Hiroyuki Kikuchi

Usefulness of quantitative real‐time polymerase chain reaction in following up patients with Epstein–Barr virus infection after liver transplantation

Background. Post‐transplant lymphoproliferative disease (PTLD), which is mainly induced by Epstein–Barr virus (EBV) infection, is a cause of significant morbidity and mortality for patients undergoing liver transplantation, especially when it is detected at such an advanced stage as monoclonal malignant lymphoma. 
Methods. In this series, 6 of 22 1iver transplant patients suffered from EBV infection. We tested quantitative DNA (Qt‐DNA) by real‐time polymerase chain reacton (PCR), qualitative DNA in plasma (Ql‐pDNA) by PCR, and EBV‐encoded mRNA 1 (EBER 1) by in situ hybridization to clarify which of them is a better marker for the early diagnosis and prediction of EBV‐associated disorders. 
Results. Four had signs or symptoms of PTLD, but 2 did not develop individualized lymphoid lesions. In all patients, both Qt‐DNA and EBER 1 exceeded the cut‐off level of 102.5 copies/μg DNA and 0.002%, respectively, at the time of diagnosis. In 2 patients, when Qt‐DNA had a poor decline, EBER 1, even if it seemed to decrease after antiviral therapy, increased again after a few months and the clinical symptoms recurred. In 2 patients, Qt‐DNA and EBER 1 increased again after a few months of antiviral therapy, and Ql‐pDNA remained positive, whereas, in 3 patients, no reaction of EBV could be detected once Ql‐pDNA became negative, even after the cessation of therapy. 
Conclusions. These results suggest that real‐time PCR for Qt‐DNA was more sensitive to the real‐time activity of EBV and that Ql‐pDNA could indicate when to stop antiviral therapy.

Reactivation of hepatitis and lamivudine therapy in 11 HBsAg‐positive renal allograft recipients: a single centre experience

Abstract:  Background:  In hepatitis B virus (HBV) surface antigen (HBsAg) (+) renal allograft recipients, the mortality associated with liver disease reaches 37–78%. An antiviral agent, lamivudine, has recently been reported to be safe and effective for preventing hepatic damage in these patients, although either resurgence of HBV‐DNA levels after discontinuation or emerging resistant HBV mutants caused by long‐term administration are still unsettled.

Successful Steroid Withdrawal After Long-Term Adminstration in Renal Transplant Patients

OBJECTIVE This study evaluated the effect of steroid withdrawal after long-term administration on stably functioning renal transplant recipients. METHODS Between April 2000 and October 2006, steroid administration was safely withdrawn in 47 patients with stable graft function for >1 year after renal transplantation. The period between renal transplantation and steroid withdrawal varied from 12 to 234 months. We also investigated the current steroid doses of all 274 outpatients who had undergone renal transplantation at our hospital between July 1977 and October 2006. RESULTS Twelve patients out of 47 had to resume steroid administration, 10 (21%) owing to acute rejection with/without recurrent glomerulonephritis, 1 owing to treatment of subacute thyroiditis, and the other owing to accompanying cessation of azathioprine for ovarian cancer. Thirty-five patients have maintained stable graft function for 12 to 90 months (median, 49) after steroid withdrawal as confirmed by follow-up. At present, only 1 of the 47 patients had to resume hemodialysis owing to chronic deterioration of renal graft function. The current steroid doses (prednisolone equivalent) of the 274 outpatients at our hospital are as follows: The number of patients for withdrawn, <5 mg, 5 mg, >5 to 10 mg, and >10 mg/d is 38, 20, 155, 57, and 4, respectively. Of 294 patients, 213 (77.7%) are maintaining stable renal graft functions on </=5 mg prednisolone per day. CONCLUSION Steroids can be safely withdrawn in renal transplant patients with stable graft functions, even after long-term administration.

A Clinical Study on the Gastrointestinal Surgery in Regular Hemodialysis Patients.

最近10年間の当施設での維持透析患者の消化器外科手術症例をA待期的手術群52例, B緊急手術群33例の比較を中心に検討を加えた.A群術後合併症28.8%, 直死3.8%, B群合併症48, 5%, 直死21.2%であり, 術後在院死の主因はA群で肺合併症, B群でseptic multiple organ failureであった.B群の51.5%を虚血性大腸炎壊死型を主とする下部消化管穿孔例が占め, 手術までの経過時間は大きな予後規定因子であり24時間以内の早期手術が肝要である.A群の60歳以上の術後合併症66.7%, 在院死58.3%で, 60歳未満で合併症17.5%, 在院死2.5%であり, 前者の在院死はすべて担癌患者であった.A群の血漿fibronectin値は術前, 術後3, 7病日ともに成人健常者に比べ有意に低く, また術後の回復遅延が認められた.以上より維持透析患者は消化器外科手術において術後感染防御・創傷治癒の両面でのriskを有し, 特に60歳以上の担癌患者はhigh riskと考えられる.