Long-Term Outcomes in Kidney Transplantation From Expanded-Criteria Donors After Circulatory Death

The number of recipients waiting for a transplant is increasing. In Japan, there is more frequent use of organs from expanded-criteria donors (ECDs) after circulatory death. We retrospectively analyzed long-term outcomes of kidney transplantation (KT) from expanded-criteria donation after circulatory death (DCD). From 1995 to 2013, 97 cases of KT from DCD donors were performed in our department. Death-censored graft survival rates of ECD kidneys (n = 50) versus standard-criteria deceased-donor (SCD) kidneys (n = 47) for 1, 5, and 10 years after transplantation were 84.0% vs 97.9%, 74.8% vs 95.6%, and 70.2% vs 81.8%, respectively. No significant difference was found between the 2 groups (P = .102). Kidneys from donors with a history of hypertension (HTN) and cerebrovascular events (CVE) and contribution from older donors had significantly lower 10-year graft survival rates (P values of .010, .036, and .050, respectively). Cox proportional hazard regression analyses showed donor age to be significantly associated with long-term graft survival independently from other factors. These results suggest that ECD kidneys remain an acceptable alternative to dialysis under certain conditions. Increased donor age was a significant risk factor determining long-term graft function. Moreover, comorbidities of HTN and CVE could become significant risk factors, especially in older donors.     

Radical Prostatectomy for Localized Prostate Cancer in Renal Transplant Recipients: 13 Cases Studied at a Single Center

Objectives

We aimed to evaluate the feasibility and efficacy of surgical prostatectomy in renal transplant recipients (RTRs).

No Evidence for Particular Association Between HLA-Haploidentical Hematopoietic Stem Cell Transplantation and Psychological Distress

BackgroundThe psychological distress experienced by patients scheduled for hematopoietic stem cell transplantation (HSCT) is of clinical concern. However, distress experienced by patients scheduled for HLA-haploidentical HSCT vs that of patients scheduled for other types of matched HSCT is unknown. We conducted a retrospective study to clarify whether the type of HSCT influences the appearance of psychological distress in patients anticipating HSCT.MethodsOne hundred fifty-seven patients who had undergone any of 4 types of HSCT at Tokyo Metropolitan Komagome Hospital between October 2013 and September 2016 and had completed the Profile of Mood States (POMS) questionnaire within 2 weeks before the procedure were included. We computed T-scores for the tension-anxiety (TA) and depression (D) subscales, took scores ≥ 60 to represent mood disturbance of clinical concern, and examined scores and other clinical variables in relation to each procedure.ResultsTwenty-two (14.0%) patients had a POMS-TA score ≥ 60, and 26 (16.6%) had a POMS-D score ≥ 60. The numbers of POMS-TA and POMS-D scores ≥ 60 did not differ significantly with respect to age, sex, leukemia type, number of previous transplants, disease status, comorbidity index, or transplant type. A multivariate logistic regression analysis confirmed the absence of an influence of the type of HSCT on the incidence of POMS-TA or POMS-D scores ≥60.ConclusionAttention should be paid to the matter of psychological distress in patients with leukemia who will be treated by HSCT, even HLA-haploidentical HSCT. Such patients need psychological support, especially during the waiting period immediately prior to the transplantation procedure.     

C1 lateral mass screw insertion caudally from C2 nerve root – An alternate method for insertion of C1 screws: A technical note and preliminary clinical results

Background

C1 lateral mass screw was widely used for fixation of the upper cervical spine. However, massive bleeding from the C1–2 venous plexus is sometimes encountered. In this study, we proposed an alternate method for C1 lateral mass screw insertion, which involves insertion of the screws caudally from the C2 nerve root to reduce bleeding from C1–2 venous plexus.

Follow-up Survey of Donor Candidates for Living Related Kidney Transplantation With Prostate Cancer

Introduction

With the increasing number of elderly kidney donor candidates due to the lack of available donors, prostate cancer has sometimes been detected in these candidates during pretransplant screening examinations. There are currently no guidelines or consensus on prostate cancer screening and treatment in donors. We retrospectively evaluated the clinical course of donor candidates with prostate cancer.

An Improved de Vega Tricuspid Annuloplasty

Constricting the tricuspid annulus to an optimal size and ensuring competency of the suture in situ are essential to the performance of a successful de Vega annuloplasty. An approach to this goal is presented. Important maneuvers include placement of the inside suture just on the ring portion, use of a 33 mm or 35 mm valve obturator to obtain an annulus of the desired size, and ligation of the knots at their roots to prevent potential loosening.     

Left Axillary Incision (Minithoracotomy) for PDA Division

From 1955 to 1975, 417 patent ductus arteriosus (PDA) operations were performed at Sapporo Medical University. The last 118 operations (28.3%) were done by division through the left axillary incision without mortality.Forty patients were less than 2 years old and 14 were less than 1 year old. The ratio of girls to boys was 3.5:1. Because the majority of patients with PDA are girls, parents commonly show considerable concern over the size of the operative scar. Our clinical experience demonstrates clearly the feasibility and safety of an axillary incision in dividing a PDA, even in premature infants. A minithoracotomy through the axilla is recommended.     

Primary Nonfunction on Kidney Transplant Recipients From Donation After Circulatory Death Donors

BackgroundThe need for donor pool expansion remains an important task for kidney transplantation. The aim of this study is the evaluation of primary nonfunction (PNF) from donation after circulatory death (DCD) kidneys.MethodsBetween 1996 and 2017, 100 kidney transplants from DCD donors were conducted in our department. We retrospectively analyzed PNF of kidney transplant recipients from DCD donors in terms of donors’ and recipients’ epidemiologic characteristics.ResultsOf 100 grafts, 95 recipients (95.0%) had discontinued hemodialysis at the time of hospital discharge. Only 5 recipients (5.0%) developed PNF. All 5 PNF recipients received a single graft from an expanded criteria donor (ECD). The mean donor age in the PNF group was 65.0 (SD, 6.2) years. Significant differences between the PNF group and discontinued dialysis group were found for donor age (P < .01) and for the use of ECD kidneys (P < .02). Nevertheless, no significant difference was found between groups for several factors: a history of hypertension and cerebrovascular events, terminal creatinine levels, and graft weight.ConclusionThe incidence of PNF from DCD kidneys was very low. Although ECD kidneys in older donors might be a significant risk factor for PNF, these findings suggest that DCD kidneys should be used more frequently for donor expansion.     

Comparative Study on Variation of Quality of Life of Patients of Preemptive Kidney Transplantation and Nonpreemptive Kidney Transplantation

Background

There have been few studies that have reported the influence of kidney transplantation on the quality of life (QOL) of patients of preemptive kidney transplantation (PKT) and nonpreemptive kidney transplantation (NPKT).

Influence of Long-term Dialysis on the Outcome of Kidney Transplantation: A Single-Center Study

Aim

We investigated clinical outcomes of patients in Japan with a history of long-term dialysis treatment.

Causes of Ineligibility for Recipients in Living Kidney Transplantation

Background

Even if a living donor candidate exists, there are some cases that do not result in kidney transplantation (KTx) due to problems on the recipient side. The aim of this study was to clarify causes of ineligibility for KTx in these cases, so as to make RTx more applicable for patients.

The aging micromechanisms of alumina matrix composite (AMC) used in total hip arthroplasty

Background

The aim of the present study is to simulate and better understand the long-term interplay between alumina matrix composite (AMC) femoral head and aqueous environment. In particular, we focused on clarifying the role of alumina grains on zirconia phase stability and mechanical equilibrium in AMC head during aging processes in a clinically-relevant time frame.

A new method of external cardiac massage to improve diastolic augmentation and prolong survival time.

Experiments were performed on 50 dogs to determine the reason for unsatisfactory survival rates following closed-chest cardiac massage and to help develop new means for increasing survival following acute myocardial infarction and other causes of cardiac arrest. A new technique, named the countermassage method, was subsequently developed. Coronary and carotid flows after use of countermassage following cardiac arrest were increased 1.4 and 2 times, respectively, in contrast to flows obtained during manual closed-chest cardiac massage. These increases brought flows up to normal levels. We also tried to determine whether survival could be extended by this method to facilitate clinical treatment such as defibrillation or placing a temporary pacemaker catheter under fluoroscopic control, which are hard to accomplish during the brief time permitted by conventional closed-chest cardiac massage.     

Effect of lateral lymph node dissection for mid and low rectal cancer: An ad-hoc analysis of the ACTS-RC (JFMC35-C1) randomized clinical trial

Background

Lateral lymph node dissection has been 1 of the standard treatments for mid and ow rectal cancer in Japan. The aim of this ad-hoc analysis was to evaluate the impact of lateral lymph node dissection on outcomes in the randomized clinical trial, referred to as the Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial.

Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: A prospective,randomized, controlled trial

Background

The difference in clinical results between the direct anterior approach (DAA) and the anterolateral approach (ALA) for total hip arthroplasty (THA) is still unclear. The purpose of this study was to compare clinical results, including nerve injuries, between DAA and ALA in one-stage bilateral THA in a prospective, randomized controlled trial.

Long-Term Follow-up of Artificial Valves in Patients under 15 Years Old

Forty-nine artificial cardiac valves implanted in 44 patients less than 15 years old were reviewed. Out of 49 valves, 16 were mechanical and 33 were xenografts. Average follow-up was 2 years 5 months. Marked valvular stenosis developed in 11 out of the 33 xenografts, an incidence of 15% per patient-year. In patients with a xenograft valve, the incidence of sepsis was found to be 4% per patient-year and brain accidents, 4% per patient-year. In patients with mechanical valves, the incidence of stenosis was only 2% per patient-year and brain accidents, 2% per patient-year. There was no sepsis. From these follow-up results, mechanical valves seem to be superior to xenografts when used in patients less than 15 years old.     

Outcomes of persistent lymph node involvement after neoadjuvant therapy for stage III rectal cancer

Introduction

Lymph node involvement is a well-known predictor of recurrent rectal cancer in patient who did not undergo neoadjuvant therapy patients. The role of persistent lymph node disease after neoadjuvant treatment, however, is debatable. This study compares outcomes of patients with clinical, stage III rectal cancer who had nodal disease on surgical pathology after neoadjuvant treatment to patients with negative nodes.

Validation of the Japanese version of the life satisfaction checklist (LiSat-11) in patients with low back pain: A cross-sectional study

Background

Previous studies suggest that life satisfaction assessment using the Life Satisfaction checklist (LiSat-11) is a meaningful outcome measure and may play an important role in setting rehabilitation goals in patients with chronic pain. Until now, there was no Japanese version of this questionnaire, and the psychometric properties of the original version of the LiSat-11 have only been investigated using classical test theory approaches. The objective of the present study was to evaluate the psychometric properties of the LiSat-11-J using Rasch analysis in a sample of Japanese people with low back pain (LBP).