Hisakazu Degawa

Effect of anti-ICAM-1 and anti-LFA-1 antibodies on rat liver transplantation.

The effect of the anti-cell adhesion molecule anti-bodies, anti-ICAM-1 (1A29) and anti-LFA-1 (WT1), on rat liver transplantation was investigated. Livers from ACI rats were transplanted into Lewis rats by Kamadas method and during the recipient operation 1A29 1 mg/kg, and WT1 1 mg/kg were administered intravenously to one group of rats (treated group). The survival time of the treated group was significantly longer than that of the untreated group, but permanent unresponsiveness could not be induced. Postmortem examination revealed little histological evidence of acute rejection in the treated rats, in which the main cause of death was thought to be chronic rejection.

A NONSPECIFIC COLONIC ULCER OCCURRING AFTER HEPATECTOMY : REPORT OF A CASE

We herein report the case of a 53-year-old man with a nonspecific acute colonic ulcer whose liver function deteriorated after he had undergone hepatectomy. He was referred to our hospital for a hepatoma caused by hepatitis B virus and a right hemihepatectomy was performed. His liver function was poor after the operation, and minor complications such as pleural effusion and biliary fistula developed. A large amount of melena was seen 29 days after the hepatectomy and he developed hemorrhagic shock. Superior mesenteric arteriography revealed pooling of blood in both the hepatic flexure of the ascending colon and the cecum. An emergency right hemicolectomy was performed. There was a 5 x 1-mm ulcer 18 cm distal to the ileocecal valve. Numerous erosions were observed to be scattered throughout the colonic mucosa. The patient recovered slowly and was discharged 6 months after the hepatectomy. This is the first report of an acute colonic ulcer that could have been caused by liver dysfunction.

IDENTIFICATION OF INFLAMMATORY CELLS INFILTRATING RENAL ALLOGRAFTS

Eight nephrectomies and 13 biopsies of renal allografts (living 15, cadaveric 6) were investigated on the origin of inflammatory cells in the graft tissues by the use of an immunohistologic method (ABC method). Various monoclonal antibodies and heterosera were used to identify different leukocyte subsets. In all specimens the most predominant inflammatory cells were T cells. Other cells decreased in the following order; B cells, neutrophils and monocytes, and natural killer cells. In T cell subsets Leu 2a‐positive cells (suppressor/ cytotoxic T cells) predominated over Leu 3a‐positive cells (helper/inducer T cells) in 4 nephrectomies (living 1, cadaveric 3) and 12 biopsies (living 11, cadaveric 1). Among these 16 cases, 7 were undergoing acute rejection in various degrees, and 9 were without clinical rejection. In the former 7 cases only one was suffering from another disease. In contrast, Leu 3a‐positive cells predominated over Leu 2a‐positive cells in 1 biopsy (living) and 4 nephrectomies (living 2, cadaveric 2). Four of these 5 cases concurrently had other diseases in addition to acute rejection. Two cases underwent acute tubular necrosis (cadaveric graft nephrectomies) and 2 underwent chronic rejection and crescentic glomerulonephritis (living graft nephrectomies). The one remaining case was without clinical rejection.

Efficacy of Once‐weekly Intravenous Administration of Epoetin‐β as a Maintenance Treatment for Anemia in Japanese Hemodialysis Patients: A Multicenter, Open‐label Clinical Study

Epoetin‐β is extremely useful as a drug for treating anemia in hemodialysis (HD) patients and is widely used for that purpose. The aim of this study was to determine whether once‐weekly intravenous administration of epoetin‐β is as effective in maintaining hemoglobin (Hb) concentration as the same weekly dose administered 2 or 3 times per week as maintenance treatment of anemia in HD patients. The subjects were stable HD patients who had been receiving HD for at least 12 months. Using a fixed weekly dose of 3000 or 6000 IU of epoetin‐β, this study evaluated maintenance of improvement of anemia by comparing Hb concentration in the study period (once‐weekly) with Hb concentration in the prestudy period (2 or 3 times per week). Of the 112 patients treated with epoetin‐β, 111 patients (full analysis set; 3000 IU, 52 patients; 6000 IU, 59 patients) were evaluated, after excluding one patient whose dose was changed immediately before study initiation. The change in the Hb concentration was maintained within ±1.5 g/dL in 89.2% of patients (3000 IU, 88.5%; 6000 IU, 89.8%). The mean Hb concentration was 10.42 ± 0.73 g/dL at study initiation and 10.14 ± 1.00 g/dL at study completion. Adverse reactions occurred in 9.8% of patients (11 out of 112 patients). The main adverse reactions were malaise and increased blood pressure. Once‐weekly intravenous administration of epoetin‐β is useful as maintenance treatment of anemia in HD patients and may be a treatment option.

Case report of ten adults who underwent or desired to undergo liver transplantation abroad.

肝移植が末期肝不全に対する標準的な治療法として世界で確立されている現在, 日本でも肝移植が普及することが予想されるが, 臨床面での問題点も多い. そこで, 海外で肝移植を受けることを希望した成人10例の臨床経過を検討したので報告をする. 原疾患の内訳は, 肝硬変7例, 慢性活動性肝炎, 原発性胆汁性肝硬変, 薬剤性肝炎各1例であった. 実際に肝移植を受けた5例のうち2例は術後に肝不全または敗血症のために死亡した. 4例は肝移植を受けることができずに死亡し, 薬剤性肝炎の1例は待機中に肝機能が軽快したため肝移植を受けずに生存している. 肝移植術後生存中の3例はいずれも肝炎ウイルスの再感染を認めた. 今後日本国内で脳死肝移植が可能となっても, 適応疾患の選択, ウイルス性肝炎や肝癌などの原疾患の再発, 待機中の死亡, 拒絶反応や免疫能低下による感染症の発生の問題など, なお解決せねばならない諸問題が残されている.