19. 腎移植 2, 9, 12 CKD 13 9, 11 PET QOL 3 腎移植後のレシピエントおよびドナーにおける CKD ケア a CKD CKD 2 3 T 4 GFR 3 b GFR 58.7 ml1.73 m 2 60 CKD 3T C

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1 19 腎移植ステートメント 1 腎代替療法としての腎移植の位置づけ腎移植は生命予後を改善する可能性があり,CKD ステージ 4,5 で医学的に腎移植手術が可能と考えられるすべての患者およびその家族に, 腎移植というオプションの提示を行う必要がある 1). 2 先行的腎移植 (PET) の意義透析導入前でも腎移植は可能であり, これを先行的腎移植 (preemptive transplantation:pet) と呼ぶ.PET は, 従来の透析導入後の腎移植に比べて, 患者生存率や移植腎生着率に優れている 2, 3). 3 腎移植後の CKD ケア腎移植レシピエントと腎移植ドナーは, どちらも, 移植後に CKD ステージ 3 ~ 5 の腎機能障害を示すことが多く, 非移植 CKD 患者と同様な長期的かつ定期的な CKD ケアが重要である 4). 解説 1 腎代替療法としての腎移植の位置づけ 1 CVD 5 QOL CKD 4, 5 ABO 6 2 先行的腎移植 (PET) の意義 PET 2, 3, 7 11 PET 234

2 19. 腎移植 2, 9, 12 CKD 13 9, 11 PET QOL 3 腎移植後のレシピエントおよびドナーにおける CKD ケア a CKD CKD 2 3 T 4 GFR 3 b GFR 58.7 ml1.73 m 2 60 CKD 3T CKD GFR CKD 15 CVD 16 CKD 17, 18 CVD 1 CKD CVD 19 CKD CKD 20 K DOQI CKD c 30 GFR ml1.73 m GFR 80 ml1.73 m 2 GFR GFR 60 ml1.73 m 2 21, b CKD CKD d 235

3 エビデンスに基づく CKD 診療ガイドライン 2009 アブストラクトテーブル論文コード対象方法結果 1.Wolfe RA, N Engl J Med ,164 23, % 2.Mange KC, N Engl J Med 2001 states Renal Data System 8,481 PET 1,819 PET 3.Meier Kriesche HU, 2002 States Renal Data System 73,103 PET 1, Karthikeyan V, Am J Transplant 横断研究 CKD CKD 1 90% 3 60% CKD CKD 5.Meier Kriesche HU, Am J Transplant USRDS 60,141 66, Takahashi K, Am J Transplant ABO ABO , % 89% 87% 85% 84% 84% 80% 71% 65% 59% 1 ABO ABO ABO 7.Vats AN, 2000 NAPRTCS the North American Pediatric Renal Transplant Cooperative Study 2,495 PET PET 3 HD PD 82% PET 89% p

4 19. 腎移植論文コード対象方法結果 8.Kasiske BL, J Am Soc Nephrol 2002 UNOS United Network for Organ Sharing 38,836 PET5,118 PET 9.Mange KC, Nephrol Dial Transplant 2003 States Renal Data System Cox non PET PET non PET 10.Goldfarb Rumyantzev A, Nephrol Dial Transplant 2005 States Renal Data System 81,130 Cox 11.Papalois VE, , PET PET non PET PET 12.Kaul H, Am J Kidney Dis PHA T cell HD 6 13.Shinohara K, Kidney Int PWV aortic stiffening % % % 15.Kasiske BL, Am J Transplant ,278 GFR ml1.73 m 2 16.Kaplan B, Am J Transplant US- RDS 4, % vs. 2.81% 17.Gill JS, Kidney Int ,643 EPO Ht GFR 27.5%, 3.3 g dl, 8.4 ml1.73 m 2 KDOQI 237

5 エビデンスに基づく CKD 診療ガイドライン 2009 論文コード対象方法結果 Hb 8.6 g dl mmhg KDOQI RAS EPO D intact PTH P 19.Meier Kriesche HU, US- RDS 1 58,900 1 CVD 1 1 CVD Cr 1.5 mg dl CVD 1 20.Textor SC, GFR CKD % 91.5% CKD 3 5 GFR 50 ml1.73 m 2 50% 238

6 19. 腎移植文献 1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med Meier Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes a paired donor kidney analysis Karthikeyan V, Karpinski J, Nair RC, Knoll G. The burden of chronic kidney disease in renal transplant recipients. Am J Transplant Meier Kriesche HU, Schold JD, Srinivas TR, Reed A, Kaplan B. Kidney transplantation halts cardiovascular disease progression in patients with end stage renal disease. Am J Transplant Takahashi K, Saito K, Takahara S, Okuyama A, Tanabe K, Toma H, Uchida K, Hasegawa A, Yoshimura N, Kamiryo Y Japanese ABO Incompatible Kidney Committee. Excellent long term outcome of ABO incompatible living donor kidney transplantation in Japan. Am J Transplant Vats AN, Donaldson L, Fine RN, Chavers BM. Pretransplant dialysis status and outcome of renal transplantation in North American children a NAPRTCS Study. North American Pediatric Renal Transplant Cooperative Study Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation the advantage and the advantaged. J Am Soc Nephrol Mange KC, Joffe MM, Feldman HI. Dialysis prior to living donor kidney transplantation and rates of acute rejection. Nephrol Dial Transplant Goldfarb Rumyantzev A, Hurdle JF, Scandling J, Wang Z, Baird B, Barenbaum L, Cheung AK. Duration of end stage renal disease and kidney transplant outcome. Nephrol Dial Transplant Papalois VE, Moss A, Gillingham KJ, Sutherland DE, Matas AJ, Humar A. Pre emptive transplants for patients with renal failure an argument against waiting until dialysis Kaul H, Girndt M, Sester U, Sester M, Kohler H. Initiation of hemodialysis treatment leads to improvement of T cell activation in patients with end stage renal disease. Am J Kidney Dis Shinohara K, Shoji T, Tsujimoto Y, Kimoto E, Tahara H, Koyama H, Emoto M, Ishimura E, Miki T, Tabata T, Nishizawa Y. Arterial stiffness in predialysis patients with uremia. Kidney Int Kasiske BL, Gaston RS, Gourishankar S, Halloran PF, Matas AJ, Jeffery J, Rush D. Long term deterioration of kidney allograft function. Am J Transplant Kaplan B, Meier Kriesche HU. Death after graft loss an important late study endpoint in kidney transplantation. Am J Transplant Gill JS, Abichandani R, Khan S, Kausz AT, Pereira BJ. Opportunities to improve the care of patients with kidney transplant failure. Kidney Int CKD Meier Kriesche HU, Baliga R, Kaplan B. Decreased renal function is a strong risk factor for cardiovascular death after renal transplantation Textor SC, Taler SJ, Driscoll N, Larson TS, Gloor J, Griffin M, Cosio F, Schwab T, Prieto M, Nyberg S, Ishitani M, Stegall M. Blood pressure and renal function after kidney donation from hypertensive living donors 参考にしたガイドラインなど a. Sayegh MH, Carpenter CB. 50 years later progress, challenges, and promises. N Engl J Med b. CKD c. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease evaluation, classification, and stratification. Ann Intern Med d. Ethics Committee of the Society. The consensus statement of the Amsterdam Forum on the Care of the Live Kidney Donor

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C/NC : committed/noncommitted 110 time post-icd implant 1) The Cardiac Arrhythmia Suppression Trial (CAST) Investigators Preliminary report : Effect of encainaide and flecainide on mortality in a