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Introduction:Herein, we discuss clinicopathological analyses of cases of chronic renal allograft arteriopathy (CRA) after renal transplantation and clarify the mechanisms underlying the development and prognostic significance of CRA. Methods:CRA was diagnosed in 34 renal allograft biopsy specimens (BSs) obtained from 27 renal transplant patients who were followed up at the Department of Urology and Transplant Surgery, Toda Chuo General Hospital, between January 2010 and December 2020. Results:CRA was diagnosed at a median of 33.4 months post-transplantation. Of the 27 patients, 16 had a history of rejection. Among the 34 BSs showing evidence of CRA, CRA was mild (cv1 in Banff’s classification) in 22, moderate (cv2) in 7, and severe (cv3) in 5 patients. We then classified the 34 BSs showing evidence of CRA based on their overall histopathological features as follows: cv alone seen in 11 (32%) BSs, cv + antibody-mediated rejection (AMR) in 12 (35%), and cv + T-cell-mediated rejection (TCMR) in 8 (24%). Loss of the renal allograft occurred during the observation period in 3 patients (11%). Of the remaining patients with functioning grafts, deterioration of renal allograft function after biopsies occurred in 7 cases (26%). Conclusions:Our study results suggest that AMR contributes to CRA in 30–40% of cases, TCMR in 20–30% of cases, isolated v lesions in 15% of cases, and cv lesions alone in 30%. The intimal arteritis was a prognostic factor in CRA.

Proliferative glomerulonephritis with monoclonal immunoglobulin IgG deposits (PGNMID) is an already described form of renal involvement by monoclonal gammopathy. PGNMID is known to recur in kidney allografts. Bortezomib has shown clinical success in the treatment of multiple myeloma. However, its effect for recurrent PGNMID in kidney allografts has rarely been reported. We present the case of a 61-year-old woman who developed recurrent PGNMID 3 weeks after kidney transplantation. This patient was initially treated with steroid pulses (500 mg/day for 2 days) and two cycles of rituximab therapy (200 mg/body). However, disease progression was observed with mesangial matrix expansion and subendothelial deposits by light microscopy and stronger staining for IgG3 and kappa in the mesangial area by Immunofluorescence (IF) microscopy. Thus, we started treatment with bortezomib therapy (1.3 mg/m2, once weekly, on days 1, 8, 15, and 22 in a 5-week cycle, for a total of six cycles). Bortezomib therapy reduced massive proteinuria, although monoclonal immune deposits on IF and the serum creatinine level did not change during the treatment period. Seven months after completion of the first bortezomib course, we decided to prescribe a second course of bortezomib with the same regimen. Each course resulted in a > 50% reduction of proteinuria. Bortezomib may delay the progress of PGNMID in kidney allograft patients.

The excess mortality of COVID-19 solid organ transplant recipients (SOTRs) throughout the pandemic remains unclear. This prospective cohort study based on the Japanese nationwide registry included 1,632 SOTRs diagnosed with COVID-19 between February 1, 2020, and July 31, 2022, categorized based on dominant phases of variants of concern (VOC): Waves 1–3 (Beta), 4 (Alpha), 5 (Delta), 6 (Omicron BA.1/BA.2), and 7 (Omicron BA.5). Excess mortality of COVID-19-affected SOTRs was analyzed by calculating standardized mortality ratios (SMRs). Overall, 1,632 COVID-19-confirmed SOTRs included 1,170 kidney, 408 liver, 25 lung, 20 heart, 1 small-intestine, and 8 multiorgan recipients. Although disease severity and all-cause mortality decreased as VOC transitioned, SMRs of SOTRs were consistently higher than those of the general population throughout the pandemic, showing a U-shaped gap that peaked toward the Omicron BA.5 phase; SMR (95% CI): 6.2 (3.1–12.5), 4.0 (1.5–10.6), 3.0 (1.3–6.7), 8.8 (5.3–14.5), and 21.9 (5.5–87.6) for Waves 1–3 (Beta), Wave 4 (Alpha), Wave 5 (Delta), Wave 6 (Omicron BA.1/2), and Wave 7 (Omicron BA.5), respectively. In conclusion, COVID-19 SOTRs had greater SMRs than the general population across the pandemic. Vaccine boosters, immunosuppression optimization, and other protective measures, particularly for older SOTRs, are paramount.

Introduction:Extra efferent arterioles, also known as polar vasculosis (PV), are often observed in the glomerular vascular pole and are associated with glomerular hypertrophy, indicating early recurrent diabetic kidney disease (DKD) in renal allografts. However, its significance in patients without diabetes remains uncertain. Methods:A total of 9,004 renal allograft biopsy specimens obtained between January 2007 and December 2017 at Tokyo Women’s Medical University were retrospectively analyzed to examine the clinical and pathological significance of PV in renal allografts. PV was identified in 186 biopsy specimens obtained from 165 patients. The PV group comprised 46 patients; 35 patients without DKD and 11 patients with DKD as the initial cause of ESRD, whose clinical information was available and treated with the calcineurin inhibitor (CNI) tacrolimus. The non-PV group comprising patients with renal allografts matched for age and postoperative day included 93 patients without DKD and 16 patients with DKD as the initial cause of ESRD. Results:In patients with nondiabetic renal allografts, systolic blood pressure was significantly higher in the PV group than in the non-PV group. The trough tacrolimus levels during the overall study period and at 2 weeks, 1 month, and 2 years after transplantation were significantly higher in the PV group compared with the non-PV group. Glomerulomegaly was significantly more common. Moreover, ah and aah scores in Banff score were significantly higher in the PV group than in the non-PV group. In those with diabetic renal allografts, although the clinical parameters and tacrolimus trough levels in all time periods were not significantly different between the PV and non-PV groups, the ah score was significantly higher in the PV group. Conclusion:PV was associated with CNI toxicity in nondiabetic but not in diabetic renal allografts. The pathogenesis of PV in renal allografts is considered to be multifactorial.

Glomerular IgG deposition is rarely observed in antibody-mediated rejection. Here, we report chronic active antibody-mediated rejection with linear IgG deposition on glomerular capillary walls in a pediatric kidney transplant recipient. A 6-year-old boy with bilateral renal hypoplasia underwent preemptive deceased-donor kidney transplantation. Five years after the transplantation, an allograft biopsy revealed chronic active antibody-mediated rejection with diffuse linear IgG deposition on glomerular capillaries. Anti-glomerular basement membrane antibody, donor-specific anti-human leukocyte antigen (HLA) antibodies, and anti-angiotensin II type 1 receptor antibody were negative. A multiplex antibody assay identified anti-major histocompatibility complex class I chain-related molecule A antibody. Additionally, a single-antigen bead assay identified autoantibodies to 12 non-HLA antigens, including vimentin and glutathione S-transferase theta-1. To investigate whether IgG autoantibodies in the patient’s serum bind to antigens on glomerular capillaries, we incubated the patient’s serum with 0-h biopsy specimens of tissue donated to the patient and a control subject, both obtained immediately after nephrectomy from respective donors. IgG signals were observed in neither patient nor control samples. Nevertheless, linear IgG deposition may be explained by the binding of autoantibodies to non-HLA antigens that are usually hidden and only exposed via severe endothelial cell injury. Further studies are needed to confirm the significance of non-HLA antibodies in glomerular IgG deposition.

The major obstacle to successful ABOblood group–incompatible kidney transplantation (ABOi KT) is antibody‐mediated rejection (AMR). This study aimed to investigate transcriptional profiles through RNAsequencing and develop a minimally invasive diagnostic tool for discrimination between accommodation and early acute AMRin ABOi KT. Twenty‐eight ABOi KTpatients were selected: 18 with accommodation and 10 with acute AMRat the 10th day posttransplant protocol biopsy. Complete transcriptomes of their peripheral blood were analyzed by RNAsequencing. Candidate genes were selected by bioinformatics analysis, validated with quantitative polymerase chain reaction, and used to develop a classification model to diagnose accommodation. A total of 1385 genes were differentially expressed in accommodation compared with in AMRwith P‐adjusted < .05. Functional annotation and gene set enrichment analysis identified several immune‐related and immunometabolic pathways. A 5‐gene classification model including COX7A2L,CD69,CD14,CFD, and FOXJ3was developed by logistic regression analysis. The model was further validated with an independent cohort and discriminated between accommodation and AMRwith 92.7% sensitivity, 85.7% specificity, and 91.7% accuracy. Our study suggests that a classification model based on peripheral blood transcriptomics may allow minimally invasive diagnosis of acute AMRvs accommodation and subsequent patient‐tailored immunosuppression in ABOi KT. This study proposes and validates a 5‐gene classification model based on peripheral blood transcriptomics for minimally invasive diagnosis of early acute antibody‐mediated rejection versus accommodation in ABO‐incompatible kidney transplant patients.

The major obstacle to successful ABO blood group–incompatible kidney transplantation (ABOi KT) is antibody-mediated rejection (AMR). This study aimed to investigate transcriptional profiles through RNA sequencing and develop a minimally invasive diagnostic tool for discrimination between accommodation and early acute AMR in ABOi KT. Twenty-eight ABOi KT patients were selected: 18 with accommodation and 10 with acute AMR at the 10th day posttransplant protocol biopsy. Complete transcriptomes of their peripheral blood were analyzed by RNA sequencing. Candidate genes were selected by bioinformatics analysis, validated with quantitative polymerase chain reaction, and used to develop a classification model to diagnose accommodation. A total of 1385 genes were differentially expressed in accommodation compared with in AMR with P-adjusted < .05. Functional annotation and gene set enrichment analysis identified several immune-related and immunometabolic pathways. A 5-gene classification model including COX7A2L, CD69, CD14, CFD, and FOXJ3was developed by logistic regression analysis. The model was further validated with an independent cohort and discriminated between accommodation and AMR with 92.7% sensitivity, 85.7% specificity, and 91.7% accuracy. Our study suggests that a classification model based on peripheral blood transcriptomics may allow minimally invasive diagnosis of acute AMR vs accommodation and subsequent patient-tailored immunosuppression in ABOi KT.

Background: Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. Methods: A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. Results: Donors in the PRDN group had a longer operation time (P?&lt;?0.0001), reduced estimated blood loss (P?&lt;?0.0001), less open conversion (P?=?0.0002), lower postoperative serum C-reactive protein levels (P?&lt;?0.0001), and a shorter postoperative hospital stay (P?&lt;?0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1–6 and the decreased incidence of slow graft function (P?=?0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P?=?0.0211) and graft loss (P?=?0.0193). Conclusions: Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.

Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft‐versus‐host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor‐specific tolerance results in improved outcomes remains unanswered. We collected follow‐up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper‐matched living‐donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72‐99) in the tolerant cohort and 118 μmol/l (IQR 99‐143) in the control group. Mixed linear‐model showed around 29% lower average creatinine levels throughout follow‐up in the tolerant group (P< .01). Our data clearly show stable renal graft function without long‐term immunosuppression for many years, suggesting permanent donor‐specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients. A long‐term follow‐up analysis shows stable renal graft function without immunosuppression and no graft loss in patients receiving renal transplantation after hematopoietic stem cell transplantation from the same donor.

Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P< .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.

The cellular uptake of mizoribine (MZR), an immunosuppressant, and metabolism of MZR to MZR-5′- monophosphate (MZRP), an active metabolite, were evaluated in L5178Y-R mouse lymphoma cells and peripheral blood mononuclear cells (PBMCs) of rats and kidney transplant recipients (KTRs, n = 22). Real-time PCR analysis revealed the expression of ENT1 and ENT2 mRNAs, but not of CNTs, in L5178Y-R cells and rat's PBMCs. In L5178Y-R cells, the uptake of MZR was suppressed by adenosine, a substrate for ENT1 and ENT2, but not by 5-(4-nitrobenzyl)-6-thioinosine (0.1 μM), an ENT1 inhibitor. Saturable metabolism of MZR to MZRP was observed. In rats, peak plasma concentrations of MZR and peak concentrations of MZR and MZRP in PBMCs were observed 3 h after oral administration. MZR disappeared from PBMCs in parallel with plasma MZR, but the disappearance of MZRP from PBMCs appeared to be slow. In KTRs, the mean plasma concentration of MZR 3–4 h after ingestion was 3.14 μg/ml and the mean MZRP concentration in PBMCs was 16.8% of MZR, reflecting the involvement of ENT in the uptake of MZR. A linear relationship was observed between plasma MZR concentrations ranging from 1 to 6 μg/ml and PBMC's MZRP concentrations ranging from 90 to 200 ng/ml.

Low-dose rituximab, 200 mg per kg body weight, used in Japan for desensitization in ABO-incompatible kidney transplants, is not associated with hepatitis B virus reactivation even in the absence of prophylaxis.

Development of de novo donor-specific anti-HLA antibodies (dnDSA) has been associated with poor graft outcome, although the preventive factor for its production is still elusive. We analyzed the incidence of dnDSA within 5 years posttransplant in 562 living-kidney transplant recipients to evaluate predicting and preventive factors for dnDSA development.

A prolonged-release formulation of tacrolimus (Tacrolimus QD) was developed to allow once-daily dosing and to have similar safety and efficacy profiles to twice-daily tacrolimus (Tacrolimus BID). This study compared the pharmacokinetics (PK) and renal pathology by protocol biopsy in de novo living kidney transplant recipients treated with either low-dose Tacrolimus QD or Tacrolimus BID.

Endothelial chimerism in transplanted organs can be defined as the presence of recipient-derived endothelial cells in the donor organ. The mechanism of endothelial chimerism is not well understood and remains controversial. The purpose of this study was twofold. First, we investigated the presence of chimerism in renal allografts of ABO-incompatible kidney transplantation recipients. Second, we analyzed the association between chimerism and the clinical course and histopathological changes.

Bladder dysfunction after kidney transplantation (KTx) impairs the patients' quality of life. We examined the bladder function status perioperatively in patients undergoing KTx and performed a randomized prospective study to determine the efficacy of an antimuscarinic agent, solifenacin, in ameliorating the bladder dysfunction after KTx.

Rrituximab has been used for desensitization of anti-blood type antibody and anti-human leukocyte antigen (HLA) antibody as an induction immunosuppressant in our hospital. After having used rituximab for more than 2 years, we performed a retrospective study to clarify the effectiveness and safety of rituximab.

Blood group O individuals are known to have larger amounts of anti-ABO blood group (anti-A/B) IgG antibodies than A or B individuals. Therefore, in ABO-incompatible (ABOI) kidney transplantation (KTX), it is expected that blood group O recipients are more likely to suffer graft damage, because anti-A/B IgG antibodies are believed to be responsible for worse graft outcomes.

Few studies have been conducted to determine the efficacy of tonsillectomy in suppressing IgA nephropathy recurring after the kidney transplantation.

Renal transplantation across the blood barrier is a unique model for investigating the humoral response to different carbohydrate antigens. However, in such a renal transplantation, the characteristics of B cells as well as of the antibodies produced by B cells are less well defined.

While screening for genes that reverse the sporulation-deficient phenotype of the ras1Δ diploid Schizosaccharomyces pombestrain, we identified zds1. This gene shares sequence homology with the ZDS1and ZDS2genes from Saccharomyces cerevisiae, which appear to be involved in multiple cellular events. Expression of Zds1 in ras1Δ diploid cells elevated their sporulation rate from 0.3 to 11.2%. Expression of the Zds1 C-terminal region increased the sporulation rate further (to 21.9%) while introduction of the Zds1 N-terminal region had no effect. zds1expression did not induce sporulation in strains with mutations in genes participating in the downstream MAP kinase cascade. The zds1-disrupted strain is sensitive to CaCl2, and this effect is suppressed by the C-terminal region of Zds1. The growth of the zds1Δ strain is markedly inhibited by cold temperatures, while its viability decreased in the stationary phase. Moreover, the zds1Δ strain is round in shape and very sensitive to zymolyase, and its cell wall becomes thicker than that of wild type. Thus, zds1must be required to maintain cell wall integrity. The Zds1–GFP fusion protein localized to the cytosol, the septum, and the cell cortex. Its localization in the septum was dependent on its C-terminal region. Overexpression of the C-terminal region of Zds1 induced multi-septa and abnormal zygotes. We propose that the C-terminal region is the functional domain of Zds1 while the N-terminal region is a negative regulatory region. Thus, Zds1 is involved in multiple cellular events in fission yeast, including sexual differentiation, Ca2+tolerance, cell wall integrity, viability in the stationary phase, and cell morphology.

In this study, we examined the impact of preoperative anti-A/B antibody titers on the results of ABO-incompatible living kidney transplantation (LKT). In all, 167 recipients underwent ABO-incompatible LKT at our institution between 1989 and 2002. These patients were subdivided into those transplanted under cyclosporine with azathioprine or mizoribine (Group 1, n78) and those transplanted under tacrolimus or mycophenolate mofetil (Group 2, n89). Overall patient survival at 5 and 10 years was 93.8% and 88.0%, respectively. Overall graft survival at 5 and 10 years was 76.9% and 55.9%, respectively. Graft survival in the patients with anti-A/B IgG titers over 1:128 was significantly lower in group 1, whereas no significant correlation between the anti-A/B IgG titers and graft survival was found in group 2. In conclusion, no correlation between anti-A/B antibody titers and the results of ABO-incompatible LKT was seen after tacrolimus or mycophenolate mofetil application.

Background:Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use. Methods:To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 ± 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 ± 10.8 months. Results:Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P< 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P< 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P< 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders. Conclusion:In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.

We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN).

Objective: We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN).Patients and method: Between July 2001 and March 2004, 135 renal transplant donors underwent RPLDN. Low (average: 7 mmHg) CO2 gas pressure was employed during the procedure. All procedures were performed through a three-port retroperitoneal approach without opening the peritoneal cavity. The hand-assisted technique was not used. One hundred and twenty-seven cases were of left and eight cases were of right nephrectomy.Results: Donor nephrectomy was carried out successfully in all patients. In one donor, the procedure was changed to open donor nephrectomy because of severe adhesion around the renal vein due to previous surgery. No serious complications, such as massive bleeding or bowel injury were encountered. Return of bowel function took 0.7 days on average. Post-operative hospital stay was 4.9 days on average, and return to work was 12 days on average. Ureteral complications occurred in 2 patients and were treated with temporally retrograde ureteral stenting. Average serum creatinine levels were 1.5 mg/dL, 1.3 mg/dL and 1.3 mg/dL at 3, 7 and 14 days after transplantation, respectively. No patients required hemodialysis after transplantation due to acute tubular necrosis.Conclusion: RPLDN could be an option for laparoscopic live donor nephrectomy.

Posttransplant proteinuria and hypertension are difficult to treat after renal transplantation. Therefore, we examined whether candesartan cilexetil is effective in reducing urinary protein excretion or in controlling hypertension in patients with renal allograft dysfunction.

Kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications. In the present study, we retrospectively reviewed multiple renal artery reconstruction in kidney transplantation to elucidate the usefulness of these grafts.

The most prevalent anticarbohydrate antibodies in human serum are anti-Gal interacting specifically with the -gal epitope (Gal1-3Gal1-4GlcNAc-R) and anti-blood group antibodies interacting with blood group A and B antigens. The -gal epitope, although absent in humans, comprises part of the core of carbohydrate chain in A and B antigens. Therefore, it was of interest to determine whether immunoglobulin (Ig) G antibodies, elicited in patients rejecting ABO-incompatible kidney allografts, can interact with the -gal epitope.

Abstract Hemolysis may occur after organ transplantation. In most cases, hemolysis is drug‐related, such as to cyclosporin, etc. However, it is important to consider graft‐versus‐host antibody formation as one of the causes of hemolysis. We evaluated the effect of local graft irradiation as a method of preventing hemolysis arising from ABO antibody formation after ABO‐mismatched renal transplantations. The participants in this study were 44 patients who had undergone ABO‐mismatched renal transplantation. Of these patients, 23 were subjected to postoperative local irradiation, and 21 were not. We examined the characteristics of anti‐blood‐type antibodies, and we also compared the frequency of the development of antibody formation and hemolysis development between the groups. The development rates of anti‐ABO‐antibody formation and hemolysis were significantly higher in the patients without local irradiation (15/21, 71%; 6/21, 29%) than in those with local irradiation (1/23, 4%; 0/23, 0%). The elevated antibodies mainly belonged to the IgG class, not the IgM class. The hemolysis‐ and antibody formation observed in the patients originally without postoperative local irradiation was dramatically improved by graft irradiation. Local graft irradiation after ABO‐mismatched renal transplantations may be needed to prevent the formation of anti‐ABO antibodies and to impede the development of hemolysis.

Abstract. Hemolysis may occur after organ transplantation. In most cases, hemolysis is drug-related, such as to cyclosporin, etc. However, it is important to consider graft-versus-host antibody formation as one of the causes of hemolysis. We evaluated the effect of local graft irradiation as a method of preventing hemolysis arising from ABO antibody formation after ABO-mismatched renal transplantations. The participants in this study were 44 patients who had undergone ABO-mismatched renal transplantation. Of these patients, 23 were subjected to postoperative local irradiation, and 21 were not. We examined the characteristics of anti-blood-type antibodies, and we also compared the frequency of the development of antibody formation and hemolysis development between the groups. The development rates of anti-ABO-antibody formation and hemolysis were significantly higher in the patients without local irradiation (15/21, 71%; 6/21, 29%) than in those with local irradiation (1/23, 4%; 0/23, 0%). The elevated antibodies mainly belonged to the IgG class, not the IgM class. The hemolysis- and antibody formation observed in the patients originally without postoperative local irradiation was dramatically improved by graft irradiation. Local graft irradiation after ABO-mismatched renal transplantations may be needed to prevent the formation of anti-ABO antibodies and to impede the development of hemolysis.

A shortage of organ donors for transplantation has become a serious problem throughout the world. To overcome this problem, transplantations across ABO blood barriers have been performed with some success. In general, however, the graft survival rate for transplantation with ABO incompatibility is lower than that of transplantation with ABO compatibility. Unfortunately, the mechanism by which isohemagglutinins might injure an ABO-incompatible graft remains uncertain. Here, the pre- and posttransplantation anti-AB titers in patients who received transplants from ABO-incompatible living donors are reviewed and the pathological findings are compared.

Sialyl LewisX(CD15s), which is known to serve as a ligand for the cell adhesion molecules E-selectin and P-selectin, is expressed on peripheral lymphocytes in renal transplant patients with rejection. In this study, we examined whether CD15s monitoring could differentiate the patients with rejection in whom steroids were effective from those in whom steroids were not effective.

Abstract: Increased glucose metabolism has been reported to occur in association with colorectal cancer. As positron emission tomography (PET) using [18F]fluorodeoxyglucose is able to depict hypermetabolic sites, it can therefore be used to detect colorectal cancer. A 69-year-old male patient with a recurrent solitary liver metastasis from colon cancer underwent whole-body PET which revealed high [18F]fluorodeoxyglucose uptake in the lesion. Furthermore, PET revealed peritoneal metastases that had not been detected by conventional imaging methods. Consequently, PET proved useful in helping us to avoid performing unnecessary treatment for the liver metastasis. Although it is uncertain whether early identification of recurrence can prolong survival, it may help to prevent unnecessary treatments being carried out. Thus, the application of PET in carefully selected patients could be beneficial to the management of recurrent colorectal cancer.

PURPOSE: Bilateral ligation of the internal iliac arteries has been reported to be a safe procedure in pelvic surgery because there are five collateral pathways. Some of the five pathways are surgically interrupted after resection of the rectum and two cases in which necrosis developed in the perineum were reported. The aim of the study was to assess the degree of safety and blood flow reducing efficacy of internal iliac artery ligation in rectal cancer surgery. METHODS: The subjects were 23 patients with advanced rectal cancer. Tissue blood flow on the surface of the bladder was measured using a laser Doppler flow meter when unilateral or bilateral internal iliac artery were clamped at a central site or at a peripheral site. RESULTS: Tissue blood flow of the bladder before clamping the internal iliac artery was 6 to 74 ml/min/100 g. Blood flow in the right half of the bladder decreased significantly when the right and both internal iliac arteries were clamped (both,P<0.01), but it did not decrease significantly when only the left internal iliac artery was clamped. The results were the same whether the central site or peripheral site was clamped. When the central site was clamped, there was no difference between the decrease in blood flow in the right half of the bladder whether the right internal iliac artery was clamped or both internal iliac arteries were clamped. By contrast, when the peripheral site was clamped, the decrease in blood flow in the right half of the bladder was much greater when both internal iliac arteries were clamped than when the right internal iliac artery alone was clamped (P<0.01). The results in the left half were the same as in the right half. Blood flow became 33 to 110 (mean, 73; median, 75) percent of the value before clamping when both internal iliac arteries were clamped at the central site, and 18 to 114 (mean, 52; median, 47) percent when both internal iliac arteries were clamped at the peripheral site. No changes in the color of the bladder or other pelvic organs were observed while the internal iliac arteries were clamped. CONCLUSION: Our study suggests that bilateral internal iliac artery ligation causes a temporary decrease in blood flow to the pelvic organs, but the reduction is not great enough to induce necrosis histologically. We recommend the ligation of the internal iliac arteries at the point below the takeoff of the superior gluteal artery to gain a considerable blood flow reducing effect on the pelvic organs.

A stereo controlled, facile total synthesis of gangliosides GM1 and GD1a, in connection with systematic synthesis of ganglio-series of ganglioside, is described. Glycosylation of 2-(trimethylsilyl) ethyl O-(2-acetamido-6-O-benzoyl-2-deoxy-(β-D-galactopyranosyl)-(l→4)-O-[(methyl 5-acetamido-4,7,8,9-tetra-O-acetyl-3,5-dideoxy-D-glycero-α-D-galacro-2-nonulopyranosylonate)-(2→3)]-O-2,6-di-O-benzyl-β-D-galacto-pyranosyl)-(l→40)-2,3,6-tri-O-benzyl-β-D-glucopyranoside (4), with methyl 2,4,6-tri-O-benzoyl-3-O-benzyl-l-thio-β-D-galactopyranoside (8) or methyl O-(methyl 5-acetamido -4,7,8,9-tetra-O-acetyl-3,5-dideoxy-D-glycero-α-D-galacro-2-nonulopyranosylonate)-(2→3)-2,4,6-tri-O-benzoyl-l-thio-β-D-galactopyranoside (9) by use of N-iodosuccinimide (NIS)-trifluoromethanesulfonic acid (TfOH) or dimethyl(methylthio)sulfonium triflate (DMTST) as a promoter, gave the corresponding [β-glycoside 10 and 18 in 66 and 62% yields, which were converted, via reductive removal of the benzyl groups, O-acetylation, selective removal of the 2-(trimethylsilyl)ethyl group, and subsequent imidate formation, into the α-trichloroacetimidates 13 and 21. Glycosylation of (2S, 3R, 4E)-2-azido-3-O-benzoyl-4-octadecene-l,3-diol (14) with 13 or 21 by use of trimethylsilyl trifluoromethanesulfonate gave the corresponding β-glycoside 15 and 22, which on channeling through selective reduction of die azido group, coupling of the thus formed amino group with octadecanoic acid, O-deacylation, and saponification of the methyl ester group, gave the tital gangliosides GM1 and GD1a.