegrating tablets 25 and 50 μg in male patients with nocturia: A Japanese real‐world multicenter clinical study. Low Urin Tract Symptoms 2022; 14:410-415. [DOI: 10.1111/luts.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Kyoda
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
- Nemuro City Hospital Nemuro Japan
- Yakumo General Hospital Yakumo Japan
- Hokkaido Prefectural Haboro Hospital Haboro Japan
- Rumoi Municipal Hospital Rumoi Japan
| | | | | | | | - Takuto Ogasawara
- Department of Urology Steel Memorial Muroran Hospital Muroran Japan
| | | | | | - Wakako Yorozuya
- Department of Urology Kushiro Red Cross Hospital Kushiro Japan
| | - Jiro Hashimoto
- Teine Urological Clinic Sapporo Japan
- Teine Ekimae Urological Clinic Sapporo Japan
| | - Koji Ichihara
- Department of Urology Sapporo Central Hospital Sapporo Japan
| | - Fumiyasu Takei
- Tokachi Urological Clinic Otofuke Japan
- Obihiro Urological Clinic Obihiro Japan
| | | | - Nodoka Kouzen
- Department of Urology JCHO Hokkaido Medical Center Sapporo Japan
| | | | | | | | - Ippei Muranaka
- Department of Urology Hokkaido Social Work Association Obihiro Hospital Obihiro Japan
| | - Manabu Okada
- Department of Urology Hokkaido Social Work Association Obihiro Hospital Obihiro Japan
| | | | - Kosuke Shibamori
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
- Kuriyama Red Cross Hospital Kuriyama Japan
- Hokkaido Social Work Association Toya Hospital Toyako Japan
- JCHO Noboribetsu Medical Center Noboribetsu Japan
| | - Seisuke Nofuji
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
- Kuriyama Red Cross Hospital Kuriyama Japan
- Hokkaido Social Work Association Toya Hospital Toyako Japan
- JCHO Noboribetsu Medical Center Noboribetsu Japan
| | - Keiko Fujino
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
- Kuriyama Red Cross Hospital Kuriyama Japan
- Hokkaido Social Work Association Toya Hospital Toyako Japan
- JCHO Noboribetsu Medical Center Noboribetsu Japan
| | - Tomohiro Toyota
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yu Ito
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Nobuo Shinkai
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Kohei Hashimoto
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Ko Kobayashi
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Toshiaki Tanaka
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
| | - Naoya Masumori
- Department of Urology Sapporo Medical University School of Medicine Sapporo Japan
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28
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Yajima A, Tsuchiya K, Kuro-O M, Urena P, Tominaga Y, Okada M, Ichimori T, Tomosugi T, Hiramitsu T, Murata T, Nakamura M, Sasaki M, Ito A, Nitta K. Renal hyperparathyroidism. Vitam Horm 2022; 120:305-343. [PMID: 35953115 DOI: 10.1016/bs.vh.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The number of the patients with chronic kidney disease is now increasing in the world. The pathophysiology of renal hyperparathyroidism is closely associated with Klotho-FGF-endocrine axes, which must be solved definitively as early as possible. It was revealed that the expression of fgf23 is activated by calciprotein particles, which induces vascular ossification. And it is well known that phosphorus overload directly increases parathyroid hormone and hyperparathyroid bone disease develops in those subjects. On the other hand, low turnover bone disease is often recently. Both the patients with chronic kidney disease suffering from hyperparathyroid bone disease or low turnover bone disease are associated with increased fracture risk. Micropetrosis may be one of the causes of increased fracture risk in the subjects with low turnover bone disease. In this chapter, we now describe the diagnosis, pathophysiology and treatments of renal hyperparathyroidism.
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Affiliation(s)
- Aiji Yajima
- Department of Anatomy, Cell Biology and Physiology, Indiana University, School of Medicine, Indianapolis, IN, United States; Department of Urology, Tokyo, Teishin Hospital, Tokyo, Japan; Department Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ken Tsuchiya
- Department Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Pablo Urena
- Division of Nephrology, Clinique du Landy, Saint Ouen, France
| | - Yoshihiro Tominaga
- Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshihide Tomosugi
- Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Taro Murata
- Department of Urology, Tokyo, Teishin Hospital, Tokyo, Japan
| | - Masaki Nakamura
- Department of Nephrology and Urology, NTT East Kanto Hospital, Tokyo, Japan
| | - Masahiko Sasaki
- Department of Urology, Tokyo, Teishin Hospital, Tokyo, Japan
| | - Akemi Ito
- Ito Bone Histomorphometry Institute, Niigata, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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29
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Okada M, Tominaga Y, Sato T, Tomosugi T, Futamura K, Hiramitsu T, Ichimori T, Goto N, Narumi S, Kobayashi T, Uchida K, Watarai Y. Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia. BMC Nephrol 2022; 23:212. [PMID: 35710357 PMCID: PMC9205154 DOI: 10.1186/s12882-022-02840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hypercalcemic hyperparathyroidism has been associated with poor outcomes after kidney transplantation (KTx). However, the clinical implications of normocalcemic hyperparathyroidism after KTx are unclear. This retrospective cohort study attempted to identify these implications. Methods Normocalcemic recipients who underwent KTx between 2000 and 2016 without a history of parathyroidectomy were included in the study. Those who lost their graft within 1 year posttransplant were excluded. Normocalcemia was defined as total serum calcium levels of 8.5–10.5 mg/dL, while hyperparathyroidism was defined as when intact parathyroid hormone levels exceeded 80 pg/mL. The patients were divided into two groups based on the presence of hyperparathyroidism 1 year after KTx. The primary outcome was the risk of graft loss. Results Among the 892 consecutive patients, 493 did not have hyperparathyroidism (HPT-free group), and 399 had normocalcemic hyperparathyroidism (NC-HPT group). Ninety-five patients lost their grafts. Death-censored graft survival after KTx was significantly lower in the NC-HPT group than in the HPT-free group (96.7% vs. 99.6% after 5 years, respectively, P < 0.001). Cox hazard analysis revealed that normocalcemic hyperparathyroidism was an independent risk factor for graft loss (P = 0.002; hazard ratio, 1.94; 95% confidence interval, 1.27–2.98). Conclusions Normocalcemic hyperparathyroidism 1 year after KTx was an independent risk factor for death-censored graft loss. Early intervention of elevated parathyroid hormone levels may lead to better graft outcomes, even without overt hypercalcemia. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02840-5.
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Affiliation(s)
- Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan.
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Tetsuhiko Sato
- Department of Diabetes and Endocrinology, Japanese Red Cross Nagoya Daini Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
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30
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Okada M, Hiramitsu T, Futamura K, Norihiko G, Narumi S, Watarai Y, Ichimori T. MO1002: Two-Step Desensitization Protocol Consisting of High-Dose Intravenous Immunoglobulin, Plasmapheresis and Rituximab in Highly Sensitized Kidney Transplantation. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac088.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
High-dose intravenous immunoglobulin (IVIG) therapy has not only immediate effects but also gradual effects via Fc receptors. To optimize IVIG therapy, we adopted a two-step desensitization protocol in kidney transplantation (KTx) with positive flow cytometry crossmatch (FCXM).
METHOD
In the first step, rituximab 200 mg and IVIG 2 g/kg were administered 2 months before KTx. In the second step, patients received additional rituximab 200 mg and IVIG 2g/kg for 2 weeks prior to transplantation in combination with plasmapheresis.
RESULTS
Of the six KTx with positive FCXM, there was no rejection except one (16.7%) subclinical antibody-mediated rejection within 1 month after transplantation. Average graft function was acceptable (serum creatinine level of 1.17 mg/dL).
CONCLUSION
The two-step desensitization protocol is an effective option for achieving successful transplant outcomes in KTx with positive FCXM, which can spare more aggressive and expensive treatments, such as C5 inhibitors, proteasome inhibitors and imlifidase.
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Affiliation(s)
- Manabu Okada
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Goto Norihiko
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
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31
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Tasaki M, Tateno H, Sato T, Tomioka A, Kaji H, Narimatsu H, Saito K, Nakagawa Y, Aoki T, Kamimura M, Ushiki T, Okada M, Miwa Y, Hotta K, Yoshida Y, Takahashi K, Tomita Y. A Novel Method of CD31-Combined ABO Carbohydrate Antigen Microarray Predicts Acute Antibody-Mediated Rejection in ABO-Incompatible Kidney Transplantation. Transpl Int 2022; 35:10248. [PMID: 35401036 PMCID: PMC8985549 DOI: 10.3389/ti.2022.10248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/16/2022] [Indexed: 12/22/2022]
Abstract
Isohemagglutinin assays employing red blood cells (RBCs) are the most common assays used to measure antibody titer in ABO-incompatible kidney transplantation (ABOi KTx). However, ABO antigens expressed on RBCs are not identical to those of kidney and antibody titers do not always correlate with clinical outcome. We previously reported that CD31 was the main protein linked to ABO antigens on kidney endothelial cells (KECs), which was different from those on RBCs. We developed a new method to measure antibody titer using a microarray of recombinant CD31 (rCD31) linked to ABO antigens (CD31-ABO microarray). Mass spectrometry analysis suggested that rCD31 and native CD31 purified from human kidney had similar ABO glycan. To confirm clinical use of CD31-ABO microarray, a total of 252 plasma samples including volunteers, hemodialysis patients, and transplant recipients were examined. In transplant recipients, any initial IgG or IgM antibody intensity >30,000 against the donor blood type in the CD31-ABO microarray showed higher sensitivity, specificity, positive predictive value, and negative predictive value of AABMR, compared to isohemagglutinin assays. Use of a CD31-ABO microarray to determine antibody titer specifically against ABO antigens expressed on KECs will contribute to precisely predicting AABMR or preventing over immunosuppression following ABOi KTx.
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Affiliation(s)
- Masayuki Tasaki
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroaki Tateno
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Takashi Sato
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Azusa Tomioka
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hiroyuki Kaji
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hisashi Narimatsu
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Kazuhide Saito
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshinari Aoki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masami Kamimura
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takashi Ushiki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Manabu Okada
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yuko Miwa
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagoya, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Yutaka Yoshida
- Department of Structural Pathology, Kidney Research Center, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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32
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Hidaka Y, Goto N, Yamanaga S, Kinoshita K, Tanaka K, Kawabata C, Toyoda M, Tomosugi T, Futamura K, Okada M, Tsujita M, Hiramitsu T, Yokomizo H, Miyata A, Narumi S, Kobayashi T, Watarai Y. Two-Year Outcomes of Low-Exposure Extended-Release Tacrolimus and Mycophenolate Mofetil Regimen in De Novo Kidney Transplantation: A Multi-center Randomized Controlled Trial. Clin Transplant 2022; 36:e14655. [PMID: 35343620 DOI: 10.1111/ctr.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Once-daily extended-release tacrolimus (TACER) is commonly administered following kidney transplantation (KTx); however, its optimal dosage remains unknown. METHODS In this multi-center, randomized controlled trial, 62 living donor KTx recipients were assigned to either standard-exposure (SE; n = 32) or low-exposure (LE; n = 30) TACER (Graceptor®, Astellas Pharm Inc.) groups. All patients received basiliximab and mycophenolate mofetil (MMF). The primary outcomes were acute rejection, graft/patient survival, and the secondary outcomes were incidence of cytomegalovirus infection, and de novo donor-specific antibodies (dnDSA) production. RESULTS The tacrolimus trough level and estimated area under the blood concentration-time curve (eAUC) were significantly higher in SE than in LE (SE vs LE; one year: 5.0 ± 0.9 ng/mL and 206.9 ± 26.8 ngཥh/mL vs 3.4 ± 1.0 ng/mL and 153.9 ± 26.4 ngཥh/mL; two years: 4.8 ± 1.0 ng/mL and 204.9 ± 30.1 ngཥh/mL vs 3.8 ± 0.9 ng/mL and 164.4 ± 27.0 ngཥh/mL). In contrast, the dosage and eAUC of MMF did not differ between groups. Two-year graft and patient survival rates were 100% in both groups, and acute rejection rates were 0% and 10% in the SE and LE, respectively (p = 0.11). The mean estimated glomerular filtration rates did not differ between the groups. Cytomegalovirus infection was slightly lower in the LE (SE: 12.5% and LE: 6.7%, p = 0.37). In the LE, four cases of dnDSA were noted within two years of transplantation; no case was observed in the SE (p = 0.034). CONCLUSIONS Although the LE TACER regimen showed similar rates of acute rejection, as well as graft and patient survival compared with SE after KTx, LE was significantly more associated with dnDSA. Further investigation of its long-term effect on graft survival is warranted. (University Hospital Medical Information Network Clinical Trials Registry ID: UMIN000033089). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.,Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kohei Kinoshita
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Toshihide Tomosugi
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Makoto Tsujita
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akira Miyata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shunji Narumi
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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Okada M, Inoue K, Tanaka N, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Sunaga A, Sotomi Y, Dohi T, Shungo H, Sakata Y. Impact of heart rate reduction on recurrence after catheter ablation of persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK
OnBehalf
OCVC Arrhythmia Investigators
Background
Predicting heart rate (HR) after restoration of sinus rhythm (SR) remains one of the challenges when performing catheter ablation (CA) of persistent atrial fibrillation (AF).
Purpose
To evaluate the association between pre-ablation HR during AF and post-ablation HR during SR, and whether the HR reduction is associated with AF recurrence.
Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. After excluding patients with beta-blocker prescription, a total of 216 patients (median age, 67 years; 20% female; 23% long-standing persistent AF) with AF rhythm at baseline and SR at discharge were enrolled in this study. Baseline HR during AF and post-ablation HR during SR was measured on admission and at discharge using the 12-lead electrocardiograms, respectively.
Results
There was a mild correlation between baseline HR (median 82 [interquartile range 72-95] bpm) and post-ablation HR (78 [48-117] bpm) (r = 0.27, p <0.001). Reduction in HR was positively associated with baseline HR (r = 0.79, p <0.001) and was negatively associated with post-ablation HR (r = - 0.37, p <0.001). During the follow-up of 1 year, 56 patients (25.9%) experienced AF recurrence. HR reduction had the higher diagnostic accuracy in predicting AF recurrence than HR at baseline and HR after CA (area under the curve, 0.625; 95% confidence interval, 0.557–0.690; p = 0.003). AF recurrence rate was significantly higher in 141 patients with smaller HR reduction (cut-off, <14bpm) than those with larger HR reduction (31.9% vs. 14.7%, p = 0.009). After adjustment of age, gender, long-standing persistent AF, and CA strategy, HR reduction of <14 bpm was a significant predictor of AF recurrence (hazard ratio, 2.32; 95% confidence interval, 1.20–4.51; p = 0.013).
Conclusions
There was a mild correlation between HR during AF and HR after restoration of SR in patients underwent CA of persistent AF. HR reduction after restoration of SR predicted AF recurrence.
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Osaka, Japan
| | | | | | - M Miyoshi
- Osaka Kouseinenkin Hospital, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Shungo
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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34
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Tsujita M, Doi Y, Obi Y, Hamano T, Tomosugi T, Futamura K, Okada M, Hiramitsu T, Goto N, Isaka Y, Takeda A, Narumi S, Watarai Y. Cholecalciferol Supplementation Attenuates Bone Loss in Incident Kidney Transplant Recipients: A Prespecified Secondary Endpoint Analysis of a Randomized Controlled Trial. J Bone Miner Res 2022; 37:303-311. [PMID: 34747516 PMCID: PMC9298992 DOI: 10.1002/jbmr.4469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
Vitamin D deficiency, persistent hyperparathyroidism, and bone loss are common after kidney transplantation (KTx). However, limited evidence exists regarding the effects of cholecalciferol supplementation on parathyroid hormone (PTH) and bone loss after KTx. In this prespecified secondary endpoint analysis of a randomized controlled trial, we evaluated changes in PTH, bone metabolic markers, and bone mineral density (BMD). At 1 month post-transplant, we randomized 193 patients to an 11-month intervention with cholecalciferol (4000 IU/d) or placebo. The median baseline 25-hydroxyvitamin D (25[OH]D) level was 10 ng/mL and 44% of participants had osteopenia or osteoporosis. At the end of the study, the median 25(OH)D level was increased to 40 ng/mL in the cholecalciferol group and substantially unchanged in the placebo group. Compared with placebo, cholecalciferol significantly reduced whole PTH concentrations (between-group difference of -15%; 95% confidence interval [CI] -25 to -3), with greater treatment effects in subgroups with lower 25(OH)D, lower serum calcium, or higher estimated glomerular filtration rate (pint < 0.05). The percent change in lumbar spine (LS) BMD from before KTx to 12 months post-transplant was -0.2% (95% CI -1.4 to 0.9) in the cholecalciferol group and -1.9% (95% CI -3.0 to -0.8) in the placebo group, with a significant between-group difference (1.7%; 95% CI 0.1 to 3.3). The beneficial effect of cholecalciferol on LS BMD was prominent in patients with low bone mass pint < 0.05). Changes in serum calcium, phosphate, bone metabolic markers, and BMD at the distal radius were not different between groups. In mediation analyses, change in whole PTH levels explained 39% of treatment effects on BMD change. In conclusion, 4000 IU/d cholecalciferol significantly reduced PTH levels and attenuated LS BMD loss after KTx. This regimen has the potential to eliminate vitamin D deficiency and provides beneficial effects on bone health even under glucocorticoid treatment. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Makoto Tsujita
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.,Department of Kidney Transplantation, Masuko Memorial Hospital, Nagoya, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshitsugu Obi
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Takayuki Hamano
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshihide Tomosugi
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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35
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Hiramitsu T, Tomosugi T, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Adult Living-Donor Kidney Transplantation, Donor Age, and Donor-Recipient Age. Kidney Int Rep 2021; 6:3026-3034. [PMID: 34901571 PMCID: PMC8640566 DOI: 10.1016/j.ekir.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Owing to organ shortage, the number of kidney transplantation (KT) involving older adult living donors is increasing. We aimed to investigate the effects of living-donor age and donor-recipient age differences on KT outcomes. METHODS This single-center, retrospective cohort study involved 853 adult LDKTs performed between January 2008 and December 2018. Recipients were stratified into the following 5 groups based on donor age and donor-recipient age difference: donor age, 30 to 49 years and age difference, -10 to 15 years; donor age, 50 to 69 years and age difference, -10 to 15 years; donor age, 50 to 69 years and age difference, 15 to 40 years; donor age, 70 to 89 years and age difference, -10 to 15 years; and donor age, 70 to 89 years and age difference, 15 to 40 years (groups 1, 2, 3, 4, and 5, respectively). As a primary outcome, the risk of graft loss was investigated. The secondary outcomes were postoperative estimated glomerular filtration rates (eGFRs) and mortality rates of recipients. RESULTS Group 4, representing KT between older adult donors and older adult recipients, had the highest graft loss risk and mortality. The eGFRs of the recipients from donors aged 70 to 89 years (groups 4 and 5) were significantly lower than those from donors in the other groups. Although the differences in the eGFR between groups 4 and 5 were not significant, the eGFR of group 4 was lower than that of group 5 at 6 months post-KT. CONCLUSION LDKTs from older adult donors to older adult recipients resulted in the worst graft survival and mortality rates.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
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36
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Kurosaka S, Honda K, Okada M, Ikura Y, Ishihara Y, Takaura M, Ueda T, Deguchi T, Wang Y, Saeki W, Yanaoka T. Effects of the on-demand SMILE exercise on bone strength and salivary immunoglobulin A. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Okada M, Tanaka N, Tanaka K, Hirao Y, Harada S, Onishi T, Koyama Y, Okamura A, Iwakura K, Fujii K, Inoue K. Association between myocardial wall thickness and left ventricular functional recovery after catheter ablation of atrial fibrillation in patients with reduced ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation of atrial fibrillation (AFCA) is an effective treatment to develop left ventricular (LV) functional recovery. However, the degree of recovery differs between individuals due to the different extent of myocardial fibrosis and scarring.
Purpose
To examine whether pre-ablation LV wall thickness (WT) and its regional heterogeneity predict LV functional recovery after AFCA in patients with LV systolic dysfunction.
Methods
Of 3682 consecutive patients who underwent first-time AFCA between January 2012 and September 2020 in our institution, 174 (age, 63±10 years; male, 83%; ischemic cardiomyopathy, 14%) with a baseline LV ejection fraction (LVEF) of <40% were retrospectively evaluated. They were subjected to 256-slice MDCT scanning at baseline and 3 months after AFCA. Baseline WT was evaluated by 16-segment model. Mean and standard deviation (SD) of 16 regional WT were calculated in both end-systolic and end-diastolic phase.
Results
LVEF significantly improved from 30±7% to 57±17% (p<0.001) after AFCA. Increase in LVEF (delta-LVEF) was positively correlated with baseline end-diastolic WT (r=0.31, p<0.001) and negatively correlated with SD of end-systolic WT (r=−0.21, p=0.007). Independent of WT measurements, delta-LVEF was negatively correlated with LV end-diastolic volume (r=−0.42, p<0.001). We created a scoring system to predict the degree of wall motion recovery using the median value of the 3 variables; assigned 1 point each for end-diastolic WT >7.4mm, SD of end-systolic WT <1.61mm, and LV end-diastolic volume <125ml. The model successfully predicted improvement in LVEF after AFCA (0 point (N=13) vs. 1 point (N=72) vs. 2–3 point (N=89), 11±16% vs. 20±17% vs. 33±12%, p<0.001).
Conclusion
Myocardial WT and its regional heterogeneity as well as LV end-diastolic volume predicted functional recovery after AFCA in patients with reduced LVEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Harada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
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38
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Iwakura K, Onishi T, Sotomi Y, Okada M, Koyama Y, Okamura A, Tamaki S, Yano M, Hayashi T, Yamada T, Yasumura Y, Fujii K, Hikoso S, Sakata Y. Prediction of functional capacity by the HFA-PEFF score in patients with acute decompensated heart failure with preserved ejection fraction: a post-hoc analysis from the PURSUIT-HFpEF registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diagnosing heart failure with preserved ejection fraction (HFpEF) is still challenging, and the H2FPEF- and the HFA-PEFF score were proposed as simple and reliable diagnostic tools. We recently reported that the HFA-PEFF score was significantly associated with the composite endpoint of all-cause death and heart failure readmission in patients with acute decompensated HFpEF (Sotomi. Eur J Heart Fail, in press).
Purpose
To investigate the relation whether the HFA-PEFF or H2FPEF score can evaluate functional capacity in patients with HFpEF
Methods
We calculated H2FPEF score and the second step of HFA-PEFF score among the registered patients in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, which is a multicenter registration of patients hospitalized for acute decompensated HFpEF. We performed 6 minute walk (6MW) test and measured NT-proBNP before discharge. We followed the study patients for median of 360 days (IQR 237–630 days) to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke).
Results
We enrolled 757 patients (age 81±9 years, male gender 45%) hospitalized for acute decompensated HFpEF for the present study. The H2FPEF score was obtained in 588 (77.7%) patients and all patients had ≥2 points. The HFA-PEFF score was obtained in 615 (81.2%) patients, though global longitudinal strain was not available. We divided these patients into 3 groups based on the HFA-PEFF score (score 2 to 4, 5, and 6) or on the H2FPEF score (score 0 to 3, 4 to 5 and 6 to 8). There were a significant difference in NT-pro BNP between 3 groups based on HFA-PEFF score (p=0.01, Table 1), and patients with score 6 had significantly higher NT-proBNP than those with score 2 to 4 (p=0.02). A significant difference was observed in 6MW distance among these groups (p=0.04, Table), and those with score 6 had significantly shorter distance than those with score 2 to 4 (p=0.04). Cox proportional hazard model selected HFA-PEFF score as a significant predictor for MACE, and Kaplan-Meier survival analysis demonstrated that classification of HFA-PEFF score significantly stratified the patients' risk for MACE. On the other hand, there was no significant difference in 6MW distance among 3 groups based on H2FPEF score (p=0.53), and H2FPEF score was not an independent predictor for MCE by the Cox model analysis. Moreover, the lowest H2PEF score group had higher NT-proBNP than other 2 groups (p=0.02)
Conclusions
The HFA-PEFF score predicted functional capacity as well as prognosis in patients hospitalized for HFpEF, while the H2PEF score did not.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Yano
- Osaka Rosai Hospital, Osaka, Japan
| | | | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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Okada M, Inoue K, Tanaka N, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Sunaga A, Sotomi Y, Dohi T, Hikoso S, Sakata Y. Reappraising the role of baseline plasma C-reactive protein levels on recurrence after catheter ablation of persistent atrial fibrillation: insight from EARNEST-PVI trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Subclinical inflammation is an important pathogenesis of developing and sustaining atrial fibrillation (AF). Because AF itself contribute to the inflammatory response, the role of baseline subclinical inflammation on AF recurrence after catheter ablation (CA) remains controversial in patients with persistent AF.
Purpose
To evaluate whether baseline plasma C-reactive protein (CRP) levels, a sensitive marker of inflammation, are associated with AF recurrence following CA.
Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. A total of 441 patients (median age, 67 years; 26% female; 25% long-standing persistent AF) whose plasma CRP levels were measured at baseline were included in this study.
Results
At baseline, a median (interquartile range) of plasma CRP level was 0.10 [0.06–0.19] mg/dl. Plasma CRP levels significantly increased at discharge (0.83 [0.21–1.84] mg/dl, p<0.001) and decreased 1 year after CA (0.10 [0.05–0.20] mg/dl, p=0.040) compared to the baseline value. During the follow-up of 1 year, 115 patients (26%) experienced AF recurrence, and the incidence was significantly higher in 124 patients with low CRP levels at baseline (cut-off ≤0.06 mg/dl) than the other 317 patients (33.9% vs. 23.0%, p=0.017). After adjustment of age, gender, body mass index, long-standing persistent AF, CA strategy, and plasma brain natriuretic peptide levels, low plasma CRP levels was a significant predictor of AF recurrence (hazard ratio, 1.51; 95% confidence interval, 1.02–2.24; p=0.042).
Conclusions
Low plasma CRP levels at baseline predicted AF recurrence in the EARNEST-PVI trial. Reappraising the role of CRP on AF recurrence may be needed in patients with persistent AF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Osaka, Japan
| | | | | | - M Miyoshi
- Osaka Kouseinenkin Hospital, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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Tanaka N, Inoue K, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Okada M, Sunaga A, Sotomi Y, Dohi T, Hikoso S, Sakata Y. Renal function and arrhythmia outcomes in persistent atrial fibrillation patients after catheter ablation: subanalysis of the EARNEST-PVI trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) reduces the renal function. Renal dysfunction and AF often coexist. Catheter ablation (CA) of persistent AF can maintain a sinus rhythm and may improve the renal function.
Purpose
We sought to elucidate whether the estimated glomerular filtration rate (eGFR) in patients with persistent AF was increased after CA, especially with the presence of an AF recurrence.
Methods
We enrolled 487 persistent AF patients whose eGFR data were available both before and 1-year after the CA out of 512 patients in the EARNEST-PVI trial.
Results
The mean age was 65±9 year and 113 patients (24.8%) had long-standing persistent AF. We compared the eGFR at baseline with that 1-year after the CA. AF recurrences were recognized in 118 patients (25.8%). The eGFR was similar between the group without recurrence and that with recurrence at baseline (without AF recurrence vs. with AF recurrence; 63.8±14.3 vs. 62.7±13.6 mL/min/1.73m2, p=0.46). In patients without AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 13 (3.8%), 198 (58.4%), 98 (28.9%), 26 (7.7%), 3 (0.9%), and 1 (0.3%), respectively at baseline. In the patients with AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 3 (2.5%), 68 (57.8%), 38 (32.2%), 6 (5.1%), 3 (2.5%), and 0 (0%), respectively at baseline. The ΔeGFR was significantly higher in the patients without AF recurrence than in those with AF recurrence (without AF recurrence vs. with AF recurrence; 5.1 [−0.3, 10.8] vs. 3.0 [−3.0, 7.6], p=0.0033). In the patients without AF recurrence, a better eGFR class at 1-year after the CA than in those before the CA was recognized in 75 patients (22.1%), while it was recognized in 19 patients (16.1%) with AF recurrences.
Conclusion
Successful catheter ablation in patients with persistent AF led to a better renal outcome.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was funded by Medtronic, Johnson & Johnson, and Abbott.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Sakai, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | | | - M Miyoshi
- Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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Tsutani Y, Ito M, Mimae T, Miyata Y, Shimada Y, Ito H, Ikeda N, Nakayama H, Okada M. MA08.03 Adjuvant Chemotherapy for Patients with High-Risk Stage I Lung Adenocarcinoma Stratified by Epidermal Growth Factor Receptor Mutation Status. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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42
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Takei H, Kunitoh H, Wakabayashi M, Kataoka T, Mizutani T, Tsuboi M, Ikeda N, Asamura H, Okada M, Takahama M, Ohde Y, Okami J, Shiono S, Aokage K, Watanabe S. FP01.04 Prospective Observational Study of Activities of Daily Livings in Elderly Patients After Lung Cancer Surgery (JCOG1710A). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Okada M, Kobayashi K, Fukuta F, Hashimoto K, Tanaka T, Masumori N. What sexual symptoms are most related to testosterone deficiency among older Japanese men? Int J Urol 2021; 28:1306-1307. [PMID: 34528304 DOI: 10.1111/iju.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Manabu Okada
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Fumimasa Fukuta
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Doi Y, Tsujita M, Hamano T, Obi Y, Namba‐Hamano T, Tomosugi T, Futamura K, Okada M, Hiramitsu T, Goto N, Nishiyama A, Takeda A, Narumi S, Watarai Y, Isaka Y. The effect of cholecalciferol supplementation on allograft function in incident kidney transplant recipients: A randomized controlled study. Am J Transplant 2021; 21:3043-3054. [PMID: 33565715 PMCID: PMC8518814 DOI: 10.1111/ajt.16530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/25/2023]
Abstract
It is unknown whether cholecalciferol supplementation improves allograft outcomes in kidney transplant recipients (KTRs). We conducted a single-center randomized, double-blind, placebo-controlled trial of daily 4000 IU cholecalciferol supplementation in KTRs at 1-month posttransplant. The primary endpoint was the change in eGFR from baseline to 12-month posttransplant. Secondary endpoints included severity of interstitial fibrosis and tubular atrophy (IFTA) at 12-month posttransplant and changes in urinary biomarkers. Of 193 randomized patients, 180 participants completed the study. Changes in eGFR were 1.2 mL/min/1.73 m2 (95% CI; -0.7 to 3.1) in the cholecalciferol group and 1.8 mL/min/1.73 m2 (95% CI, -0.02 to 3.7) in the placebo group, with no significant between-group difference (-0.7 mL/min/1.73 m2 [95% CI; -3.3 to 2.0], p = 0.63). Subgroup analyses showed detrimental effects of cholecalciferol in patients with eGFR <45 mL/min/1.73 m2 (Pinteraction <0.05, between-group difference; -4.3 mL/min/1.73 m2 [95% CI; -7.3 to -1.3]). The degree of IFTA, changes in urine albumin-to-creatinine ratio, or adverse events including hypercalcemia and infections requiring hospitalization did not differ between groups. In conclusion, cholecalciferol supplementation did not affect eGFR change compared to placebo among incident KTRs. These findings do not support cholecalciferol supplementation for improving allograft function in incident KTRs. Clinical trial registry: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) as UMIN000020597 (please refer to the links below). UMIN-CTR: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023776.
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Affiliation(s)
- Yohei Doi
- Department of NephrologyOsaka University Graduate School of MedicineSuitaJapan
| | - Makoto Tsujita
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan,Department of Kidney TransplantationMasuko Memorial HospitalNagoyaJapan
| | - Takayuki Hamano
- Department of NephrologyOsaka University Graduate School of MedicineSuitaJapan,Department of NephrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Yoshitsugu Obi
- Division of NephrologyUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Tomoko Namba‐Hamano
- Department of NephrologyOsaka University Graduate School of MedicineSuitaJapan
| | - Toshihide Tomosugi
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Kenta Futamura
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Manabu Okada
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Takahisa Hiramitsu
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Norihiko Goto
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Akira Nishiyama
- Department of PharmacologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Asami Takeda
- Department of NephrologyNagoya Daini Red Cross HospitalNagoyaJapan
| | - Shunji Narumi
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Yoshihiko Watarai
- Department of Transplant Nephrology and SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
| | - Yoshitaka Isaka
- Department of NephrologyOsaka University Graduate School of MedicineSuitaJapan
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Abe T, Futamura K, Goto N, Ohara K, Ogasa T, Tomosugi T, Okada M, Hiramitsu T, Narumi S, Watarai Y. Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation. Nephrology (Carlton) 2021; 27:97-103. [PMID: 34390080 PMCID: PMC9291901 DOI: 10.1111/nep.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
Aim Bacterial and fungal infections are serious, life‐threatening conditions after kidney transplantation. The development of oral/oesophageal candidiasis after kidney transplantation is not a reported risk factor for subsequent severe infection. This study was performed to investigate the relationship between oral/oesophageal candidiasis after kidney transplantation and the development of subsequent infection requiring hospitalization. Methods This retrospective study included 522 consecutive patients who underwent kidney transplantation at Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital from 1 January 2010 to 1 February 2019. Ninety‐five percentage of patients were living donor transplant recipients. Visual examination was performed to detect oral candidiasis, beginning immediately after kidney transplantation; upper gastrointestinal endoscopy was performed 8–10 months after kidney transplantation. Twenty‐five patients developed candidiasis (Candida‐onset group) and 497 did not (non‐Candida‐onset group). The follow‐up periods were 67 (37–86) months in the Candida‐onset group and 55 (34–89) months in the non‐Candida‐onset group. Severe infection was defined as bacterial or fungal infection requiring hospitalization; viral infections were excluded. Results Severe infection developed in 9/25 (36%) patients in the Candida‐onset group and in 77/497 (15%) patients in the non‐Candida‐onset group (p = .006). Binomial logistic analysis revealed that Candida infection (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.06–6.06; p = .037) and use of rituximab (OR 1.81, 95% CI 1.12–2.93; p = .016) were significant predictors of subsequent severe infection. Conclusion Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation and suggests an over‐immunosuppressive state, which should prompt evaluation of immunosuppression. This paper concludes that oral/oesophageal candidiasis is a risk factor for severe infection following kidney transplantation. The authors suggest that the presence of oral/oesophageal candidiasis indicates an over‐immunosuppressed state, which should prompt a review of immunosuppression.
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Affiliation(s)
- Tetsuya Abe
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kiyomi Ohara
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Taiki Ogasa
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Toshihide Tomosugi
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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Shindo T, Hashimoto K, Tanaka T, Taguchi K, Takahashi A, Itoh N, Okada M, Hotta H, Kunishima Y, Hirose T, Matsukawa M, Tachiki H, Kato R, Hinotsu S, Masumori N. Therapeutic options to reduce intravesical recurrence in newly diagnosed Ta high-grade bladder cancer according to risk stratification: A multicenter retrospective study. Int J Urol 2021; 28:1136-1142. [PMID: 34342065 DOI: 10.1111/iju.14657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the risk factors for intravesical recurrence in patients with newly diagnosed Ta high-grade non-muscle-invasive bladder cancer and the optimal management to reduce the risk of recurrence. METHODS We retrospectively evaluated Ta high-grade bladder cancer in patients who were newly diagnosed by transurethral resection from January 2007 through October 2018. Using multivariate analyses, we evaluated the risk factors and therapeutic options affecting intravesical recurrence and stratified the patients according to the risk numbers. RESULTS We included 390 patients and the median follow-up period was 31 months after the initial transurethral resection. According to multivariate analysis, having a previous history of upper urinary tract carcinoma, and multiple and sessile tumors were risk factors for intravesical recurrence (P = 0.001, P = 0.02 and P = 0.01, respectively). Risk groups were stratified according to these risk factors into favorable, intermediate and poor. In the entire cohort, induction and immediate intravesical instillation therapy were treatment options to reduce intravesical recurrence (P < 0.01 and P = 0.02, respectively). Analyses in each risk group showed that a second transurethral resection was the only therapeutic option to reduce intravesical recurrence in the favorable group (P = 0.048), whereas induction intravesical instillation therapy was effective in the intermediate and poor risk groups (P = 0.01 and P < 0.01, respectively), as was immediate intravesical instillation for the poor risk group (P < 0.001). CONCLUSIONS Sessile, multiple tumors and a history of upper urinary tract carcinoma are risk factors for intravesical recurrence in Ta high-grade bladder cancer patients.
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Affiliation(s)
- Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Urology, Hakodate Koseiin Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Keisuke Taguchi
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Koseiin Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Naoki Itoh
- Department of Urology, NTT East Corporation Sapporo Hospital, Sapporo, Japan
| | - Manabu Okada
- Department of Urology, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Japan
| | - Hiroshi Hotta
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | - Takaoki Hirose
- Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan
| | | | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Shiro Hinotsu
- Department of Biostatistics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Fukui S, Kawaai S, Tamaki H, Fukuda K, Okada M. A novel combination treatment with apremilast and tumor necrosis factor inhibitor for a patient with refractory intestinal Behcet's disease. Scand J Rheumatol 2021; 51:81-82. [PMID: 34232114 DOI: 10.1080/03009742.2021.1929458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - S Kawaai
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - H Tamaki
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - K Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - M Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
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48
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Sakai Y, Shindo T, Sato S, Takahashi A, Kunishima Y, Kato R, Itoh N, Okada M, Tachiki H, Taguchi K, Takayanagi A, Hotta H, Horita H, Matsukawa M, Matsuki M, Nishiyama K, Miyazaki A, Hashimoto K, Tanaka T, Masumori N. Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in urological malignancies: a multi-center retrospective study. J Bone Miner Metab 2021; 39:661-667. [PMID: 33704573 DOI: 10.1007/s00774-021-01207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We evaluated the incidence and risk factors for antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in prostate and kidney cancer patients. MATERIALS AND METHODS We retrospectively reviewed the clinical data of 547 patients from 13 hospitals. Prostate and kidney cancer patients with bone metastases who were treated with a bone-modifying agent (BMA) between January 2012 and February 2019 were enrolled. Exclusion criteria were BMA use for hypercalcemia, a lack of clinical data, a follow-up period of less than 28 days and a lack of evaluation by dentists before BMA administration. The diagnosis and staging of ARONJ were done by dentists. RESULTS Two-hundred eighteen patients were finally enrolled in the study, including 168 prostate cancer patients and 50 kidney cancer patients. Of them, 49 (29%) prostate cancer patients and 18 (36%) kidney cancer patients needed tooth extraction prior to BMA initiation. The mean follow-up period after BMA initiation was 552.9 ± 424.7 days (mean ± SD). In the cohort, 23% of the patients were diagnosed with ARONJ in the follow-up period. The 1-year cumulative incidences of ARONJ were 9.4% and 15.4% in prostate and kidney cancer patients, respectively. Multivariate analysis indicated that kidney cancer, tooth extraction before BMA and a body mass index (BMI) ≥ 25 kg/m2 were significant predictors for ARONJ. CONCLUSION ARONJ is not a rare adverse event in urological malignancies. Especially, kidney cancer, high BMI patients and who needed tooth extraction before BMA were high risk for developing ARONJ.
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Affiliation(s)
- Yasuyuki Sakai
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, 040-8611, Japan.
| | - Shunsuke Sato
- Department of Urology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, 040-8611, Japan
| | | | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Naoki Itoh
- Department of Urology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Center, Muroran, Japan
| | - Keisuke Taguchi
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Akio Takayanagi
- Department of Urology, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Hiroshi Hotta
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hiroki Horita
- Department of Urology, Hokkaido Saiseikai Otaru Hospital, Otaru, Japan
| | | | - Masahiro Matsuki
- Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan
| | - Koyo Nishiyama
- Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akihiro Miyazaki
- Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Okada M, Tominaga Y, Tomosugi T, Hiramitsu T, Ichimori T, Sato T. Predictors of Bone Mineral Density Improvement after Parathyroidectomy for Secondary Hyperparathyroidism: A Retrospective Single-Center Analysis. World J Surg 2021; 45:2777-2784. [PMID: 34132848 PMCID: PMC8322001 DOI: 10.1007/s00268-021-06186-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
Background Parathyroidectomy (PTx) reportedly increases bone mineral density (BMD) in patients with severe secondary hyperparathyroidism (SHPT). To date, however, there has not been sufficient evidence on predictors of BMD improvement post-PTx for SHPT, an issue the present retrospective cohort study aimed to address. Methods A total of 173 SHPT patients who underwent total PTx with forearm autograft between 2009 and 2017 were included in the present study. Demographic information, perioperative laboratory data and pre- and post-PTx BMD values (measured by dual-energy X-ray absorptiometry) were collected from their medical records. The change in BMD post-PTx in the lumbar spine was evaluated as the primary outcome. Then, a multivariate logistic regression analysis was performed for a ≥ 10% increase in BMD post-PTx. Results Overall, the median BMD in the lumbar spine was increased by 8.7% post-PTx. The multivariate logistic regression analysis revealed that age ≥ 70 years (P = 0.005; odds ratio [OR], 0.138; 95% confidence interval [CI]: 0.034–0.555), serum Ca level (P = 0.017; OR, 0.598; 95% CI: 0.392–0.911) and pre-PTx BMD in the lumbar spine (P = 0.003; OR, 0.013; 95% CI: 0.001–0.229) were negatively associated with a ≥ 10% increase in BMD post-PTx. Conclusion Our study demonstrated that presurgical age, serum Ca levels and BMD values could better predict an improvement in BMD post-PTx in SHPT patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06186-1.
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Affiliation(s)
- Manabu Okada
- Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan.
| | - Yoshihiro Tominaga
- Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan
| | - Toshihide Tomosugi
- Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan
| | - Takahisa Hiramitsu
- Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan
| | - Toshihiro Ichimori
- Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan
| | - Tetsuhiko Sato
- Department of Endocrinology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Ito T, Fukui S, Kanie T, Nakai T, Kidoguchi G, Ozawa H, Kawaai S, Ikeda Y, Koido A, Haji Y, Nomura A, Tamaki H, Yamaguchi K, Okada M. AB0763 IGG4-RELATED CORONARY PERIARTERITIS: SYSTEMATIC LITERATURE REVIEW WITH OUR CASE SERIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Coronary periarteritis is one of the clinical manifestations of IgG4-related disease. It can cause serious conditions such as angina and ruptured aneurysms. Therefore, it is important to recognize the clinical and radiological characteristics, which was little known.Objectives:We report four patients with IgG4-related coronary periarteritis with a systematic literature review.Methods:We identified four patients with IgG4-related coronary periarteritis at the St. Luke’s International Hospital in Tokyo, Japan from 2014 to 2020. A systematic literature review was conducted for English articles on IgG4-related coronary periarteritis cases with a full text or abstract available. We summarized patient demographics, IgG and IgG4 titers, the site and morphological type of coronary lesion, and other organ involvements.Results:Our 4 cases and 38 cases identified by the literature review were assessed. Coronary artery lesions were detected by a coronary CT in all but two cases. Wall thickening was the most common type of the lesion. Moreover, there were 32 (76.1%) patients with other organ involvements. The commonest other lesion was peri-aortitis in 21 (50.0%) patients. In cases with peri-aortitis, IgG and IgG4 titers were significantly higher than those without peri-aortitis (IgG4; 1540 [705.0, 2570.0] vs 246.0 [160.0, 536.3]; p = 0.001, IgG; 3596.5 [2838.3, 4260.0] vs 1779.0 [1288.3, 1992.8]; p =0.040). In addition, 15 (71.4%) patients of them had three or more IgG4 related organ involvements.Conclusion:Coronary CT was a useful imaging modality for the diagnosis of IgG4-related coronary periarteritis, and wall thickening was the most common lesion. Moreover, about half cases coexisted with peri-aortitis. Peri-aortitis and other organ involvements should be screened in those with higher IgG and IgG4.Table 1.Characteristics of our cases and the literature review cases.RCA: right coronary artery, LAD: left anterior descending artery, LCx: left circumflex arteryDisclosure of Interests:None declared
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