Despite these findings, hyperacute rejection of ABO-incompatible cardiac allografts is only 33%, whereas the hyperacute rejection of pig to baboon cardiac xenograft occurred in nearly all grafts. ......factors other than hemagglutinin must determine whether hyperacute rejection will occur. Because porcine complement regulatory proteins may function poorly against heterologous complement, a porcine xenograft may be especially susceptible to complement-mediated injuries. References 1.Ishida, HMiyamaoto, NShirakawa, HShimizu, TTokumoto, TIshikawa, N. Evaluation of immunosuppressive regimen in ABO incompatible living kidney transplantation-single center analysis.
Solid‐phase single antigen bead (SAB) assay for detection of anti‐human leukocyte antigen (HLA) antibodies and high‐resolution HLA typing have enabled tremendous progress in virtual crossmatch (VXM) ...technology in recent years. However, misinterpretation of the SAB assay may result in detrimental consequences after kidney transplantation. Meanwhile, epitope analysis could be an effective method to estimate immunizing eplets, which may provide ancillary information for better understanding of the SAB assay. To perform epitope analysis appropriately, it is necessary to understand the basic principles related to histocompatibility testing and the characteristics of the SAB assay. Therefore, knowledge of the properties and limitations of the SAB assay is critical. In this review, we aim to describe the fundamental concepts regarding immunobiological assessment, including HLA, anti‐HLA antibodies, and SAB assay, and explain epitope analysis using examples.
Objective
Identifying the predictive factors for tumor recurrence after partial nephrectomy (PN) is useful to determine patients who require careful observation after surgery. Therefore, we ...investigated recurrence after partial nephrectomy (PN) in patients with clinical T1 renal cell carcinoma (RCC) and analyzed predictive factors for recurrence-free survival (RFS).
Methods
This study included 1227 patients who underwent PN for clinical T1 RCC and retrospectively investigated patients’ characteristics and tumor factors that are associated with tumor recurrence.
Results
The median patient age was 59 years, and the median tumor size was 30 mm. Although 970 (74%) and 319 (26%) patients had clinical T1a and T1b RCCs, respectively, 20 patients (1.6%) were upstaged to pathological T3a. A positive surgical margin was found in 19 (1.5%) patients. The distribution of surgical approaches was open surgery in 428 (35%) patients and minimally invasive surgery in 799 (65%) patients. With a median follow-up of 35 months (Interquartile range 19–55 months), 39 (3.2%) patients, including ten with local recurrence, five with recurrence in the ipsilateral kidney, and 28 with other organs or lymph-nude, developed recurrence. The 3-year RFS was 99%, and the median recurrence time from PN was 19 months (interquartile range: 11–37 months). Multivariate analysis identified high grade tumor and upstaging to pT3a as significant predictors for worse RFS.
Conclusion
Patients with high grade tumors and tumors upstaged to pT3 had a high risk of worse RFS, which suggested that careful monitoring is required for such patients after PN, even if a good prognosis is achieved in patients with clinical T1 RCC.
Background
Primary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation and is associated with poor graft survival. To date, few studies have investigated ...predictive factors for treatment responses in recurrent FSGS.
Methods
We retrospectively analyzed 16 patients who were < 16 years at the age of onset and had post-transplant recurrence of FSGS from 1993 to 2018. Patients who achieved complete remission or partial remission after initiating therapy for recurrent FSGS were defined as responders. We compared several clinical characteristics between responders and non-responders. Time to remission was also analyzed.
Results
Ten patients were responders, and six patients were non-responders. Univariate analysis showed that responders had a significantly lower amount of maximum proteinuria at the time of recurrence (
P =
0.015) and more highly selective proteinuria (
P =
0.013) than non-responders. The time to remission from initiation of therapy was 2 months (interquartile range 0.2–4.4). In all responders, except for one patient, remission was achieved within 6 months.
Conclusions
Therapeutic responses may be predicted by examining the amount and selectivity of proteinuria at the time of recurrence. Further studies with larger numbers of patients are clearly required to validate these findings.
Graphical abstract
We aimed to freeze-dry the ciliate Spirostomum ambiguum, obtained from water, without fixation and observe it using scanning electron microscopy (SEM). Living cells were placed on a specimen stub and ...frozen upon contact with a Cu block kept at either −80 °C or −100 °C. Samples were then freeze-dried and observed by SEM. In most cases, no damage to the specimen due to ice crystal formation was observed. Because of the instantaneous freezing, the metachronal wave of cilia on the body surface of the ciliate was well preserved. Approximately 70–80% of cells were preserved in the contracted state due to inevitable exposure to mechanical vibration immediately before freezing. The remaining samples were preserved in a fully-extended state. Morphometric measurements of the cell surface showed that in the extended state, ciliary rows were almost parallel to the long axis of the cell, whereas in the contracted state, they were twisted in a left-handed helix at an angle of 45–65°. The distance between adjacent cilia along a ciliary row was 1.88 ± 0.43 μm in the extended state and 1.32 ± 0.41 μm in the contracted state (mean ± SD). However, the spacing between adjacent ciliary rows remained unchanged.
To investigate the detection of peritumoral pseudocapsule (PC) using multi-detector row computed tomography (MDCT) for tumors resected by robot-assisted laparoscopic partial nephrectomy (RAPN) for T1 ...renal cell carcinoma (RCC). Study participants included 206 patients with clinical T1 RCC who underwent RAPN between October 2017 and February 2018. Two radiologists who were blinded to the pathological findings evaluated the computed tomography (CT) images. Radiological diagnosis of a PC was defined by a combination of observations, including a low-attenuation rim between the tumor and renal cortex in the cortico-medullary phase and a high-attenuation rim at the edge of the tumor in the nephrogenic or excretory phase. A PC was detected on CT in 156/206 tumors (76%) and identified by pathology in 182/206 (88%) tumors including 153/166 (92%) clear cell RCC, 13/14 (93%) papillary RCC, and 7/16 (44%) chromophobe RCC. In the whole cohort, CT findings showed a sensitivity of 81.3% (148/182), specificity of 66.7% (16/24), and positive predictive value of 94.9% (148/156). When the data were stratified according to pathological subtypes, MDCT was observed to have a sensitivity of 86.9% (133/153) and specificity of 61.5% (8/13) in clear cell RCC, sensitivity of 38.5% (5/13) and specificity of 100% (1/1) in papillary RCC, and sensitivity of 44.4% (4/7) and specificity of 66.7% (6/9) in chromophobe RCC. A low or high-attenuation rim around the tumor in the cortico-medullary or nephrographic-to-excretory phase indicates a PC of RCC, though the accuracy is not satisfactory even with 64- or 320-detector MDCT.
Objective
To evaluate the quality of recovery in patients who underwent robot‐assisted partial nephrectomy and to compare the outcomes of the transperitoneal or retroperitoneal approach.
Methods
This ...study included 121 patients who underwent robot‐assisted partial nephrectomy under general anesthesia from April 2019 to September 2019 at Tokyo Women’s Medical University, Tokyo, Japan. Quality of recovery was defined according to the QoR‐40 Japanese version. The participants responded to the QoR‐40 Japanese version on three designated days. The patients were assigned to two groups according to the surgical approach: transperitoneal or retroperitoneal. A multivariate logistic regression analysis was carried out to identify independent factors associated with better quality of recovery.
Results
Out of the 121 patients, 56 (46%) and 65 (54%) patients were included in the transperitoneal and retroperitoneal group, respectively. Although the QoR‐40 Japanese version scores were not different between the two groups at admission, a better quality of recovery was observed in the retroperitoneal group than in the transperitoneal group at discharge based on the total score: physical comfort, emotional state, physical independence and pain. A multivariate analysis showed that the retroperitoneal approach and male sex were associated with a better QoR‐40 Japanese version score at discharge.
Conclusions
A retroperitoneal approach offers better quality of recovery than a transperitoneal approach, and therefore it might represent the optimal approach in selected patients undergoing robot‐assisted partial nephrectomy.
Objectives
To compare surgical and functional outcomes between robot‐assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with renal cell carcinoma with stage 4 chronic ...kidney disease.
Methods
This was a retrospective analysis of 60 patients with stage 4 chronic kidney disease (estimated glomerular filtration rate 15–30 ml/min/1.73 m2) who underwent partial nephrectomy for T1 renal cell carcinoma between April 2004 and April 2020. We compared perioperative outcomes according to the surgical approach. Multivariable analysis was performed to identify predictive factors for end‐stage renal disease.
Results
Robot‐assisted laparoscopic partial nephrectomy and open partial nephrectomy were performed in 31 and 29 patients, respectively. The median age was 68 years and 17% of all patients were women. Patient and tumor characteristics did not differ between groups. The operative time (155.2 vs. 221.0 min, p < 0.0001) and the postoperative length of hospital stay (5.2 vs. 10.6 days, p = 0.0083) were significantly shorter, and the estimated blood loss was lower (53.4 vs. 363.2 ml, p = 0.0003) in the robot‐assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group. Preoperative estimated glomerular filtration rate was the only significant predictor of end‐stage renal disease after partial nephrectomy on multivariable analysis.
Conclusions
Both procedures preserved renal function in this patient cohort, delaying the requirement for postoperative dialysis. Furthermore, robot‐assisted laparoscopic partial nephrectomy was associated with shorter operative time and postoperative length of hospital stay, as well as lesser estimated blood loss than open partial nephrectomy.
Recent developments in intensive desensitization protocols have enabled kidney transplantation in human leukocyte antigen (HLA)-sensitized recipients. However, cases of active antibody-mediated ...rejection (AABMR), when they occur, are difficult to manage, graft failure being the worst-case scenario. We aimed to assess the impact of our desensitization and AABMR treatment regimen and identify risk factors for disease progression. Among 849 patients who underwent living-donor kidney transplantation between 2014 and 2021 at our institution, 59 were diagnosed with AABMR within 1 year after transplantation. All patients received combination therapy consisting of steroid pulse therapy, intravenous immunoglobulin, rituximab, and plasmapheresis. Multivariable analysis revealed unrelated donors and preformed donor-specific antibodies as independent risk factors for AABMR. Five-year death-censored graft survival rate was not significantly different between patients with and without AABMR although 27 of 59 patients with AABMR developed chronic AABMR (CABMR) during the study period. Multivariate Cox proportional hazard regression analysis revealed that a donor age greater than 59 years and microvascular inflammation (MVI) score (g + ptc) ≥4 at AABMR diagnosis were independent risk factors for CABMR. Our combination therapy ameliorated AABMR; however, further treatment options should be considered to prevent CABMR, especially in patients with old donors and severe MVI.
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.
All patients were considered to be non-HLA sensitized, as determined by the preoperative single-antigen bead assay (SABA), although they included various ABO blood type compatibilities. Preoperative administration of rituximab was indicated for 48% of patients, mainly for ABO incompatible transplantation. We retrospectively compared the patients with dnDSA and those without.
Development of dnDSA was observed in 27 of the total 562 patients (5%). Chronic rejection was more frequently observed in patients with dnDSA than in those without (41% vs. 6%, P<0.001). The dnDSA-positive patients showed decreased graft function and poorer graft survival rates than those who tested negative. In multivariate analysis, higher likelihood of dnDSA production was observed in male recipients (odds ratio 6.57, P=0.012) and patients with a higher number of HLA-DR mismatches (odds ratio 2.41, P=0.008), whereas lower likelihood was observed in patients treated with rituximab induction (odds ratio 0.33, P=0.040).
Results suggest that rituximab induction as a standard immunosuppression protocol may have a preventive effect for dnDSA production in the non-HLA sensitized low immunologic risk patients.
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