In Japan, the new law of organ transplantation was introduced in 2010 as broad opt in system likely WHO standard. However option for organ donation from the patients with brain death is not regulated by the law and depends on the decision of charged doctors. Organ donation is prohibited from the child injured with child abuse and the patients with mental retardation. Directed donation is adopted in USA and Korea, although it is prohibited in all European countries. It is permitted only for pre-registered donors and their parents, children and spouse in Japan. Opt out system should not be established in Japan because it is still not enough that general people accept brain death. Recruit and education of more coordinators and ICU doctors and nurses are also necessary, in terms of donor action program. In addition we have to keep on enlightening organ donation for general people.
Obesity and hypervolemic status are mainly one of causes of hypertension in chronic kidney disease (CKD) patients. However, it is difficult to assess these factors because changes in body weight (BW) in CKD patients are affected not only by muscle and fat, but also by fluid status. The objective of this study is to assess the relationship between blood pressure (BP) and body composition using dry mass index (DMI), which subtracts total body water (TBWBIA) from BW, and a ratio of TBWBIA to estimated TBWwatson by anthropometric formula (Watson). In 40 randomly selected CKD patients, body composition and BP measured by bioelectrical impedance analysis (BIA) and by 24 hour ambulatory BP monitoring, respectively. Based on DMI and TBWBIA/TBWwatson ratio, participants were categorized into 3 of obese, 15 of overweight, 21 of optimal weight, and one of underweight, or into 13 with hypovolemia, 19 with euvolemia, and 8 hypervolemia.Empty CellDMITBWBIA/TBWwatsonrprpDaytime sBP-0.0050.9980.4290.006Night-time sBP-0.0860.5880.534<0.001Non-dipping status0.0950.5580.413<0.001 Ambulatory BP was associated with the ratio of TBWBIA to TBWwatson. In conclusion, the ratio of TBWBIA to TBWwatson is a reliable marker of fluid status, which is of practical use to assess cause of hypertension in CKD patients.
Background/Aims: Obesity and hypervolemic status are the main causes of hypertension in patients with chronic kidney disease (CKD). However, it is difficult to differentiate between them. We aimed to assess the associations of body mass index (BMI) and total body water (TBW) with ambulatory blood pressure (ABP). Methods: Body composition by bioelectrical impedance analysis (BIA) and 24-h ABP were measured in 40 patients with CKD. TBW was assessed using corrected TBWBIA adjusted for body surface area (cTBWBIA) and the TBWBIA/TBWWatson ratio obtained using an anthropometric formula (Watson). Results: Elevated ABP (average 24-h BP ≥ 135/85 mmHg) was noted in 23 patients, who were more likely to have a higher cTBWBIA and TBWBIA/TBWWatson ratio than patients without elevated BP. Patients with nocturnal non-dipping (<10% drop in BP during sleep) were more likely to have a higher TBWBIA/TBWWatson ratio. Proteinuria and the TBWBIA/TBWWatson ratio were significant independent factors for 24-h ABP. BMI had a positive correlation with the cTBWBIA, TBWBIA/TBWWatson ratio and furosemide use. Conclusion: Hypertension is dependent on proteinuria and fluid volume imbalance. The TBWBIA/TBWWatson ratio can serve as an indicator of fluid volume-dependent hypertension. BMI is affected by TBW, in which case BMI can become less involved with 24-h ABP.
Introduction: To overcome chronic kidney allograft damage is important in order to improve graft survival; however, still problematic with current regular immunosuppressants. Thus we conducted the multicenter cooperative study using 15-deoxyspergualin (DSG), which is a potent immunosuppressive agent regulating vasculitis other than acute T-cell mediated rejection for chronically damaged kidney grafts. Methods: Twenty-four kidney transplant recipients whose graft was chronically damaged (14 chronic antibody mediated rejection, 1 chronic T-cell mediated rejection, 7 interstitial fibrosis and tubular atrophy, and 2 unknown cause) with creeping creatinine and urine protein secretion were enrolled and treated with multi sessions of DSG with written permission. DSG (3-5 mg/kg, each) were administrated intravenously for 5 consecutive days and repeated every month for 6 months. We evaluated the safety of this treatment and the efficacy according to the monthly examinations. P-values were obtained by mixed linear regression model for continuous variables and Cochran-Mantel-Haenszel test for categorical variables. Results: The average of recipients was 45.9 yeas old and they 23 accepted living grafts and one deceased graft 8-213 (median 61) months ago. Fourteen recipients (58.3%) experienced previous rejection episodes. Sixteen recipients were treated with calcineurin inhibitor-based maintenance immunosuppression (16; tacrolimus, 8; cyclosporine). Seventeen patients took ACE-inhibitor or angiotensin receptor blockade before the study entry. DSG induced mild anemia (decrease of RBC, hemoglobin and hematocrit), although other blood cells were not affected even after multi sessions of DSG administration. Surprisingly DSG significantly improved serum creatinine; however, could not reduce urine protein secretion (table).Conclusion: Long-term DSG treatment is a promising agent, which can recover chronically damaged graft function without any life-threatening adverse event. Although, the result of launched mechanistic study is awaited.
Microchimerism in 23 female renal transplant recipients from male donors was studied using nested polymerase chain reaction (nPCR) and fluorescence in situ hybridization (FISH) to detect Y-chromosome. nPCR was a sensitive and specific assay enabling a detection rate of 1/10(6) male/female cells, compared with a sensitivity of 1/10(2) by standard PCR (sPCR). None of the 23 patients with a male allograft demonstrated Y-chromosome using sPCR. In contrast, 1 3 (56.5%) patients demonstrated Y-chromosome with nPCR. Of 9 patients proven to have microchimerism by nPCR, only 3 also demonstrated Y-chromosome using FISH. The existence of B cells and CD8 cells in donor chimeric cells were proved by separation with Dynabeads class I and class II. Dynamic changes of microchimerism occurred in 4 of 5 patients. Four patients were proven to have microchimerism within a year of transplantation and the microchimerism later disappeared in 3, although the sequential change was variable in individual patients. There was no correlation between microchimerism and patients'clinical factors such as donor-specific blood transfusion, HLA matching, immunosuppression, past history of acute rejection and chronic rejection. The degree of microchimerism in renal transplant recipients was relatively low, and its existence did not seem to be compatible with long-term graft acceptance. However, further studies are required to elucidate the immunological mechanism of microchimerism, and it might be an important clue to immunological tolerance.
Objectives. Epithelial mesenchymal transition (EMT) is important for peritoneal deterioration. We evaluated the association between peritoneal solute transport rate (PSTR) and effluent markers related to EMT with adjusted values for effluent cancer antigen 125 (CA125). Methods. One hundred five incident peritoneal dialysis (PD) patients on PD for 25 (12-68) months with biocompatible solutions were included in the study. Fast peritoneal equilibration test was used to evaluate PSTR. Effluent hepatocyte growth factor (HGF), bone morphogenic protein-7 (BMP-7), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and CA125 at 4 h were measured. Results. Patients with dialysate/plasma creatinine ≧0.82 showed significantly higher effluent HGF (240 versus 133 pg/mL, P < .001), VEGF, IL-6, and IL6/CA125 levels than the others but no significant differences in effluent HGF/CA125, BMP-7, and BMP7/CA125 were observed. Conclusion. Increase in the effluent HGF levels as a compensatory mechanism is a marker of peritoneal deterioration, but controversy remains regarding adjusted value for CA125.
