基本情報
- 所属
- 自治医科大学 医学部 腎泌尿器外科学講座 腎臓外科学部門 教授
- 学位
- 博士(医学)(2010年3月 北海道大学)
- 研究者番号
- 80581115
- ORCID ID
- https://orcid.org/0000-0002-8274-848X
- J-GLOBAL ID
- 201501010762258618
- researchmap会員ID
- B000246451
- 外部リンク
経歴
5-
2023年8月 - 現在
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2023年8月 - 2023年8月
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2020年4月 - 現在
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2018年4月 - 2020年3月
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2015年1月 - 2018年3月
学歴
2-
2006年4月 - 2010年3月
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1994年4月 - 2000年3月
論文
90-
Journal of viral hepatitis 29(11) 976-985 2022年11月Donors with resolved hepatitis B virus (HBV) infection may be a solution for the organ shortage for kidney transplantation (KT). The purpose of this study was to clarify the current state of HBV markers after KT from donors with resolved HBV infection to HBV naïve recipients and the rate of HBV reactivation in recipients with resolved HBV infection. Furthermore, we investigated HBV covalently closed circular DNA (cccDNA) in transplanted organs from donors with resolved HBV infection and the capability of HBV replication in kidney cell lines. We retrospectively analysed the HBV status of 340 consecutive donors and recipients who underwent KT in a single centre. We prospectively measured cccDNA by real-time polymerase chain reaction in kidney biopsy specimens of 32 donors with resolved HBV infection. HBV reactivation was found in three recipients with resolved HBV infection (4.8%, 3/63) after KT. We analysed 45 cases of transplantation from donors with resolved HBV infection to HBV-naive recipients. One case (2.2%, 1/45) became seropositive for hepatitis B core antibody (anti-HBc) and in another case (2.2%, 1/45), HBV-DNA was detected qualitatively in an HBV naive recipient with a donor with resolved HBV infection. In the latter case, cccDNA was measured in the donor kidney during KT. HBV replication was observed in kidney cell lines with HBV plasmid transfection. In conclusion, the risk of reactivation in anti-HBc-positive donors is relatively low. However, post-transplant HBV monitoring should be conducted in all at-risk cases.
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IJU case reports 5(3) 199-202 2022年5月Introduction: We present a case of urothelial carcinoma in a renal allograft successfully treated with pembrolizumab. Case presentation: A 39-year-old woman presented with nausea and anorexia 9 years after a renal transplantation. Positron emission tomography revealed a neoplasm of the renal pelvis of the allograft and multiple lymph nodes with peritoneal metastasis. A diagnosis of a non-muscle-invasive bladder tumor with peritoneal dissemination and jejunal metastasis of urothelial carcinoma was made. After five cycles of gemcitabine and carboplatin, the tumor progressed and pembrolizumab was administered. One week after the first dose, the allograft was rejected, necessitating arterial embolization. After the second cycle, the patient developed Stevens-Johnson syndrome. After discontinuing pembrolizumab, positron emission tomography revealed no increased tumor activity. A complete response was achieved for 21 months without additional treatment. Conclusion: Pembrolizumab was effective in treating urothelial carcinoma of the renal allograft; however, allograft rejection and loss should be considered.
MISC
397-
臨床泌尿器科 75(3) 212-218 2021年3月<文献概要>ポイント ・移植腎尿路結石の発生頻度は1%以下である.・5mm以上の上部尿路結石が治療適応である.・逆行性の内視鏡操作は尿路再建術の影響を受けやすく,容易ではない.・腎杯穿刺は腹膜損傷に注意が必要で,自己腎と比べて穿刺範囲が限定される.
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北海道外科雑誌 65(2) 158-163 2020年12月今回、原発性胆汁性胆管炎による肝腎不全に対し脳死肝腎同時移植を施行したので報告する。症例は46歳女性。35歳頃、原発性胆汁性胆管炎と診断。43歳時に黄疸発症し、非代償性肝硬変(T-bil 7.4mg/dl、Child Turcotte Pugh(CTP)B9点、Model for End-stage Liver Disease(MELD)score 7点)で当院紹介。2年後に肝不全進行し(T-bil 15.9、CTP C12、MELD22)、脳死登録された。3ヵ月後、T-bil 21.1、CTP C12、MELD27と増悪し、肝腎症候群から透析導入となった。透析導入8週後に腎移植も脳死移植登録した。待機期間246日で脳死ドナー発生、肝腎同時移植を実施した。術後膵炎を認めたが、肝機能は良好に推移し、術後12日目で透析離脱、術後57日目で退院した。術後11ヵ月の時点で、経過良好で外来フォロー中である。今後、肝腎不全に陥った症例に対しても肝腎同時移植を施行することで長期予後改善の可能性が期待される。(著者抄録)
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日本臨床腎移植学会雑誌 8(1) 72-77 2020年7月下部尿路機能障害の管理は腎移植患者には必要である。しかしながら、下部尿路症状(lower urinary tract symptoms:LUTS)を評価するための体系的なプロトコルは確立されていない。本稿では、そのLUTSに関連した最近の論文と日本発の質問票である主要下部尿路症状質問票(Core Lower urinary tract Symptom Score:CLSS)を紹介する。CLSSは医療スタッフがLUTSを評価する上で検証されている有用でシンプルなアンケートである。(著者抄録)
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International immunology 32(5) 335-346 2020年1月13日Chronic allograft rejection is the most common cause of long-term allograft failure. One reason is that current diagnostics and therapeutics for chronic allograft rejection are very limited. We here show that enhanced NFκB signaling in kidney grafts contributes to chronic active antibody-mediated rejection (CAAMR), which is a major pathology of chronic kidney allograft rejections. Moreover, we found that urinary orosomucoid 1 (ORM1) is a candidate marker molecule and therapeutic target for CAAMR. Indeed, urinary ORM1 concentration was significantly higher in kidney transplant recipients pathologically diagnosed with CAAMR than in kidney transplant recipients with normal histology, calcineurin inhibitor toxicity, or interstitial fibrosis and tubular atrophy. Additionally, we found that kidney biopsy samples with CAAMR expressed more ORM1 and had higher NFκB and STAT3 activation in tubular cells than samples from non-CAAMR samples. Consistently, ORM1 production was induced after cytokine-mediated NFκB and STAT3 activation in primary kidney tubular cells. The loss- and gain-of-function of ORM1 suppressed and promoted NFκB activation, respectively. Finally, ORM1 enhanced NFκB-mediated inflammation development in vivo. These results suggest that an enhanced NFκB-dependent pathway following NFκB and STAT3 activation in the grafts is involved in the development of chronic allograft rejection after kidney transplantation and that ORM1 is a non-invasive candidate biomarker and possible therapeutic target for chronic kidney allograft rejection.
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Transplantation proceedings 51(5) 1382-1386 2019年6月BACKGROUND: Rituximab (RIT) is effective as a part of the desensitization therapy before ABO-incompatible kidney transplantation (ABOi-KTx), and a single dose of RIT at 375 mg/m2 or less is recommended. However, adequate RIT dose recommendations have not yet been established for individual recipients. Therefore, we evaluated the relationship between the proportion of B cells in peripheral blood and acute antibody-mediated rejection (AAMR). METHODS: Forty-four consecutive ABOi-KTx recipients were enrolled in this retrospective study. Before transplantation, subjects were treated with RIT at various doses, ranging from 65 to 400 mg/body (46-263 mg/m2), followed by plasmapheresis and intravenous immunoglobulin as a desensitization therapy. The percentage of CD19+ cells in the total peripheral blood lymphocytes population (%CD19) was determined the day before transplantation. Transplant recipients were divided into 2 groups according to pretransplant %CD19, as follows: low %CD19 group, ≤ 1.2% (n = 35) and high %CD19 group, > 1.2% (n = 9). The relationship between %CD19 and incidence of AAMR was evaluated, and the predicting factors for AAMR incidence were determined by univariate and multivariate analyses. RESULTS: The incidence of AAMR was significantly higher in the high %CD19 group than in the low %CD19 group (44.4% vs 5.7%, P = .006). Furthermore, multivariate analysis showed that %CD19 > 1.2% was the only independent factor to predict AAMR, with an odds ratio of 14.31 (P = .038). CONCLUSION: High %CD19 values after rituximab administration in ABOi-KTx recipients implies insufficient depletion of B cells, which can lead to AAMR.
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Transplantation proceedings 51(5) 1317-1320 2019年6月BACKGROUND: Multiple renal arteries are found in approximately 20% of living donor kidneys. We have been using an accessory artery cutoff diameter of 2 mm on preoperative computed tomography angiography to determine whether to sacrifice or reconstruct the artery. In this study, we assessed the validity and feasibility of this cutoff value. METHODS: Living related kidney recipients from 2005 to 2013 were enrolled in this retrospective study. The diameter of the accessory artery and adverse events were evaluated. The lost parenchymal volume (%) due to vascular obstruction or branch ligation was calculated by computed tomography volumetry. RESULTS: Among 128 kidney transplants, 30 donor kidneys had multiple arteries. Accessory arteries were reconstructed in 18 cases and intentionally ligated in 12 cases (mean diameter of accessory arteries, 3.10 [SD, 0.75] mm and 1.81 [SD, 0.28] mm, respectively). The mean estimated glomerular filtration rate at 1 or 12 months after transplant was not significantly different between the groups. Among reconstructed cases, 14 cases (77.8%) had good patency in the reconstructed arteries whereas the other 4 had vascular complications. The percentage of lost parenchymal volume due to ligation or occlusion of the reconstructed artery (calculated in 16 cases) was predictable with the following formula: lost volume (%) = 9.09 × diameter (mm) - 10.5 (P= .03, rs= 0.533 by Spearman rank correlation coefficient). This formula indicated that ligation of a 2-mm accessory artery leads to 7.68% loss of the renal parenchyma. CONCLUSIONS: Reconstruction using a cutoff diameter of 2 mm is worth attempting in terms of the success rate and graft function. Sacrifice of a 2-mm accessory artery leads to parenchymal loss of <8%.
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Journal of endourology 33(6) 504-504 2019年6月
共同研究・競争的資金等の研究課題
4-
日本学術振興会 科学研究費助成事業 基盤研究(B) 2021年4月 - 2024年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2018年4月 - 2021年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2018年4月 - 2021年3月
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日本学術振興会 科学研究費助成事業 研究活動スタート支援 2014年8月 - 2016年3月