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T Chikaraishi

Publications and source records attributed to T Chikaraishi.

At least 19 recordsLinked to original sources
PubMed2001

Pre-emptive renal transplantation in children.

BACKGROUND: Renal transplantation is a definitive therapeutic modality in end-stage renal disease (ESRD). Most ESRD patients in Japan experience dialysis prior to renal transplantation. The present study was undertaken to examine the usefulness of pre-emptive renal transplantation (PET). METHODS: Between 1987 and 1998, 255 renal transplantations were carried out by the authors. Among those consecutive cases, 10 were cases of PET. In nine pediatric cases, demographics, graft and patient survival, height growth and benefits from successful transplantation were studied and compared with age-matched dialyzed transplantation controls. RESULTS: All transplantation was living-related. There was a disparity of causes of ESRD between the two groups. In PET, acquired renal deterioration due to a congenital lower urinary tract disorder was the major cause. Graft and patient prognosis was favorable in both groups. Growth retardation in PET patients under 15 years of age was significantly less apparent at the time of transplantation and after 3 years compared to the control. The benefits from transplantation were different in the two groups. Most PET patients felt an improvement of their physical condition; however, all of the control patients felt that the major boon was the freedom from the restriction of the daily diet and time for dialysis. CONCLUSION: In pediatric renal transplantation, short-term preceding dialysis does not have a detrimental effect, but PET could benefit ESRD patients by maintaining their quality of life. Moreover, PET minimizes the production of renal dwarfism in prepubertal children. Thus, PET should be taken into consideration in the choice of renal replacement therapy.

Acute Disease↗
PubMed1998

Experience with kidney transplantation in children and adolescents.

BACKGROUND: Paediatric kidney transplantation has different aspects in adults in terms of underlying primary renal disease, surgical technique, perioperative care and graft prognosis. Significant urological problems are present in a high percentage of paediatric recipients. This study was undertaken to characterize paediatric kidney transplantation as performed at our institutes. METHODS: Twenty-eight patients (age range 4-17 years, 10 girls, 18 boys) were included in this study. We analyzed (1) urologic procedures performed prior to or simultaneously with transplantation, (2) intraoperative changes in haemodynamics, (3) postoperative complications and (4) acute allograft rejection and graft prognosis. RESULTS: Of 4 patients with lower urinary tract abnormalities (neurogenic bladder in 3, posterior urethral valve in 1), 2 underwent augmentation ileocystoplasty prior to transplantation. The Mitrofanoff procedure as a diversion for neourethra was also performed in 2 of the 4 patients. All these 4 patients were managed with clean intermittent catheterization. Central venous pressure changes before and after graft vessel declamping were much greater in patients with body weight below 25 kg than in those above 25 kg. Five surgical complications and 6 infections were encountered postoperatively and hypertension was lasting in 6. Thirteen patients experienced 19 periods of acute allograft rejection. All of the 24 patients in the cyclosporin era (1986-) overcame rejections and they are all alive with good graft function. CONCLUSIONS: As long as proper pretransplant patient evaluation and management, and intensive perioperative care are undertaken, good prognosis of renal allograft can be achieved in young patients.

Adolescent↗
PubMed1998

Kidney transplantation in patients with neurovesical dysfunction.

BACKGROUND: Five renal recipients with neurovesical dysfunction (NVD) were retrospectively reviewed focusing on anatomical and urodynamic abnormalities of the lower urinary tract and their management prior to kidney transplantation. METHODS: The underlying anomalies in these 5 patients were a posterior urethral valve (1 with an imperforate anus; n = 2), meningomyelocele (n = 2) and a congenital short urethra with an imperforate anus (n = 1). Their urinary tracts were evaluated prior to transplantation with voiding cystourethrography, urethrocystoscopy, cystometrography and electromyography of the external urethral sphincter to identify a possible focus of urinary tract infection, urine storage and voiding function. RESULTS: All 5 patients had NVD proven by urodynamic studies or by documentation of urinary retention in the absence of mechanical outlet obstruction. Bilateral high grade vesicoureteral reflux was noted in all patients, requiring ureteroneocystostomy. Clean intermittent catheterization (CIC) was ultimately employed for bladder emptying in all patients. Two patients with poor bladder compliance underwent augmentation cystoplasty before transplantation. The Mitrofanoff procedure was used in 2 patients with structural urethral abnormalities to access the bladder for catheterization. After eradication of possible sources of infection and establishment of a low-pressure urine storage system with bladder emptying by CIC, kidney transplantation was performed. Following kidney transplantation, all of the recipients were asymptomatic for urinary tract infections using CIC. Although 1 patient lost his graft due to chronic rejection, the other 4 other patients have good renal function. CONCLUSION: Kidney transplantation in patients with NVD can be performed provided that their urinary tract problems are properly resolved.

Adolescent↗
PubMed1998

Immunological analysis of rat renal transplant recipients exhibiting long-term survival following treatment with 15-deoxyspergualin in the early postoperative phase.

BACKGROUND: We previously reported that short-term administration of 15-deoxyspergualin (DSG), 5 mg/kg/day on postoperative days 4 through 7, prolonged survival of rat renal allografts indefinitely. We now report the immunologic environment of DSG-treated recipients in the early postoperative phase. METHODS: TO (RT1u) rat kidneys were transplanted into WKAH (RT1k) rats. Peripheral blood lymphocytes (PBL), splenocytes (SPC) and graft infiltrating lymphocytes (GIL) were harvested from rejecting (untreated) recipients on day 7 (group AR) and from DSG-treated recipients on days 7 (Group DSG7) and 14 (group DSG14). Flow cytometric analysis was done to determine characteristics of these cells. Mixed lymphocyte culture reactions (MLRs) were also studied to examine suppressive activities of sera, SPC, and GIL of each group by adding them to TO/WKAH MLRs. RESULTS: In all groups, the proportions of CD8- and interleukin 2 receptor (IL-2R)-positive cells were higher for GIL than for either PBL or SPC. The CD4/CD8 ratio was lowest in GIL. Comparing groups DSG7 and DSG14, significant decreases in the proportion of CD8- and IL-2R-positive cells were found only in GIL. Sera of all groups nonspecifically suppressed MLRs, independent of DSG-administration. GIL of all groups also nonspecifically suppressed MLRs, while these suppressive activities were not observed with SPC. Suppressive activities of GIL remained unchanged in the first 2 postoperative weeks. CONCLUSIONS: Differences in the immunologic environment were reflected primarily in GIL. DSG seemed to decrease CD8- and IL-2R-positive cells in allografts. In the presence of DSG, this model may feature a predominance of nonspecific suppressor T cells over cytotoxic T cells during the first 2 postoperative weeks.

Animals↗
PubMed1998

Kidney transplantation in a child with posterior urethral valve from a hepatitis B virus-carrier mother. Report of a case with special reference to urinary tract reconstruction for dysfunctionalized uropathies and seroimmunological preparation against viral transmission.

The case of a 7-year-old boy with posterior urethral valve (PUV) who underwent successful kidney transplantation for progressive renal failure is reported. He required complex reconstructive surgery for PUV-related disorders, and also specific serological preparation for hepatitis B (HB) as his living donor mother was a proven carrier. By carefully executing the principles of reconstructive surgery and with well-planned seroimmunological preparation, we have demonstrated that successful kidney transplantation can be done from an HB Ag-positive mother to an HB Ag- and HB Ab-negative son, even when his urinary tract is severely dysfunctional due to PUV.

Carrier State↗
PubMed1997

Experience with revascularizing renal artery aneurysms: is it feasible, safe and worth attempting?

PURPOSE: We retrospectively evaluated the feasibility and efficacy of surgical revascularization for renal artery aneurysms. MATERIALS AND METHODS: Beginning in 1984, 12 patients with renal artery aneurysm underwent renal revascularization regardless of clinical features. Postoperative results were analyzed regarding split renal function, patency of the revascularized arteries, blood pressure control and surgical complications. RESULTS: Postoperative renal function was stable or improved in all but 1 case and patency in branched arteries was preserved in 86%. Hypertension in 8 patients was cured in 7 (88%), including 2 with renovascular hypertension, and improved in 1 (12%). Complications were minimal with only 1 ureteral stricture that required reoperation. CONCLUSIONS: The majority of renal artery aneurysm cases are amenable to surgical repair. Carefully performed renal revascularization is rewarding in that high blood pressure is better controlled, renal function is improved and the potential risk of rupture is obviated.

Adult↗
PubMed1997

Idiopathic and spontaneously regressing thrombus in right renal vein and inferior vena cava.

We present the case of a 57-year-old woman with a thrombus in the right renal vein and the inferior vena cava that disappeared spontaneously during 6 months of observation. She had no thrombus-related disease such as kidney cancer, dehydration, multiple myeloma, nephrotic syndrome, or abnormal coagulability. While various examinations were being performed over a 2 month period the thrombus regressed spontaneously. After 6 months of follow-up the thrombus could not be seen on abdominal computerized tomography scan. Twenty months after disappearance of the thrombus the patient is doing well and has no recurrence of thrombus.

Abdomen↗
PubMed1997

Kidney-alone transplantation in diabetic patients with end-stage renal disease.

From January 1989 to December 1995, 5 diabetic patients with end-stage renal disease (1 woman, 4 men) underwent kidney-alone transplantation. The mean age of the recipients at the time of transplantation was 37.4 years (range, 32 to 43). Craft function and glucose tolerance was evaluated for 5 to 72 months after surgery. Postoperative complications were seen in 2 patients; nonspecific subcutaneous infections and an asymptomatic partial allograft infarction. All renal allografts were functioning 1 year after transplantation, with a mean serum creatinine level of 1.10 mg/dL (range, 0.8 to 1.8 mg/dL), and a mean urinary protein level of 17.8 mg/dL (range, 5 to 27 mg/dL). The postoperative daily dose of insulin was higher than the preoperative dose, while the level of glycated hemoglobin (HbA1C) increased after surgery and peaked 6 months after transplantation; 1 year after transplantation it had reverted to the preoperative level. As long as the diabetic complications of the renal allograft recipients are not severe, the short-term survival and the renal function of diabetic patients with end-stage renal disease improves after kidney-alone transplantation, which is still the standard method of treatment in Japan.

Adult↗
PubMed1997

[Clinical evaluation of donor renal artery reconstruction in kidney transplantation].

UNLABELLED: This retrospective study describes the experience of arterial reconstruction of donor kidney in our institute since 1982. MATERIALS AND METHODS: Of total 56 living related kidney transplantations 15 required renal arterial reconstruction or ligation of donor kidneys. Renal arterial reconstruction was employed for 11 cases (end to side anastomosis [4 cases], conjoined anastomosis [3], hypogastric artery graft interposition [3], other [1], while simple ligation was employed for 4. Bench surgery with microsurgical techniques was employed for the repair. Elective surgery was done for preoperatively defined multiple renal arteries [10] and aneurysm [1], while imperative surgery for intraoperatively detected accessory arteries [2] and surgical injuries [2]. Postoperative patency of arteries and renal function (GFR) and evaluated by 99mTc-DTPA renoscintigraphy. RESULTS: The mean total ischemic time of reconstructed cases was 135 min., while that of ligated ones was 67 min. None of them required hemodialysis due to acute tubular necrosis. Postoperative graft arterial patency was impaired in 2 of 11 reconstructed cases (18%), while it was impaired in 3 of 4 ligated cases (75%). Two failure attempts of arterial reconstruction cases were all imperative ones. Postoperative GFR of the graft was well preserved in all cases. CONCLUSION: We conclude that (1) Ligation and imperative surgery tend to be associated with renal infarction, although it does not affect GFR. (2) Renal artery reconstruction was highly successful in preserving renal mass (or normal cortical image), albeit longer ischemic time than simple ligation. (3) Considering importance of preserved nephron mass in clinical renal transplantation every attempt should be made to repair the donor arterial anomalies when expected (elective) or found (imperative). (4) Thorough preoperative evaluation of donor renal arteries is mandatory.

Adult↗
PubMed1996

Parturition in six renal allograft recipients.

Between 1983 and 1994, we studied renal function and neonatal conditions for eight pregnancies and births to six women who had received renal transplants in order to assess the effect of an allograft on pregnancy and its outcome. The gestation period was 34 to 39 weeks (mean 36 weeks and 4 days), and four pregnancies ended before term. All eight babies were delivered by cesarean section. Intrauterine growth retardation (IUGR) was found in both babies of one woman who had been treated with conventional (without cyclosporin) immunosuppression. The serum creatinine level did not change during gestation in any of the women but was elevated after delivery in four. Four mothers suffered from proteinuria (25-364 mg/dl) during gestation, but the proteinuria disappeared after delivery in all but one case. The one exception, persistent proteinuria of 100-200 mg/dl, was assumed to result from the recurrence of the original renal disease (lgA nephropathy). The reduction of creatinine clearance and hydronephrosis of one graft noted during gestation were later reversed. None of the eight babies (four females and four males) was congenitally malformed, and their Apar scores were 6 to 9 (median 8). They are now 3 months to 11 years old, and seven of them are healthy and show good growth. One of the two IUGR babies has not grown well; her weight and height are more than 1 SD below the mean for her age, and she is mentally retarded and suffers from muscle weakness. Compared with dialysis patients, female renal allograft recipient have a better quality of life because they can safely deliver a child if they observe the criteria for pregnancy established for renal allogaft recipients.

Child↗
PubMed1995

Cytokine modulation of interactions between cultured human renal tubular and lymphoid blast cells.

We examined the in vitro cytokine modulation of the interaction of cultured renal tubular epithelial cells (hKEC) with lymphoid effector cells, including mixed lymphocyte reaction (MLR)-derived blasts, Concanavalin A (Con A)-activated blast, and lymphokine-activated killer (LAK) cells. Blast adhesion to hKEC was augmented by treatment with either interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), or MLR supernatant. The augmented adhesion statistically correlated with intercellular adhesion molecule-1 (ICAM-1) upregulation on hKEC cells by the cytokines. Blocking of surface ICAM-1 on hKEC or of lymphocyte-function antigen-1 (LFA-1) on the blasts significantly inhibited adhesion. LFA-1 blocking on LAK or MLR blasts resulted in a significant inhibition in cytotoxic function. TNF-alpha and IL-1 beta treatments on hKEC increased the susceptibility to LAK cytotoxicity, whereas IFN-gamma and MLR supernatant treatment significantly reduced this susceptibility. Absorption of IFN-gamma from the MLR supernatant partially restored the susceptibility of LAK cytotoxicity. The combined data suggest the importance of cytokine regulation of LFA-1/ICAM-1 adhesion molecule in these cellular interactions. Although IFN-gamma augments attachment between hKEC and blastic effector cells, this cytokine endows hKEC with resistance to LAK cytotoxicity. Thus, it is clear that cytokine modulation is a complicated phenomenon involving both adhesion molecule regulation-dependent and independent mechanisms.

Absorption↗