T Kawamura

Toho University, Edo, Tokyo, Japan

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Publications (49)54.64 Total impact


  • No preview · Article · Dec 2015 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis

  • No preview · Article · May 2015 · Pediatric Transplantation
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    ABSTRACT: Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD) in children. Although long-term survival on dialysis has improved over the past three decades, survival remains better for children who undergo kidney transplantation. Children undergoing kidney transplantation frequently require post-operative care in the Pediatric Intensive Care Unit (PICU). For example, it is frequently necessary to infuse large volumes of fluid, plasma, and blood to prevent hypovolemia, acute tubular necrosis, and venous thrombosis of the renal allograft. These problems are compounded when a relatively young child receives an adult allograft. Because a large volume of blood is shifted to the renal allograft, the recipient's heart will have to work harder to circulate a relatively higher cardiac output (CO) to the adult-sized renal allograft. Post-operative fluid management and hemodynamic monitoring is therefore of crucial importance. Finally, there are several potential complications in the early and late post-operative period that are relevant to the pediatric critical care physician.
    No preview · Article · Jan 2014 · Pediatric Critical Care Medicine

  • No preview · Article · Nov 2012 · Transplantation
  • Y. Kawamura · Y. Maemura · T. Terada · R. Ochiai · T. Kawamura · A. Aikawa
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    ABSTRACT: Background: Free liver-type fatty acid binding protein (L-FABP) is a soluble protein with a molecular weight of approximately 14 kDa and is responsible for the transport of intracellular energy, lipid metabolism, and hydrophobic ligands. It reflects oxidative stress in renal proximal convoluted tubules. We evaluated the relation between renal ischemic time and urinary L-FABP values after renal reperfusion during kidney transplantation surgery. Methods: We assessed 8 adult donor-recipient pairs who were scheduled for living related kidney transplantation. Urinary L-FABP was measured before surgery, immediately after ligation of the ureter, and after completion of surgery in donors, and before surgery and in the first urine after renal reperfusion in recipients. Preoperative urinary L-FABP in donors and in the first urine of recipients was compared by using the paired f test; p<0.05 was considered statistically significant. The correlation between urinary L-FABP in the first urine of recipients and renal ischemic time was examined by using correlation analysis. Results: As compared with preoperative values (7.1 ±6.5 μg • gCr-1) in donors, L-FABP (476.4 ±393.2 μg gCr-1) in the first urine of recipients was significantly higher. Its correlation with renal ischemic time was low (r = 0.1069), but the increment in L-FABP was weakly correlated (r = 0.6740) with renal ischemic time. Conclusions: The present study showed that urinary L-FABP was higher immediately after renal ischemia-reperfusion injury during renal transplantation surgery, which indicates that it might be a good biomarker of acute kidney injury (AKI).
    No preview · Article · Jan 2012
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    ABSTRACT: Due to the profound shortage of suitable deceased allografts, much effort has been made to investigate whether successful kidney transplantation (KT) is possible across the ABO blood group barrier even for pediatric recipients. We reviewed 52 consecutive ABO incompatible (ABOic) transplantation performed between September 1989 and March 2011. The mean age at transplantation was 10.6 ± 3.9 years (range, 4.4-19.7), with 35 boys and 17 girls. The donor-to-recipient ABO blood antigen incompatibility was as follows: A1/O (n = 17); B/O (n = 13); A1/B (n = 6); B/A1 (n = 1); A1B/B (n = 9); and A1B/A (n = 6). As a control group, data were collected from 271 pediatric ABO compatible (ABOc) living donor KT in the same period. Overall acute rejection episodes (ARE) among the ABOic group were significantly higher than those of the ABOc group (44% vs 26%; P < .02). However, there was no difference in glomerular filtration rate (GFR) at 1 year after transplantation: 86 ± 31 mL/min for ABOic vs 99 ± 37 mL/min for ABOic, respectively. The 1-y, 5-y, and 10-year patient survival rates were 98%, 92%, and 92% in the ABOic group, respectively, and 99%, 98%, and 97% in the ABOc group, respectively (P = not significant [NS]). The overall 1-, 5-, 10-, and 15-year graft survival rates were 94%, 88%, 86%, and 86% in the ABOic group, respectively, and 95%, 92%, 88%, and 78% in the ABOc group, respectively. ABOic KT provided long-term allograft and patient survivals equivalent to ABOc live donor transplantations.
    No preview · Article · Jan 2012 · Transplantation Proceedings

  • No preview · Article · Jul 2010 · Transplantation
  • T. Kawamura · A. Aikawa · S. Shishido · J. Takasu

    No preview · Article · Sep 2009
  • A Aikawa · T Kawamura · Y Mori · M Saneshige · J Takasu

    No preview · Article · Jul 2008 · Transplantation
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    ABSTRACT: Background: Serum (1→3)-beta-D-glucan (beta-glucan) values are commonly used in clinical settings as markers of mycotic infection, and increased serum beta-glucan has been reported in patients with chronic renal failure undergoing hemodialysis. In immunosuppressed renal transplant recipients, there is an increased risk of mycotic infection, such as pneumocystis carinii pneumonia. Beta-glucan is often determined as a marker of PCP in renal transplant recipients. It is essential for the management of renal transplant recipients to establish how long beta-glucan remains positive after transplantation. We monitored serum beta-glucan values after renal transplantation in recipients with elevated pre-transplant beta-glucan levels. Subjects and Methods: We determined beta-glucan in 12 male and 12 female patients before renal transplantation (recipient age range 8 to 54 years, mean 33 years), using previously described methods. The period from transplantation to the day when beta-glucan values had normalized was calculated using curve fitting by exponential function. The normal level of beta-glucan was defined as ≤20 pg/ml. Results: Beta-glucan values were elevated in 11 of the 24 patients pre-transplant, with values ranging from 33.2 to 11000 pg/ml (2557.0 ± 3932.2). We performed chest CT in these 11 patients and found no evidence of consolidation in the lung fields. We monitored beta-glucan levels after transplantation in 5 patients with elevated values. Beta-glucan levels decreased slowly in all 5 patients. The mean calculated period from transplantation to the day when the beta-glucan value had normalized was 81 days (range, 63.7-125.9 days). Conclusion: Serum values of beta-glucan that had been elevated in prospective kidney recipients before transplantation slowly decreased thereafter. The mean calculated period from transplantation to normalization of beta-glucan values was 81 days.
    No preview · Article · Nov 2005
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    ABSTRACT: Background: A renal transplant recipient developed pulmonary nocardiosis, despite receiving treatment with trimethoprim (TMP)-sulfamethoxazole (SMZ) 80-400 mg twice weekly for 5 months as prophylaxis against Pneumocystis carinii pneumonia after renal transplantation. Nocardia farcinica was isolated from the patient's sputum and the minimum inhibitory concentration (MIC) of SMZ was 20 μg/ml. We studied the pharmacokinetics of TMP-SMZ and evaluated its dosage in 2 other renal transplant recipients who did not suffer pulmonary nocardiosis. Subjects and Methods: The 2 transplant recipients were given a single oral dose TMP-SMZ 80-400 mg. Blood samples were obtained before administration and 1, 2, 3, 4, 6, 8, 12 and 24 hours after administration: serum SMZ concentrations were then determined. Results: Mean Cmax and the area under the serum concentration of SMZ were 25.32 μg/ml and 786.29 μg-hr/ml, respectively. Using data from single-dose administration, we calculated the cumulative time in a one-week period during which the serum concentration of SMZ exceeded 20 μg/ml. With daily oral administration of TMP-SMZ 160-800mg, the therapeutic dose administered to our patient with nocardiosis, the mean cumulative time during which the serum SMZ concentration exceeded 20 μg/ml was 168 hrs/week; this dose is considered effective in the treatment of nocardiosis. With twice weekly administration of TMP-SMZ 80-400 mg, the prophylactic dose administered to our patient who developed pulmonary nocardiosis, the mean cumulative time during which the serum SMZ concentration exceeded 20 μg/ml was only 26.8 hrs per week. Conclusion: These results suggest that twice weekly administration of TMP-SMZ 80-400 mg is insufficient to prevent nocardial infection in renal transplant recipients.
    No preview · Article · Sep 2005
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    ABSTRACT: The aim of this study was to evaluated the outcomes of living related kidney transplantation in small children. Ten pediatric patients with body weights less than 10 kg received parental kidney transplants (five mothers and five fathers). An intra-abdominal approach was used in nine children and a retroperitoneal approach in one child. Bilateral, left, or right nephrectomy was performed in seven, two, and one child, respectively. Immunosuppression consisted of either cyclosporine (n = 7) or tacrolimus (n = 3) with either mizoribine (n = 4) or mycophenolate mofetil (MMF) (n = 5) or azathioprine (n = 1), and methylprednisolone (n = 10). Antilymphocyte globulin was used in the first series of four children; basiliximab in the most recent five children. All renal allografts functioned immediately after transplantation despite the mismatched size of the large renal allografts. Nine of 10 children were alive with a functional allograft at 6 to 196 months posttransplantation. One child died of intra-abdominal bleeding 5 days posttransplantation. One child has suffered chronic allograft nephropathy 11 years posttransplantation (serum creatinine 3.3 mg/dL). The remaining eight children display good renal function (serum creatinine = 0.2 to 1.43 mg/dL). Steroids were withdrawn in eight of nine children; one child continues on alternative-day therapy. One child (LD55) exceeded the mean standard height. The most recent height standard deviation (SD) scores were superior (-1.75 +/- 1.39 [-3.83 to 0.54]; P < .0082) to those at transplantation (-2.91 +/- 0.79 [-2.00 to -4.14]). The outcomes of living related kidney transplantation in small children were excellent despite the operative risks and the difficulty of cardiovascular and fluid management. Transplantation for small children appears to result in much better quality of life and growth than dialysis.
    No preview · Article · Sep 2005 · Transplantation Proceedings
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    ABSTRACT: A 32-year-old man was admitted to our hospital with productive cough and fever. He had received a kidney transplant 6 months before admission and was on a regimen of 12 mg/kg of methylprednisolone and 6 mg/kg of tacrolimus at the time of admission. He had also been receiving trimethoprim (TMP) - sulfamethoxazole (SMZ) 80-400 mg twice a week for prophylaxis against Pneumocystis carinii pneumonia for 5 months. Chest radiography and computed tomography revealed multiple cavities in both lung apices. Gram-positive branching filaments in the sputum suggested a diagnosis of nocardiosis. The patient became afebrile after starting daily doses of TMP-SMZ 160-800 mg and sparfloxacin (SPFX) 200 mg. Nocardia farcinica was identified and the minimum inhibitory concentration for SMZ and SPFX were 20 and 0.5 μ g/ml, respectively. The administration of TMP- SMZ and SPFX was continued for 6 months without any side effects. During a 15-month follow-up period after completion of nocardiosis treatment, the patient has remained well without relapses.
    No preview · Article · Jul 2005
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    ABSTRACT: Forty-two ESRD patients underwent renal transplantation using basiliximab (mean age: 30.6 +/- 18.6 years at transplantation; male: 50%; ESRD duration: 51.6 +/- 13.0 months) between February, 2000 and July, 2003. All patients had a protocol biopsy on the day of transplant, on discharge from the hospital (35.5 +/- 13.2 days), and at 1 year after transplant. The immunosuppression included a calcineurin inhibitor, basiliximab, mycophenolate mofetil (MMF), and methylprednisolone. While 16 patients used tacrolimus (FK group: 29.4 +/- 16.6 years old), 26 patients used cyclosporine (CsA group: 31.4 +/- 20.1 years old). Protocol biopsies were graded according to the Banff 97 classification. The incidence of acute rejection episodes within 1 year was greater in the CsA (15%) than the FK group (6%). Serum creatinine at hospital discharge was similar (CsA: 1.01 +/- 0.59 mg/dL, FK: 0.97 +/- 0.49, p = .18); however creatinine at 1 year differed significantly (CyA: 1.22 +/- 0.88 mg/dL, FK: 0.92 +/- 0.39, P = .03). There was a trend toward an increase in the score of interstitial inflammations in the CsA group, while it remained constant in the FK cohort (P = .05 at 1 year between the two groups). Other pathologic scores (t, ci, ct, cv, ah) did not differ between the groups at 1 year. Although there were no differences in the demographics between the two groups, there were several trends toward better renal function in the FK group.
    No preview · Article · Jun 2005 · Transplantation Proceedings
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    Y Miyagi · T Morioka · K Fukui · T Kawamura · K Hashiguchi · F Yoshida · T Shono · T Sasaki
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    ABSTRACT: A 15-year-old girl developed intractable epilepsy following a right transcallosal resection of the intraventricular teratoma. Magnetic resonance (MR) imaging showed a T (2)-prolonged subcortical lesion in the right frontal lobe as well as a residual intraventricular tumor. The integration of the voltage topography of ictal onset activities of the scalp-recorded electroencephalogram (EEG) and a surface anatomy scan of MR images clearly revealed the epileptogenic area on the cortex above the subcortical lesion, with the propagation pattern towards the frontopolar area. Excision of the epileptogenic cortex and underlying gliosis resulted in a successful cessation of the epilepsy. This non-invasive EEG technique provided useful information that accurately localized the epileptogenic area on a large structural abnormality without invasive intracranial electrocorticographic monitoring.
    Full-text · Article · May 2005 · min - Minimally Invasive Neurosurgery
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    ABSTRACT: The aim of this study was to investigate whether glomerular sclerosis (GS) at the time of engraftment affects subsequent morphology and clinical course of renal allografts. Eighty-one renal transplant recipients were recruited for this study. Protocol biopsies of the renal allografts were performed at engraftment, as well as at 1, 3, 5, and 7 years after transplantation. All cases were divided into 2 groups based on the presence of GS at engraftment, namely, non-GS and GS groups. Morphological changes in the renal allografts were graded from 0 to 3+ based on the severity of chronic allograft nephropathy (CAN) of the Banff classification based on 5 factors: percentage of GS, extent of interstitial fibrosis, tubular atrophy, arterial intimal thickening, and arteriolar hyalinosis. Furthermore, the level of serum creatinine (s-Cr) at each year was examined by recipient age and gender, donor age and gender, type of donor (living/cadaver), delayed graft function, acute rejection within 1 year after transplantation, mean blood pressure, and use of calcineurin inhibitors as well as the presence of GS at engraftment. The extent of GS at engraftment significantly correlated with donor age (P = .0038) but with a weak correlation coefficient. Although the severity of CAN developed gradually in both non-GS and GS groups, differences in morphological changes at engraftment between the 2 groups persisted throughout 7 years. Donor age and recipient gender influenced s-Cr significantly. In conclusion, the presence of GS at engraftment aggravates subsequent morphological changes and affects short-term but not long-term allograft prognosis.
    No preview · Article · Apr 2005 · Transplantation Proceedings
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    ABSTRACT: ABO-incompatible renal transplantation (ABOIRTx) tend to lead to blood type antibody-mediated rejection, the so-called delayed hyperacute rejection (DHAR), which results in short-term graft loss. To clarify the accurate incidence and prognostic value of DHAR among ABOIRTx, we reviewed biopsy specimens obtained from ABOKTx allografts with abrupt dysfunction during the early period after transplantation. Among 74 ABOIRTx patients, 34 patients displayed allograft dysfunction within 14 days following transplantation. The biopsy specimens were classified based on the Banff schema. The pathological diagnosis of ABO blood type antibody-mediated humoral rejection (ABO-AMHR) was made by the following 3 findings: Specimens with all of above-mentioned findings were categorized as severe ABO-AMHR; those with at least one findings, were categorized as mild ABO-AMHR. All patients were treated with steroid pulse therapy and/or modification of other immunosuppressants. Group 1 consisted of severe ABO-AMHR (n = 6); group 2 consisted of mild ABO-AMHR (n = 5); group 3 consisted of acute cellular rejection (n = 3); group 4 consisted of recovery phase of ATN (n = 11); group 5 consisted of calcineurin inhibitor toxicity (n = 2); and group 6 consisted of normal histology (n = 5). One of 6 patients (16%) in group 1 lost the graft because of DHAR irreversible by antirejection and anticoagulation therapy. However, there has been no clear definition of histpathological criteria for DHAR after ABO-incompatible kidney transplantation. The definition must prognosticate whether the rejection process is reversible.
    No preview · Article · Apr 2005 · Transplantation Proceedings

  • No preview · Article · Jul 2004 · Transplantation

  • No preview · Article · Jul 2004 · Transplantation

  • No preview · Article · Jul 2004 · Transplantation