記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.xjtc.2026.102295

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Late-onset non-infectious pulmonary complications (LONIPCs) following hematopoietic stem cell transplantation (HSCT) are a known indication for need of lung transplantation. This study aimed to clarify the clinical characteristics of patients with LONIPCs after HSCT who were registered for lung transplantation and reveal the risk factors for waiting list mortality. METHODS: We retrospectively reviewed the clinical data of patients with LONIPCs after allogeneic HSCT who were referred to Okayama University Hospital and registered in the Japan Organ Transplant Network for deceased-donor lung transplantation between 2005 and 2023. Pediatric patients aged <18 years at the time of registration were excluded. RESULTS: Thirty-four patients were included in this study. Notably, two distinct phenotypic groups were identified: One with a bronchiolitis obliterans pattern on high-resolution computed tomography and a mixed ventilatory defect, and the other with a pleuroparenchymal fibroelastosis pattern and a restrictive ventilatory defect. The median waiting duration for a deceased-donor lung transplant was 662 days, and 16 patients died during the waiting period. The cumulative incidence of waiting list mortality was 20.6% (95% confidence interval [CI], 8.9%-35.6%) at 1 year and 46.1% (95% CI, 27.8%-62.7%) at 3 years. A history of pneumothorax, greater dyspnea on exertion, and higher serum Krebs von den Lungen-6 levels were associated with an increased risk of waiting list mortality. CONCLUSION: In patients with LONIPCs after HSCT, a history of pneumothorax may be a marker of a poor prognosis and could serve as a criterion for referral of lung transplantation.

DOI： 10.1111/ctr.70582

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: A leukocyte filter has been empirically incorporated within ex vivo lung perfusion circuits since the advent of ex vivo lung perfusion. However, the utility of the leukocyte filter has never been fully defined, and studies have questioned the beneficial effects of the filter. Additionally, there have been suggestions that such filters may become quickly saturated in use requiring replacement for better effect. Thus, we sought to determine the effects of leukocyte filters on ex vivo lung perfusion and evaluated whether a conventional arterial filter would prove to be noninferior. METHODS: Porcine donor lungs (n = 22) were extracted and placed on the Toronto ex vivo lung perfusion platform for 12 hours. Groups consisted of a leukocyte filter group (conventional ex vivo lung perfusion with a leukocyte filter), an arterial filter group (the conventional leukocyte filter was replaced with an arterial filter), a change of filter group where the leukocyte filter was clamped and exchanged for a fresh filter after 1 hour, and a no filter control group. Because of severely poor performance seen in the change of filter group, only lungs in the leukocyte filter, arterial filter, and no filter groups were then transplanted into porcine recipients and monitored during a 4-hour reperfusion period. RESULTS: The leukocyte filter, arterial filter, and no filter groups showed good lung function on ex vivo lung perfusion. The change of filter group demonstrated worse lung function on ex vivo lung perfusion. After transplant, the leukocyte filter, arterial filter, and no filter groups demonstrated equivalent early lung function performance, but on histological staining, the no filter group demonstrated increased lung injury over the other groups. Cytokine levels were not significantly different among groups. CONCLUSIONS: The traditional leukocyte filter should be used in the ex vivo lung perfusion circuit but can be exchanged for an arterial filter with noninferior performance. Changing the filter after 1 hour does not add therapeutic benefit and makes lung performance worse on ex vivo lung perfusion.

DOI： 10.1016/j.jtcvs.2025.12.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Idiopathic pulmonary fibrosis (IPF) increases the risk of lung squamous cell carcinoma (LUSC), yet its molecular pathogenesis remains unclear. We conducted multi-omics analysis, including single-cell RNA sequencing and digital spatial profiling, on LUSC specimens from seven patients with usual interstitial pneumonia (UIP). In UIP lung tissue, metaplastic basal cells arising from the transdifferentiation of alveolar type 2 (AT2) cells were increased. LUSC tumors arising within UIP exhibited molecular profiles and trajectory dynamics suggesting derivation from these metaplastic basal cells. Both UIP-affected tissue and associated tumors showed activation of Wnt signaling, particularly WNT3 expression. Additionally, enrichment of the nuclear factor erythroid 2-related factor 2 (NRF2)-linked antioxidant response was observed in LUSC within UIP. Targeting Wnt/β-catenin signaling restored the sensitivity of these stress-adapted cancer cell lines to oxidative damage. These findings suggest that LUSC within UIP originates from AT2-derived metaplastic basal cells and involves aberrant Wnt3 activation, linking fibrosis to carcinogenesis and highlighting a potential therapeutic strategy.

DOI： 10.1016/j.isci.2026.115667

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Donor-derived cell-free DNA (ddcfDNA) has been shown to be useful in monitoring lung graft health, and single nucleotide variations (SNVs) between donor and recipient are used to identify ddcfDNA in post-transplant recipient blood. One limitation is the need to map donor or recipient SNVs prior to calculating %ddcfDNA. In this study, we use Nanopore sequencing of ex vivo lung perfusion perfusate cfDNA to map donor SNVs and validate it using standard short-read whole genome sequencing (WGS). Methods: cfDNA was extracted from 11 clinical ex vivo lung perfusion perfusate samples and sequenced using a Nanopore sequencer. SNVs were identified by comparison to a reference genome and then filtered for homozygous calls overlapping the 1000 Genomes SNP database. Matching short-read WGS was performed on 6 matching samples to act as a gold standard. Following mapping, %ddcfDNA was calculated in cell-free DNA (cfDNA) collected from matching post-lung transplant recipient plasma using SNVs called by Nanopore vs SNVs called by short-read WGS and compared for accuracy. RESULTS: Nanopore sequencing yielded genomic data with a median coverage of 4.88x (range 2.27-8.79) using a single flow cell with a median run length of 72 hours. The median general error rate of the sequence was 5.55% (range 4.98%-6.49%), and the median number of SNV with a depth > 3 and overlap with the 1000 Genomes SNP database was 246,993 (range 99,357-313,721). The positive predictive value of SNVs identified using 2X to 6X coverage cutoffs ranged from 66.6% to 96.9%, with a median value of 90.3% at 6X coverage. Correlation analysis showed a strong correlation between results by Nanopore sequencing and results by WGS for detecting %ddcfDNA in post-transplant plasma (R^2 = 0.996, p < 0.001). CONCLUSIONS: Despite the lower sequencing accuracy and depth obtained from Nanopore sequencing, a high positive predictive value can be achieved in a set of donor-specific SNVs when appropriately filtered by read depth and overlap with SNP databases. This demonstrates the potential for the use of Nanopore sequencing to generate personalized donor cfDNA maps for use in post-operative donor-derived plasma cfDNA identification.

DOI： 10.1016/j.jhlto.2025.100433

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Parenchyma-preserving strategies for anomalous systemic arterial supply to the basal segment of the lung have gained increasing attention. However, pulmonary infarction of the preserved lung has been reported, and clear criteria for selecting the optimal treatment have yet to be established. We report 2 cases in which detailed preoperative imaging informed tailored management-right posterior basal segmentectomy in 1 patient and endovascular embolization of the aberrant artery in the other-both without postoperative complications. A review of the relevant literature is also provided, with an emphasis on potential selection criteria. CASE PRESENTATION: Case 1: A 20-year-old asymptomatic woman was referred after an abnormal screening chest radiograph. CT demonstrated an aberrant artery arising from the abdominal aorta supplying the right posterior basal segment (S10) with a large intravascular thrombus. The pulmonary artery showed hypoplasia limited to A10, while the other branches were normal, and no parenchymal congestion was identified. Following resection of the aberrant artery, robot-assisted right S10 segmentectomy was performed. The postoperative course was uneventful, and the patient was discharged on POD 6. Case 2: A 27-year-old woman was incidentally diagnosed on CT for an unrelated indication. An aberrant artery arising from the descending thoracic aorta supplied the left basal segment. Pulmonary arterial branches were preserved, with only minimal congestion in S9-10. Angiography revealed no evidence of an arteriovenous fistula. As surgical lung resection was considered unnecessary, coil embolization of the aberrant artery was performed. No complications occurred, and the patient was discharged on day 3 after the procedure. CONCLUSIONS: In patients with anomalous systemic arterial supply to the basal segment of the lung, when pulmonary arterial branches are preserved and background parenchymal congestion is minimal, parenchyma-sparing approaches should be considered.

DOI： 10.70352/scrj.cr.26-0288

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The role of single lung transplantation (SLT) in secondary pulmonary hypertension (SPH) remains controversial. This study evaluated the feasibility and long-term outcomes of SLT in patients with SPH-defined as mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization immediately before transplantation-within Japan's allocation system, characterized by protracted waiting periods. METHODS: We retrospectively reviewed 83 deceased-donor lung transplantations, categorized into four groups: SLT without SPH (n = 14), SLT with SPH (n = 19), bilateral lung transplantation (BLT) without SPH (n = 12), and BLT with SPH (n = 38). Outcomes analyzed included 5-year survival, CLAD-free survival, and exercise tolerance. RESULTS: At transplantation, 68.6 % of recipients exhibited SPH, a significant increase compared to registration. Among SLT recipients, the SPH group demonstrated 5-year survival (83.2 %) and CLAD-free survival (65.9 %) not inferior to those of the non-SPH group (50.0 % and 56.8 %, respectively). Perfusion ratios and 6-min walk distances remained comparable between SPH and non-SPH groups for up to five years. Additionally, 5-year survival (83.2 % vs. 81.1 %) and CLAD-free survival (65.9 % vs. 64.5 %) were similar between SLT and BLT. High preoperative oxygen requirements were associated with poorer early graft function in SPH patients receiving SLT. No definitive predictors of CLAD or long-term survival were identified. CONCLUSIONS: SLT is a viable option for patients with mild-to-moderate SPH, providing survival and functional outcomes comparable to BLT. Careful recipient and donor selection remains essential, particularly given the risk of SPH progression during extended waiting periods.

DOI： 10.1016/j.resinv.2025.09.022

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cell-free DNA (cfDNA) in ex-vivo lung perfusion (EVLP) perfusate has been shown to potentially reflect lung injury; however, the relationship between cfDNA concentration with clinical EVLP lung outcomes has not been elucidated. METHODS: A discovery cohort of n = 100 clinical EVLP cases and a validation cohort (n = 50) were used in this single-center, retrospective cohort study. cfDNA was extracted and quantified from perfusate samples. The concentration of cfDNA at 1 hour and the change in cfDNA concentration per hour of EVLP in the transplanted and declined groups were compared by univariable and multivariable logistic regression. cfDNA was introduced as an additional factor in a machine-learning algorithm to predict lung utilization and postoperative outcome and the performance evaluated. RESULTS: Significantly higher cfDNA concentrations were observed in the declined group than in the transplanted group (1 hour: p < 0.001; delta/hour: p = 0.031). Multivariable analysis among the 1 hour factors showed that [cfDNA 1 hour] (OR 4.27, p = 0.010) was an independent prognostic factor. Increases in [cfDNA 1 hour], [cfDNA delta/hour], and both showed that both initial [cfDNA] and increases in [cfDNA] over time were independently correlated with the probability of a lung being declined. The validation analysis also confirmed higher [cfDNA 1 hour] in the declined group than in the transplanted group (p = 0.010). Addition of [cfDNA] features improved the performance of a machine-learning algorithm used to predict donor lung utilization. CONCLUSIONS: The cfDNA concentration in EVLP perfusate correlates with the rate of decline of lungs for transplant from EVLP.

DOI： 10.1016/j.healun.2025.02.1693

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Bronchoscopic lung volume reduction( BLVR) and lung volume reduction surgery( LVRS) represent two complementary strategies in the management of advanced emphysema. BLVR has emerged as a minimally invasive and reversible approach, demonstrating significant clinical benefit in carefully selected patients without collateral ventilation, supported by advances in physiological assessment and imaging technologies. LVRS, by contrast, remains a well-validated surgical option offering sustained improvements in pulmonary mechanics, exercise tolerance, and quality of life, particularly in patients with heterogeneous upper-lobe predominant disease. Recent randomized trials have underscored the comparable efficacy of both modalities, highlighting the need for individualized, phenotype-driven treatment planning. A multidisciplinary, individualized approach is essential to optimize treatment selection.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The ongoing advancements in CRISPR-Cas technologies can significantly accelerate the preclinical development of both in vivo and ex vivo organ genome-editing therapeutics. One of the promising applications is to genetically modify donor organs prior to implantation. The implantation of optimized donor organs with long-lasting immunomodulatory capacity holds promise for reducing the need for lifelong potent whole-body immunosuppression in recipients. However, assessing genome-targeting interventions in a clinically relevant manner prior to clinical trials remains a major challenge owing to the limited modalities available. This study introduces a novel platform for testing genome editing in human lungs ex vivo, effectively simulating preimplantation genetic engineering of donor organs. We identified gene regulatory elements whose disruption via Cas nucleases led to the upregulation of the immunomodulatory gene interleukin 10 (IL-10). We combined this approach with adenoviral vector-mediated IL-10 delivery to create favorable kinetics for early (immediate postimplantation) graft immunomodulation. Using ex vivo organ machine perfusion and precision-cut tissue slice technology, we demonstrated the feasibility of evaluating CRISPR genome editing in human lungs. To overcome the assessment limitations in ex vivo perfused human organs, we conducted an in vivo rodent study and demonstrated both early gene induction and sustained editing of the lung. Collectively, our findings lay the groundwork for a first-in-human-organ study to overcome the current translational barriers of genome-targeting therapeutics.

DOI： 10.1089/hum.2023.223

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Chronic lung allograft dysfunction (CLAD) is a known long-term fatal disorder after lung transplantation. In this study, we evaluated the CLAD classification of the International Society for Heart and Lung Transplantation (ISHLT) for living-donor lobar lung transplantation (LDLLT). METHODS: We conducted a single-center retrospective review of data from 73 patients who underwent bilateral LDLLT between 1998 and 2019. Factors related to opacity on computed tomography (CT) and restriction on pulmonary function tests (PFTs) were also analyzed. RESULTS: Overall, 26 (36%) patients were diagnosed with CLAD, including restrictive allograft syndrome (RAS), n = 10 (38.5%); bronchiolitis obliterans syndrome (BOS), n = 8 (30.8%); mixed, n = 1 (3.8%); undefined, n = 2 (7.7%); and unclassified, n = 5 (19.2%). The 5-year survival rate after the CLAD onset was 60.7%. The survival of patients with BOS was significantly better than that of patients with RAS (p = 0.012). In particular, patients with restriction on PFT had a significantly worse survival than those without restriction (p = 0.001). CONCLUSIONS: CLAD after bilateral LDLLT does not have a major impact on the recipient survival, especially in patients with BOS. Restriction on PFT may predict a particularly poor prognosis in patients with CLAD after bilateral LDLLT.

DOI： 10.1007/s00595-023-02729-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: No proven treatment after the development of primary graft dysfunction (PGD) is currently available. Here, we established a novel strategy of in vivo lung perfusion (IVLP) for the treatment of PGD. IVLP involves the application of an in vivo isolated perfusion circuit to an implanted lung. This study aimed to explore the effectiveness of IVLP vs conventional post-lung transplant (LTx) extracorporeal membrane oxygenation (ECMO) treatment using an experimental swine LTx PGD model. METHODS: After 1.5-hour warm ischemia of the donor lungs, a left LTx was performed. Following the confirmation of PGD development, pigs were divided into 3 groups (n = 5 each): control (no intervention), ECMO, and IVLP. After 2 hours of treatment, a 4-hour functional assessment was conducted, and samples were obtained. RESULTS: Significantly better oxygenation was achieved in the IVLP group (p ≤ 0.001). Recovery was confirmed immediately and maintained during the following 4-hour observation. The IVLP group also demonstrated better lung compliance than the control group (p = 0.045). A histologic evaluation showed that the lung injury score and terminal deoxynucleotidyl transferase dUTP nick end labeling assay showed significantly fewer injuries and a better result in the wet-to-dry weight ratio in the IVLP group. CONCLUSIONS: A 2-hour IVLP is technically feasible and allows for prompt recovery from PGD after LTx. The posttransplant short-duration IVLP strategy can complement or overcome the limitations of the current practice for donor assessment and PGD management.

DOI： 10.1016/j.healun.2023.10.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Donation after cardiac death (DCD) donor lungs have been shown to express less proinflammatory genes than donation after brain death (DBD) lungs, likely due to the absence of brain-death related inflammatory physiology. However, it is unclear whether this difference is clinically significant following reperfusion. To avoid confounding by the recipient immune system and activation state, we utilized ex vivo lung perfusion (EVLP) as a reperfusion-like event and examined the effect of EVLP on the transcriptome of DCD (n = 39) and DBD (n = 49) lungs. To validate our RNA results, banked EVLP perfusates from a separate cohort of DCD (n = 24) and DBD (n = 24) cases were assayed for IL-6, IL-8, IL-10, IL-1β, soluble TNFα receptor-1 (sTNFR1), and soluble triggering receptor expressed on myeloid cells-1 (sTREM1) protein levels at 15 minutes intervals for 3 hours. While DCD lungs demonstrated lower levels of proinflammatory transcripts and perfusate cytokine protein levels than DBD lungs prior to EVLP, after EVLP, there were no significant gene expression differences or cytokine protein levels between groups. Therefore, while DCD and DBD lungs differ by the amounts of proinflammatory cytokines following procurement, the propagation of inflammation becomes limited during EVLP, and DBD and DCD lungs reach a similar plateau of transcript expression, including proinflammatory cytokines at the end of perfusion. EVLP may therefore play a preconditioning role by dampening the proinflammatory state prior to transplant reperfusion.

DOI： 10.1016/j.jhlto.2023.100027

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Although the performance lung transplantation (LTx) in the elderly (≥ 60 years) has increased globally, the situation in Japan remains quite different, because the age limit at registration for cadaveric transplantation is 60 years. We investigated the long-term outcomes of LTx in the elderly in Japan. METHODS: This was a single-center retrospective study. We divided the patients into two groups according to age: the younger group (< 60 years; Y group; n = 194) and the elderly group (≥ 60 years; E group; n = 10). We performed three-to-one propensity score matching to compare the long-term survival between the E and Y groups. RESULTS: In the E group, the survival rate was significantly worse (p = 0.003), and single-LTx was more frequent (p = 0.036). There was a significant difference in the indications for LTx between the two groups (p < 0.001). The 5-year survival rate after single-LTx in the E group was significantly lower than that in the Y group (p = 0.006). After propensity score matching, the 5-year survival rates of the two groups were comparable (p = 0.55). However, the 5-year survival rate after single-LTx in the E group was significantly lower than that in the Y group (p = 0.007). CONCLUSION: Elderly patients showed acceptable long-term survival after LTx.

DOI： 10.1007/s00595-023-02699-5

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記述言語：英語  

DOI： 10.1038/s41598-023-43995-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Renal dysfunction is a long-term complication associated with an increased mortality after lung transplantation (LT). We investigated the association of single-nucleotide polymorphisms (SNPs) with the development of renal dysfunction after LT using a Japanese-specific SNP array. First, eligible samples of 34 LT recipients were genotyped using the SNP array and divided into two groups, according to the presence of homozygous and heterozygous combinations of mutant alleles of the 162 renal-related SNPs. To identify candidate SNPs, the renal function tests were compared between the two groups for each SNP. Next, we investigated the association between the candidate SNPs and the time course of changes of the estimated glomerular filtration rate (eGFR) in the 99 recipients until 10 years after the LT. ΔeGFR was defined as the difference between the postoperative and preoperative eGFR values. Eight SNPs were identified as the candidate SNPs in the 34 recipients. Validation analysis of these 8 candidate SNPs in all the 99 recipients showed that three SNPs, namely, rs10277115, rs4690095, and rs792064, were associated with significant changes of the ΔeGFR. Pre-transplant identification of high-risk patients for the development of renal dysfunction after LT based on the presence of these SNPs might contribute to providing personalized medicine.

DOI： 10.1038/s41598-023-36143-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The prognostic nutrition index (PNI), calculated using serum albumin and total lymphocyte count, is a recent topical index related to inflammation. Preoperative PNI is regarded as a new preoperative prognostic score in lung transplantation (LTx). This study aimed to investigate the impact of PNI at the time of registration as a prognostic parameter of mortality on the waiting list for LTx. METHODS: A retrospective review was conducted on the data of 132 adult patients registered for LTx in our department between January 2013 and June 2020. Patients who finally received LTx were analyzed as censored data. The overall survival was evaluated using the Kaplan-Meier method for pre-registered clinical factors including the PNI at the time of registration. Overall survival was calculated from the date of listing to the Japan Organ Transplant Network to the date of death. RESULTS: The low-PNI group had a significantly worse prognosis. Multivariate analysis demonstrated that age (p = 0.023), idiopathic interstitial pneumonia (p < 0.001), lung allocation score (LAS) (p < 0.001), and PNI (p < 0.001) were independent prognostic factors for waitlist mortality. CONCLUSIONS: PNI at the time of registration can be an independent prognostic parameter in registered candidates for LTx.

DOI： 10.1007/s11748-022-01895-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: MicroRNAs (miRNAs) involved in the pathogenesis of pulmonary fibrosis have been shown to be associated with the development of chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). We investigated the role of circulating miRNAs in the diagnosis of CLAD after bilateral LT, including cadaveric LT (CLT) and living-donor lobar LT (LDLLT). METHODS: The subjects of this retrospective study were 37 recipients of bilateral CLT (n = 23) and LDLLT (n = 14), and they were divided into a non-CLAD group (n = 24) and a CLAD group (n = 13). The plasma miRNA levels of the two groups were compared, and correlations between their miRNAs levels and percent baseline forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and total lung capacity (TLC) values were calculated from one year before to one year after the diagnosis of CLAD. RESULTS: The plasma levels of both miR-21 and miR-155 at the time of the diagnosis of CLAD were significantly higher in the CLAD group than in the non-CLAD group (miR-21, P = 0.0013; miR-155, P = 0.042). The miR-21 levels were significantly correlated with the percent baseline FEV1, FVC, and TLC value of one year before and at the time of diagnosis of CLAD (P < 0.05). A receiver operating characteristic curve analysis of the performance of miR-21 levels in the diagnosis of CLAD yielded an area under the curve of 0.89. CONCLUSION: Circulating miR-21 appears to be of potential value in diagnosing CLAD after bilateral LT.

DOI： 10.1016/j.heliyon.2023.e14903

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

(1) Background: Lung ischemia-reperfusion (IR) injury increases the mortality and morbidity of patients undergoing lung transplantation. The objective of this study was to identify the key initiator of lung IR injury and to evaluate pharmacological therapeutic approaches using a functional inhibitor against the identified molecule. (2) Methods: Using a mouse hilar clamp model, the combination of RNA sequencing and histological investigations revealed that neutrophil-derived S100A8/A9 plays a central role in inflammatory reactions during lung IR injury. Mice were assigned to sham and IR groups with or without the injection of anti-S100A8/A9 neutralizing monoclonal antibody (mAb). (3) Results: Anti-S100A8/A9 mAb treatment significantly attenuated plasma S100A8/A9 levels compared with control IgG. As evaluated by oxygenation capacity and neutrophil infiltration, the antibody treatment dramatically ameliorated the IR injury. The gene expression levels of cytokines and chemokines induced by IR injury were significantly reduced by the neutralizing antibody. Furthermore, the antibody treatment significantly reduced TUNEL-positive cells, indicating the presence of apoptotic cells. (4) Conclusions: We identified S100A8/A9 as a novel therapeutic target against lung IR injury.

DOI： 10.3390/bioengineering9110673

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We herein review the outcomes of paediatric lung transplantation (LTx) and analyse subgroups divided by age. METHODS: We retrospectively reviewed 43 consecutive paediatric LTx recipients (< 18 years old: cadaveric LTx [n = 9], living-donor lobar LTx [n = 34]). We also analysed subgroups of patients 1-6 years old (n = 10) and 7-17 years old (n = 33). RESULTS: The 1-, 5- and 10-year overall survival (OS) rates in paediatric recipients were 93%, 82% and 67%, respectively. The 1-, 5- and 10-year graft dysfunction (GD)-free survival rates in paediatric recipients were 85%, 59% and 31%, respectively. The 1- and 5-year OS in the 1- to 6-year-old vs. 7- to 17-year-old groups were 70% vs. 100% and 48% vs. 93%, respectively (p < 0.0001). The 1- and 5-year GD-free survival rates in the 1- to 6-year-old vs. 7- to 17-year-old groups were 60% vs. 93% and 24% vs. 69%, respectively (p = 0.024). The 1- to 6-year-old group showed higher rates of non-standard LTx (p = 0.0001), interstitial pneumonia (p = 0.004) and ventilator dependency (p = 0.007) than the 7- to 17-year-old group. CONCLUSION: Paediatric recipients under 7 years old seemed to have a higher risk of mortality and GD than those 7 years old and older.

DOI： 10.1007/s00595-022-02492-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hyperimmunoglobulin E syndrome (HIES) is one of the primary immunodeficiencies characterized by recurrent staphylococcal skin and lung infections that result in lung destruction and critically diminished pulmonary function. Despite the lack of definitive treatment, there have been no reports of successful lung transplantation for HIES patients. We report the case of a 42-year-old woman with HIES with progressive bronchiectasis whose pulmonary infection was controlled before transplantation, and subsequent lung transplantation was uneventful. Lung transplantation may be feasible in HIES if the patient is immunologically stable preoperatively and perioperative infections, especially Aspergillus infections, are well controlled.

DOI： 10.1016/j.athoracsur.2021.05.088

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Post-transplant lymphoproliferative disorder (PTLD) is a major complication of lung transplantation (LTx). However, few studies on PTLD in Asian populations have been reported. We explored the characteristics of Japanese PTLD cases after LTx. METHODS: We retrospectively reviewed 195 cases of LTx at our institute. We summarized the clinical experiences of 7 PTLD cases and analyzed the patient characteristics and survival outcomes of patients with (n = 7) and without (n = 188) PTLD. RESULTS: All PTLD patients were taking corticosteroids preoperatively (p = 0.0030), and the duration of preoperative corticosteroid therapy was significantly longer in the PTLD group (p = 0.0064) than in the non-PTLD group. The overall survival after LTx was significantly worse in the PTLD group (p = 0.027) than in the non-PLTD group. Among the three patients who died within 1 year after the PTLD onset, two died of opportunistic infections without residual PTLD lesions. Chronic lung allograft dysfunction (CLAD) or bronchiolitis obliterans at an autopsy were diagnosed after PTLD treatment in four cases. CONCLUSIONS: Long-term preoperative corticosteroid therapy may be a risk factor for PTLD after LTx. Opportunistic infections are lethal complications of PTLD, regardless of the effectiveness of PTLD treatment. CLAD occurs at a high rate after PTLD treatment, and close monitoring is required.

DOI： 10.1007/s00595-021-02390-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Decreased irisin levels may be associated with the development of emphysema. Similarly, emphysematous changes may develop in patients with chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT). We investigated the severity of emphysematous changes and the relationship between irisin levels and CLAD after bilateral LDLLT and cadaveric lung transplantation (CLT). METHODS: The subjects of this retrospective study were 59 recipients of bilateral LDLLT (n = 31) or CLT (n = 28), divided into a non-CLAD group (n = 41), a LDLLT-CLAD group (n = 11), and a CLT-CLAD group (n = 7). We compared the severity of emphysematous changes, the skeletal muscle mass, and the plasma irisin levels among the groups. RESULTS: The emphysematous changes were significantly more severe in the LDLLT-CLAD and CLT-CLAD groups (p = 0.046 and 0.036), especially in patients with bronchiolitis obliterans syndrome (BOS), than in the non-CLAD group. Although the skeletal muscle mass was similar in all the groups, the plasma irisin levels were significantly lower in the LDLLT-CLAD group (p = 0.022), especially in the patients with BOS after LDLLT, than in the non-CLAD group. CONCLUSION: Emphysematous changes and lower levels of plasma irisin were associated with CLAD, especially in patients with BOS, after bilateral LDLLT.

DOI： 10.1007/s00595-021-02339-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Massive blood transfusion compensating hemorrhage during lung transplantation (LT) results in primary graft dysfunction (PGD) and worse outcomes after LT. Collateral vessels in the perihilar mediastinal pleura could be the source of hemorrhage during LT in patients with pulmonary hypertension (PH). The purpose of this study was to examine the effect of closure with hemoclips of the vessels in the perihilar mediastinal pleura on the risk of intraoperative hemorrhage and outcomes after LT in patients with PH. METHODS: We retrospectively reviewed 80 patients who underwent LT, including 13 patients with primary PH, 29 patients with secondary PH, and 38 patients with non-PH. RESULTS: The median number of hemoclips was significantly higher in the primary PH group than in the non-PH group (P=0.0045) or secondary PH group (P=0.0060). The intraoperative blood loss, transfusion volume, maximum PGD grade, and the 30-day and 90-day mortality rates in the primary PH group were equivalent to those in the other two groups. CONCLUSIONS: Meticulous closure of collateral vessels in the perihilar mediastinal pleura during LT in patients with primary PH allowed intraoperative hemorrhage to be controlled and might be associated with acceptable mortality rate in these patients similar to that of LT in patients with other diseases.

DOI： 10.21037/jtd-21-1119

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The prognostic nutritional index (PNI), calculated based on the serum albumin levels and the total lymphocyte count, has been identified as a predictor of clinical outcomes in various fields of surgery. In this study, we investigated the relationship between the PNI and the lung allocation score (LAS) as well as the impact of the PNI on the outcomes of both cadaveric lung transplantation (CLT) and living-donor lobar lung transplantation (LDLLT). METHODS: We reviewed retrospective data for 127 recipients of lung transplantation (LT), including 71 recipients of CLT and 56 recipients of LDLLT. RESULTS: The PNI was correlated significantly and negatively with the LAS (r = - 0.40, P = 0.0000037). Multivariate analysis revealed that age (P = 0.00093), BMI (P = 0.00087), and PNI (P = 0.0046) were independent prognostic factors of a worse outcome after LT. In a subgroup analysis, survival after both CLT (P = 0.015) and LDLLT (P = 0.041) was significantly worse in the low PNI group than in the high PNI group. CONCLUSION: Preoperative nutritional evaluations using the PNI can assist with the assessment of disease severity in LT recipients and may predict survival after both CLT and LDLLT.

DOI： 10.1007/s00595-021-02244-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pulmonary metastasectomy could be considered one of the treatment options for disease control in sarcoma patients with pulmonary metastases; however, there is little consensus regarding the suitable criteria for predicting the likely outcomes in these patients. The aim of this study was to establish a prognostic benefit scoring system based on preoperatively examined prognostic factors for sarcoma patients with pulmonary metastases. METHODS: This was a single-center, retrospective cohort study conducted in a cohort of 135 sarcoma patients who underwent a first pulmonary metastasectomy at Okayama University Hospital between January 2006 and December 2015. Based on the results of a multivariable logistic regression analysis performed to determine the factors influencing 3-year mortality, a Sarcoma Lung Metastasis Score was created and its correlation with 3-year survival was analyzed. RESULTS: The results of the multivariate analysis revealed significant differences in the disease-free interval (< 2 years vs. ≥ 2 years; odds ratio (OR) 4.22, 95% confidence interval (CI) 1.67-10.70), maximum tumor diameter (≥ 15 mm vs. < 15 mm; OR 3.86, 95% CI 1.75-8.52), and number of pulmonary metastases (≥ 6 vs. < 6; OR 2.65, 95% CI 1.06-6.620). The Sarcoma Lung Metastasis Score, which was defined as the total score of these three factors, reliably predicted 3-year survival (score: 0, 89.5%; 1, 63.2%; 2, 39.0%; 3, 10.5%). CONCLUSIONS: Our newly proposed simple Sarcoma Lung Metastasis Score appears to be a useful prognostic predictor for sarcoma patients with pulmonary metastases, in that it could be helpful for the selection of appropriate treatments for these patients.

DOI： 10.1245/s10434-020-09272-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Trimodality therapy is a treatment option for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Thoracic radiation has both early (radiation pneumonitis) and late (chronic lung injury [CLI]) adverse effects on the lung. While CLI is expected to result in various problems in long-term survivors, these manifestations have not been precisely investigated. METHODS: We enrolled 112 LA-NSCLC patients who had received induction chemoradiotherapy followed by surgery, and then undergone follow-up computed tomography (CT) every 6 months for greater than 1 year. All chest CT images were reviewed to evaluate any injury of the pulmonary parenchyma. RESULTS: CLI at 1 year after surgery and its progression were observed in 94 (84%) and 38 (34%) patients, respectively. Progressive lung fibrosis as the first manifestation of CLI progression was most frequent after right middle and lower lobectomy. Cavity formation was the subsequent manifestation after progressive lung fibrosis , and chronic infection was the final stage of CLI. The cumulative rate of chronic infection was 76.4% at 10 years in patients with cavity formation. Ten patients with chronic infection included 7 cases of pulmonary aspergillosis and 2 cases of cavity infections with methicillin-resistant Staphylococcus aureus or Stenotrophomonas maltophilia. Among them, 4 patients required surgical interventions including completion pneumonectomy or fenestration. CONCLUSIONS: CLI is a common incidence after trimodality therapy for LA-NSCLC. CLI frequently results in cavity formation, which is a precursor of highly refractory chronic infections requiring surgical intervention. Appropriate management needs to be established for CLI developing after trimodality therapy.

DOI： 10.1016/j.athoracsur.2020.07.068

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-020-09299-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Severe scoliosis causes anatomical distortion of structures in the chest, which raises concerns about donor-recipient size-mismatch in lung transplantation (LT), so that severe scoliosis is considered as an absolute contraindication for LT. Also, postoperative right-side bronchial stenosis is one of the common complications in LT recipients with severe scoliosis. To date, the long-term outcomes in severe scoliosis patients with bronchial stenosis after LT have not been reported. A 14-year-old female patient with scoliosis and interstitial pneumonia underwent bilateral cadaveric LT. Although she developed bronchial stenosis post-LT, necessitating bronchoscopic intervention on three occasions, her lung function and perfusion recovered to the levels recorded prior to development of the obstruction, with the good condition maintained for more than 5 years after the LT. Therefore, while patients with severe scoliosis are at an elevated risk of postoperative transient bronchial stenosis, scoliosis should not always be considered as a contraindication to LT.

DOI： 10.1007/s11748-020-01539-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

While technical considerations in lung transplantation for Kartagener syndrome have been discussed, little information is available about the postoperative morphological changes of the grafted lungs. Herein, we discuss both the technical aspects and postoperative morphological adaptation of the grafted lungs in a case of Kartagener syndrome. A 46-year-old male patient with Kartagener syndrome underwent bilateral cadaveric lung transplantation. The right arterial anastomosis for transplantation of the size-matched grafts required technical elaboration. After the transplantation, we found a free space in the cardiac notch of the left lung and partial collapse of the lower lobe of the right lung due to dextrocardia. Follow-up computed tomography performed on day 42 after the transplantation demonstrated resolution of the atelectasis and morphological adaptation of the grafts into the recipient's chest cavity with dextrocardia. Considering such early morphological adaptation of size-matched grafts, lobar reduction could be avoided in lung transplantation for Kartagener syndrome.

DOI： 10.1007/s11748-020-01509-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Sarcomas are among the most refractory malignant tumors and often recur as pulmonary metastasis. Although the presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with the prognosis of several malignancies, the relationship between the NLR and sarcoma with pulmonary metastasis is unclear. We investigated the impact of the NLR in patients who underwent surgical resection for metastatic lung tumors from various sarcomas. METHODS: The subjects of this retrospective study were 158 patients with metastatic lung tumors from various sarcomas, who underwent initial pulmonary metastasectomy between 2006 and 2015. We examined the clinicopathological variables, including the NLR and the characteristics of surgical procedures. Survival was estimated by the Kaplan-Meier method and prognostic factors were evaluated by multivariate analysis. RESULTS: Multivariate analysis revealed significantly better survival of the group with an NLR < 2.26 immediately before the most recent pulmonary metastasectomy, in addition to such factors as the largest resected lesion being < 22 mm, a disease-free interval of > 2 years, and 3 or more pulmonary metastasectomies. CONCLUSION: The NLR immediately before the most recent pulmonary metastasectomy is a novel independent prognostic factor, which may be helpful when considering repeated pulmonary metastasectomy.

DOI： 10.1007/s00595-020-02093-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Because chronic lung allograft dysfunction (CLAD) develops predominantly on one side after bilateral living-donor lobar lung transplantation (LDLLT), lung perfusion scintigraphy (Q-scinti) was expected to show a perfusion shift to the contralateral unaffected lung with the development of CLAD. Our study examined the potential usefulness of Q-scinti in the diagnosis of CLAD after bilateral LDLLT. We conducted a single-center retrospective cohort study of 58 recipients of bilateral LDLLT. The unilateral shift values on Q-scinti were calculated and compared between the CLAD group (N = 27) and the non-CLAD group (N = 31) from 5 years before to 5 years after the diagnosis of CLAD. The unilateral shift values in Q-scinti were significantly higher in the CLAD group than in the non-CLAD group from 5 years before the diagnosis of CLAD to 5 years after the diagnosis (P < 0.05). The unilateral shift values in Q-scinti were significantly correlated with the percent baseline values of the forced expiratory volume in 1 s (P = 0.0037), the total lung capacity (P = 0.0028), and the forced vital capacity (P = 0.00024) at the diagnosis of CLAD. In patients developing unilateral CLAD after bilateral LDLLT, Q-scinti showed a unilateral perfusion shift to the contralateral unaffected lung. Thus, Q-scinti appears to have the potential to predict unilateral CLAD after bilateral LDLLT.

DOI： 10.1038/s41598-020-67433-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Lung transplantation (LTx) is still limited by the shortage of suitable donor lungs. Developing flexible surgical procedures can help to increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. We report a case in which a successful left-to-right inverted LTx was completed using the interposition of a pericardial conduit for pulmonary venous anastomosis. CASE PRESENTATION: A left lung graft was offered to a 59-year-old male who had idiopathic pulmonary fibrosis with predominant damage in the right lung. He had been prescribed bed rest with constant oxygen inhalation through an oxymizer pendant and had been on the waiting list for 20 months. Considering the condition of the patient (LAS 34.3) and the scarcity of domestic organ offers, the patient was highly likely to be incapable of tolerating any additional waiting time for another donor organ if he was unable to accept the presently reported offer of a left lung. Eventually, we decided to transplant the left donor lung into the right thorax of the recipient. Because of the anterior-posterior position gap of the hilar structures, the cuff lengths of the pulmonary veins had to be adjusted. The patient did not develop any anastomotic complications after the transplantation. CONCLUSIONS: A left-to-right inverted LTx is technically feasible using an autologous pericardial conduit for pulmonary venous anastomosis in selected cases. This technique provides the potential benefit of resolving challenging situations in which surgeons must deal with a patient's urgency and the logistical limitations of organ allocation.

DOI： 10.1186/s12890-020-1075-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The differences in chronic lung allograft dysfunction (CLAD) between living-donor lobar lung transplantation (LDLLT) and cadaveric lung transplantation (CLT) remain unclear. We conducted this study to compare the impact of CLAD on the outcomes after LDLLT vs. CLT. METHODS: We conducted a retrospective review of the data of 97 recipients of bilateral lung transplantation, including 51 recipients of LDLLT and 46 recipients of CLT. RESULTS: The CLAD-free survival and overall survival after LDLLT were similar to those after CLT. CLAD and restrictive allograft syndrome (RAS), but not bronchiolitis obliterans syndrome (BOS), developed significantly later after LDLLT than after CLT (p = 0.015 and p = 0.035). Consequently, patients with CLAD and RAS, but not those with BOS, after LDLLT had a significantly better overall survival than those after CLT (p = 0.037 and p = 0.0006). Furthermore, after the diagnosis of CLAD, the survival of patients with RAS after LDLLT tended to be better than that after CLT (p = 0.083). CONCLUSION: CLAD, especially RAS, appears to develop later after LDLLT than after CLT and seems to have a lower impact on the overall survival after LDLLT than that after CLT.

DOI： 10.1007/s00595-019-01782-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Glucocorticoids are used to prevent chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). Our study was aimed at assessing the association between the glucocorticoid-induced transcript 1 gene (GLCCI1) variant, which modulates glucocorticoid sensitivity, and the postoperative lung function and development of CLAD after LT. METHODS: A total of 71 recipients of LT were genotyped for the GLCCI1 variant (rs37972) and divided into three groups: the homozygous mutant allele (TT) group, the heterozygous mutant allele (CT) group, and the wild-type allele (CC) group. The results of pulmonary function tests were compared with the postoperative baseline values. RESULTS: The total lung capacity (TLC) in the TT group was significantly lower than that in the CC group at 3 years after LT (P = 0.029). In the recipients of cadaveric LT, the TLC and forced expiratory volume in 1 s in the TT group were significantly lower than those in the CC groups, resulting in a significant worse CLAD-free survival at 3 years after LT (P = 0.016). CONCLUSION: The GLCCI1 variant was associated with a significant decrease of the TLC at 3 years after LT and the development of CLAD at 3 years, especially in patients undergoing cadaveric LT.

DOI： 10.1007/s00595-018-1717-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/jjco/hyx121

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記述言語：日本語   出版者・発行元：南江堂  

DOI： 10.15106/j00349.2014106921

PubMed

CiNii Article

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I025102139

記述言語：英語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

α1-アンチトリプシン(AAT)欠乏症は、タンパク質分解酵素阻害作用を持つAATの欠乏により若年性に肺気腫を生じる常染色体潜性遺伝性疾患で、本邦での有病率は1000万人あたり約2人と極めて稀である。有病率が日本よりも高い欧米では、AAT補充療法後の肺移植が報告されているが、2021年7月にAAT補充療法が保険適用となった日本からの報告は稀である。今回、AAT補充療法後に肺移植を施行したAAT欠乏症の1例を経験したので報告する。症例は56歳女性。労作時呼吸困難と下腿浮腫を認め、5年前にAAT欠乏症、続発性肺高血圧症と診断された。シルデナフィル内服、イロプロスト吸入、在宅酸素療法の導入後に当院に紹介され、脳死肺移植登録を行った。待機中、1年7カ月前からAAT補充療法が開始された。既存抗体陽性であり約4.5年の待機後に脳死両肺移植を施行した。ドナー特異的抗HLA抗体が陽性と診断されたため、周術期に脱感作療法を施行した。肺移植後、血中AATは漸減し術後20日目には検出感度以下まで低下した。両側胸水を認め胸腔ドレナージなどを要したが、抗体関連型拒絶反応の発症を認めず術後67日目に退院した。退院後も慢性移植肺機能不全の所見はなく順調に経過している。日本では稀な、AAT補充療法を要した重症AAT欠乏症に対する脳死肺移植の1例を経験したため文献的考察を加えて報告する。

DOI： 10.11386/jst.60.supplement_s389_2

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2025&ichushi_jid=J00083&link_issn=&doc_id=20251105480576&doc_link_id=%2Fcl8isoke%2F2025%2Ft060s1%2F142%2F0389-0389%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2025%2Ft060s1%2F142%2F0389-0389%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本移植学会  

【背景】心停止後ドナー（DCD）臓器は移植前にその機能を適切に評価する必要があるが、肺においては体外肺灌流（EVLP）が一般的であり、高額な専用機器や灌流液を必要とすることから国内導入は進んでいない。一方、腹部臓器に対しては、ドナー体内で温灌流を行うA-NRP（Abdominal Normothermic Regional Perfusion）が欧米を中心に臨床応用されている。【目的】本研究では、A-NRPを改良し、肺および腹部臓器をドナー体内で同時に評価可能な新規システPA-NRP（Pulmonary-Abdominal NRP）を開発し、大動物を用いて検証した。【方法】ブタDCDモデルを用い、A-NRP群（n=4）およびPA-NRP群（n=4）にて比較検討を行った。PA-NRPでは、A-NRP回路に加えて、主肺動脈からの送血および左心房からの脱血を可能とする肺灌流回路を構築した。灌流液にはドナー血液を使用した。灌流は2時間実施し、その後に肺を摘出して移植し、移植後の肺機能を評価した。肝・腎についても灌流後に機能および組織学的評価を行った。【結果】腹部臓器の機能および損傷程度については両群間で差を認めなかった。PA-NRP群では、灌流中の肺血管抵抗および静肺コンプライアンスは安定しており、移植後の肺酸素化能や組織学的損傷指標にも有意な差は認められなかった。PA-NRPは既存のECMO機器とドナー血液のみで構築可能な手法であり本邦特有の医療経済的制約を考慮するとEVLPに代わる現実的な選択肢となり得る。

DOI： 10.11386/jst.60.supplement_s176_2

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

目的：空間的遺伝子発現解析の進歩により、組織内の遺伝子発現を空間情報と共に解析可能となった。本研究は同手法を用いて肺移植後の虚血再還流障害（IRI）の分子機序と治療標的を探索した。

方法：マウス同系左片肺移植を行い、再還流4時間後の摘出肺に対して、Visiumによる空間的遺伝子発現解析およびシングルセル解析を行った。

結果：血管・気管支周囲・肺実質クラスターなどを抽出後、自己肺と移植肺の血管周囲を比較し、移植肺血管周囲で特異的に高発現する複数の遺伝子を同定した。その一つであるCcl7の発現細胞はシングルセル解析で明らかにした。さらにCcl7中和抗体をマウスIRIモデルに投与した結果、PaO2の改善と細胞浸潤抑制を有意に認め、IRIが抑制された。

考察：空間的および単細胞レベルの解析により、移植肺全体の解析では見逃されていた局所構造特異的な遺伝子群を多数同定できた。この手法は肺移植研究の大きな進展に寄与する可能性を示した。

DOI： 10.11386/jst.60.supplement_s171_1

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

【背景】肺移植後の患者では、一般集団と比べて新規肺癌(LC)の発症リスクが約5倍に上昇する。特に片肺移植後は特発性間質性肺炎(IIP)や慢性閉塞性肺疾患といった原疾患の影響により、自己肺のLC発症リスクは約13倍に増加する。肺移植患者では、放射線治療による放射線肺臓炎、化学療法による腎障害、免疫チェックポイント阻害薬による拒絶反応など、LCの治療関連有害事象を回避する必要がある。このため、LCを早期発見し手術で切除することが理想的である。一方、肺移植患者の手術では免疫抑制療法により感染症リスクなどが高まるため、低侵襲アプローチが望ましい。片肺移植後の自己肺に生じたLCに対しロボット支援下手術(RATS)を施行した1例を報告する。【症例】57歳男性。IIPに対する脳死右片肺移植後21か月目に、自己肺である左下葉に23mm大の結節影を認め、CTガイド下肺生検で扁平上皮癌と診断された。慢性移植肺機能不全の発症はなく肺機能も良好であったため、移植後24か月目にda Vinci Xiを用いたRATS左肺下葉切除術＋縦隔リンパ節郭清を施行した。左肺には胸膜癒着を認めたが、術中・術後ともに合併症は認められず術後6日目に退院した。病理組織学的にpT1cN0M0/IA3期と診断され、術後補助化学療法は施行しなかった。術後18か月を経過したが再発なく経過している。【結語】RATSは片肺移植後の自己肺に発生したLCに対して有効な可能性があり、手術を可能にする早期発見が重要である。

DOI： 10.11386/jst.60.supplement_s389_1

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

【背景】呼吸器外科の日常診療は悪性腫瘍が中心である。診療機会の少ない肺移植の理解を深め、肺移植医を継続的に輩出するためには、肺移植を視野に入れた人材育成を進める必要がある。一方、呼吸器外科では気管支・血管形成を経験できる機会が減少しており、肺移植の経験は悪性腫瘍の手術で強みとなる。当院では症例数の集積とともに肺移植医が増加しており、肺移植医育成の現状と工夫を報告する。【育成の工夫】肺移植の技術的な習得には海外臨床留学が近道である。希望者の臨床留学を進める一方で、国内での肺移植医の養成も進めていく。高難度な肺移植手術も開閉胸、癒着剥離、肺門剥離、気管支・血管形成とパート別に分けると日常の手術で修練できる部分が多いため、意識付けを図っていく。脳死や生体ドナー手術はレシピエント手術へのステップとなる。国内では肺移植内科の習得が先行し、臨床留学では肺移植外科の習得が先行するため、進捗状況に合わせて権限移譲を行っていく。肺移植では広範な診療力や他科との連携が不可欠なため、チーム内で経験を共有し限られた症例数でもチーム力の底上げに努める。教訓的な症例や技術の工夫などを伝承することも重要である。大学院での研究は外科学、解剖学、生理学、免疫学など肺移植を構成するエッセンスを学ぶ貴重な機会となる。【まとめ】海外だけでなく日本でも肺移植の習得が可能となっているが、今後は更なる体系化が必要である。

DOI： 10.11386/jst.60.supplement_s197_2

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu78_492

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記述言語：日本語   出版者・発行元：(株)南江堂  

DOI： 10.15106/j_kyobu78_492

CiNii Books

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記述言語：日本語   出版者・発行元：東京 : 南江堂  

CiNii Books

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I034233604

J-GLOBAL

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

α1-アンチトリプシン(AAT)欠乏症は、タンパク質分解酵素阻害作用を持つAATの欠乏により若年性に肺気腫を生じる常染色体潜性遺伝性疾患で、本邦での有病率は1000万人あたり約2人と極めて稀である。有病率が日本よりも高い欧米では、AAT補充療法後の肺移植が報告されているが、2021年7月にAAT補充療法が保険適用となった日本からの報告は稀である。今回、AAT補充療法後に肺移植を施行したAAT欠乏症の1例を経験したので報告する。症例は56歳女性。労作時呼吸困難と下腿浮腫を認め、5年前にAAT欠乏症、続発性肺高血圧症と診断された。シルデナフィル内服、イロプロスト吸入、在宅酸素療法の導入後に当院に紹介され、脳死肺移植登録を行った。待機中、1年7カ月前からAAT補充療法が開始された。既存抗体陽性であり約4.5年の待機後に脳死両肺移植を施行した。ドナー特異的抗HLA抗体が陽性と診断されたため、周術期に脱感作療法を施行した。肺移植後、血中AATは漸減し術後20日目には検出感度以下まで低下した。両側胸水を認め胸腔ドレナージなどを要したが、抗体関連型拒絶反応の発症を認めず術後67日目に退院した。退院後も慢性移植肺機能不全の所見はなく順調に経過している。日本では稀な、AAT補充療法を要した重症AAT欠乏症に対する脳死肺移植の1例を経験したため文献的考察を加えて報告する。

DOI： 10.11386/jst.60.supplement_s389_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

【背景】肺移植後の患者では、一般集団と比べて新規肺癌(LC)の発症リスクが約5倍に上昇する。特に片肺移植後は特発性間質性肺炎(IIP)や慢性閉塞性肺疾患といった原疾患の影響により、自己肺のLC発症リスクは約13倍に増加する。肺移植患者では、放射線治療による放射線肺臓炎、化学療法による腎障害、免疫チェックポイント阻害薬による拒絶反応など、LCの治療関連有害事象を回避する必要がある。このため、LCを早期発見し手術で切除することが理想的である。一方、肺移植患者の手術では免疫抑制療法により感染症リスクなどが高まるため、低侵襲アプローチが望ましい。片肺移植後の自己肺に生じたLCに対しロボット支援下手術(RATS)を施行した1例を報告する。【症例】57歳男性。IIPに対する脳死右片肺移植後21か月目に、自己肺である左下葉に23mm大の結節影を認め、CTガイド下肺生検で扁平上皮癌と診断された。慢性移植肺機能不全の発症はなく肺機能も良好であったため、移植後24か月目にda Vinci Xiを用いたRATS左肺下葉切除術＋縦隔リンパ節郭清を施行した。左肺には胸膜癒着を認めたが、術中・術後ともに合併症は認められず術後6日目に退院した。病理組織学的にpT1cN0M0/IA3期と診断され、術後補助化学療法は施行しなかった。術後18か月を経過したが再発なく経過している。【結語】RATSは片肺移植後の自己肺に発生したLCに対して有効な可能性があり、手術を可能にする早期発見が重要である。

DOI： 10.11386/jst.60.supplement_s389_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

目的：空間的遺伝子発現解析の進歩により、組織内の遺伝子発現を空間情報と共に解析可能となった。本研究は同手法を用いて肺移植後の虚血再還流障害（IRI）の分子機序と治療標的を探索した。

方法：マウス同系左片肺移植を行い、再還流4時間後の摘出肺に対して、Visiumによる空間的遺伝子発現解析およびシングルセル解析を行った。

結果：血管・気管支周囲・肺実質クラスターなどを抽出後、自己肺と移植肺の血管周囲を比較し、移植肺血管周囲で特異的に高発現する複数の遺伝子を同定した。その一つであるCcl7の発現細胞はシングルセル解析で明らかにした。さらにCcl7中和抗体をマウスIRIモデルに投与した結果、PaO2の改善と細胞浸潤抑制を有意に認め、IRIが抑制された。

考察：空間的および単細胞レベルの解析により、移植肺全体の解析では見逃されていた局所構造特異的な遺伝子群を多数同定できた。この手法は肺移植研究の大きな進展に寄与する可能性を示した。

DOI： 10.11386/jst.60.supplement_s171_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

【背景】呼吸器外科の日常診療は悪性腫瘍が中心である。診療機会の少ない肺移植の理解を深め、肺移植医を継続的に輩出するためには、肺移植を視野に入れた人材育成を進める必要がある。一方、呼吸器外科では気管支・血管形成を経験できる機会が減少しており、肺移植の経験は悪性腫瘍の手術で強みとなる。当院では症例数の集積とともに肺移植医が増加しており、肺移植医育成の現状と工夫を報告する。【育成の工夫】肺移植の技術的な習得には海外臨床留学が近道である。希望者の臨床留学を進める一方で、国内での肺移植医の養成も進めていく。高難度な肺移植手術も開閉胸、癒着剥離、肺門剥離、気管支・血管形成とパート別に分けると日常の手術で修練できる部分が多いため、意識付けを図っていく。脳死や生体ドナー手術はレシピエント手術へのステップとなる。国内では肺移植内科の習得が先行し、臨床留学では肺移植外科の習得が先行するため、進捗状況に合わせて権限移譲を行っていく。肺移植では広範な診療力や他科との連携が不可欠なため、チーム内で経験を共有し限られた症例数でもチーム力の底上げに努める。教訓的な症例や技術の工夫などを伝承することも重要である。大学院での研究は外科学、解剖学、生理学、免疫学など肺移植を構成するエッセンスを学ぶ貴重な機会となる。【まとめ】海外だけでなく日本でも肺移植の習得が可能となっているが、今後は更なる体系化が必要である。

DOI： 10.11386/jst.60.supplement_s197_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

【背景】心停止後ドナー（DCD）臓器は移植前にその機能を適切に評価する必要があるが、肺においては体外肺灌流（EVLP）が一般的であり、高額な専用機器や灌流液を必要とすることから国内導入は進んでいない。一方、腹部臓器に対しては、ドナー体内で温灌流を行うA-NRP（Abdominal Normothermic Regional Perfusion）が欧米を中心に臨床応用されている。【目的】本研究では、A-NRPを改良し、肺および腹部臓器をドナー体内で同時に評価可能な新規システPA-NRP（Pulmonary-Abdominal NRP）を開発し、大動物を用いて検証した。【方法】ブタDCDモデルを用い、A-NRP群（n=4）およびPA-NRP群（n=4）にて比較検討を行った。PA-NRPでは、A-NRP回路に加えて、主肺動脈からの送血および左心房からの脱血を可能とする肺灌流回路を構築した。灌流液にはドナー血液を使用した。灌流は2時間実施し、その後に肺を摘出して移植し、移植後の肺機能を評価した。肝・腎についても灌流後に機能および組織学的評価を行った。【結果】腹部臓器の機能および損傷程度については両群間で差を認めなかった。PA-NRP群では、灌流中の肺血管抵抗および静肺コンプライアンスは安定しており、移植後の肺酸素化能や組織学的損傷指標にも有意な差は認められなかった。PA-NRPは既存のECMO機器とドナー血液のみで構築可能な手法であり本邦特有の医療経済的制約を考慮するとEVLPに代わる現実的な選択肢となり得る。

DOI： 10.11386/jst.60.supplement_s176_2

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記述言語：日本語   出版者・発行元：東京 : 科学評論社  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00083&link_issn=&doc_id=20201019080347&doc_link_id=%2Fcl8isoke%2F2020%2Fs055s1%2F104%2F0353-0353%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2020%2Fs055s1%2F104%2F0353-0353%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00083&link_issn=&doc_id=20201019080151&doc_link_id=%2Fcl8isoke%2F2020%2F0055s1%2F157%2F0246-0246%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2020%2F0055s1%2F157%2F0246-0246%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：岡山医学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

【背景】日本における高齢者レシピエントの長期成績に関しての報告は少ない．今回当院における高齢者レシピエントの長期成績について後方視的に検討した.【対象と方法】1998年1月～2020年1月に施行した18歳以上の肺移植症例161例を対象とした.60歳以上の高齢群(H群：n=10)と18-59歳の非高齢群(L群:n=151)の2群に分けて,全生存期間(OS)およびCLAD発症までの期間(CFS)について解析を行った.【結果】H群ではL群と比較して片肺移植(p=0.03),間質性肺炎(p=0.02),男性(p=0.04)の割合が有意に多かった.BMI,ドナー年齢,総虚血時間,LASスコアには有意差は認めなかった.H群とL群の5年OSはそれぞれ51.9%と75.5%であり,有意差を認めた(p=0.02).H群とL群の5年CFSはそれぞれ53.3%と72.5%であった.サブグループ解析では，H群の片肺移植症例(5年:OS 25%)は両肺移植症例(5年OS:75%)と比較してOSが悪い傾向にあった(p=0.08)が，H群の両肺移植症例はL群の両肺移植症例(5年OS:74.2%)と比較しても同等の成績であった（p=0.5）.【結語】60歳以上のレシピエントの成績は60歳未満と比較し不良だが，両肺移植がより望ましい可能性が示唆された.

DOI： 10.11386/jst.55.supplement_253_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

日本の肺移植における移植後リンパ増殖性疾患（PTLD）は移植後死亡の約3.4％を占める。しかし、そのリスク因子や予後因子、適切な治療については不明である。我々は移植前の免疫抑制状態とCLADに着目し、当院の肺移植後PTLD症例を検討した。 2020年2月までに当院で施行された肺移植204例中、7例（3.4%）のPTLD症例（両側脳死4例、両側生体3例）が抽出された。男性5例、手術時年齢中央値44才（2～50才）。原疾患はIPF 2例、膠原病合併IP 2例、その他のIP 1例、造血幹細胞移植後のBOS 2例であった。全例、移植時点でPSL 5～30mg/日内服しており、内服期間中央値は77ヶ月（13～228ヶ月）だった。EBV非関連PTLDの1症例を除いた6例がEBV関連のDLBCLであり、その初回治療は全例Weekly Rituximabであった。追加治療は、病変切除が3例、化学療法併用が2例、自家末梢血幹細胞移植が１例（重複あり）であった。発症後１年以内に３例が死亡し、いずれも日和見感染が死亡に強く関与していた。２年以上生存した４例中３例でPTLD治療後にCLADを発症した。 肺移植後PTLD症例では移植前の免疫抑制状態が発症のリスクであることが示唆される。また、晩期にCLADを高率に発症するが、同時に日和見感染症による死亡が問題であり、適切な免疫抑制状態の指標構築が急務である。

DOI： 10.11386/jst.55.supplement_246_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

【背景】最近，栄養状態の指標であるPrognostic Nutrition Index (PNI)や，炎症の指標であるNeutrophil-to-lymphocyte Ratio (NLR)が，悪性疾患などの予後予測因子として有用であることが報告されている．一方，肺移植における待機中死亡を減少させるため，米国ではLung Allocation Score (LAS)が導入されているが，LASにはBMI以外に栄養や炎症の指標は含まれておらず，PNIやNLRの役割は明らかにされていない．今回我々は，肺移植待機中死亡の予測因子としてPNI，NLRの有用性を検討した．【対象と方法】2013年1月～2020年5月までに当院で肺移植登録された169例のうち，小児の29例と再移植目的の8例，検査結果が不足した4例を除外した128例を対象とした．登録時PNI，NLR等の因子が登録後2年時点の生存率に与える影響を検討した．【結果】単変量解析では年齢，BMI，原疾患，%VC，%FVC，pCO2，LAS，NLR，PNIで有意差が認められた．多変量解析ではLASとPNIに有意差が認められた．また，PNIとLASには有意な相関を認めた．【結論】肺移植待機患者において，登録時のPNIはLASとともに独立した予後予測因子であり，登録時の栄養状態低下は待機中の死亡リスクを上昇させる可能性がある．

DOI： 10.11386/jst.55.supplement_353_3

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(独)国立病院機構岡山医療センター  

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407211494

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I027820303

記述言語：日本語   出版者・発行元：(株)医学書院  

DOI： 10.11477/mf.1407211494

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01539&link_issn=&doc_id=20170113510029&doc_link_id=10.11477%2Fmf.1407211494&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407211494&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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出版者・発行元：金原出版  

DOI： 10.18888/j00620.2016254572

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I027333515

記述言語：日本語   出版者・発行元：金原出版(株)  

DOI： 10.18888/j00620.2016254572

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00620&link_issn=&doc_id=20160519050010&doc_link_id=10.18888%2FJ00620.2016254572&url=https%3A%2F%2Fdoi.org%2F10.18888%2FJ00620.2016254572&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01060&link_issn=&doc_id=20160413130011&doc_link_id=%2Fad3nkrsd%2F2016%2F007504%2F012%2F0438-0444%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3nkrsd%2F2016%2F007504%2F012%2F0438-0444%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：東京 : 克誠堂出版  

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I027252794

記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(独)国立病院機構岡山医療センター  

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記述言語：日本語   出版者・発行元：国立病院総合医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：国立病院総合医学会  

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出版者・発行元：南江堂  

DOI： 10.15106/j00349.2014106921

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I025102139

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

腹部救急領域において鼠径部ヘルニア嵌頓にともなう腸閉塞はしばしば遭遇する病態である。手術既往のない腸閉塞を認めた場合には，ヘルニアの嵌頓を念頭において診察する。そして可能な限りCT検査を行う。単純で行うが，腎機能が保たれており腸管の循環障害を疑う際には造影CT検査を行う。われわれは，冠状断像を多用している。ヘルニア嵌頓の診断がつけば緊急手術となる。鼠径部ヘルニア嵌頓症例は，全身麻酔下に行うことを原則に行い，最近では腹腔鏡観察下に手術を開始している。腸管の穿孔がなく血流の改善が確認されればそのまま前方から腹膜損傷をしないようにメッシュを用いた根治術を行う。穿孔し腹膜炎になっている場合や閉鎖孔ヘルニアで嵌頓解除時に穿孔した場合などは，腸管切除と腹膜炎手術を優先し，二期的にヘルニア根治手術をメッシュを用いて行う。われわれの診断治療の方針を概略する。

DOI： 10.11231/jaem.34.51

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記述言語：日本語   出版者・発行元：日本腹部救急医学会  

腹部救急領域において鼠径部ヘルニア嵌頓にともなう腸閉塞はしばしば遭遇する病態である。手術既往のない腸閉塞を認めた場合には，ヘルニアの嵌頓を念頭において診察する。そして可能な限りCT検査を行う。単純で行うが，腎機能が保たれており腸管の循環障害を疑う際には造影CT検査を行う。われわれは，冠状断像を多用している。ヘルニア嵌頓の診断がつけば緊急手術となる。鼠径部ヘルニア嵌頓症例は，全身麻酔下に行うことを原則に行い，最近では腹腔鏡観察下に手術を開始している。腸管の穿孔がなく血流の改善が確認されればそのまま前方から腹膜損傷をしないようにメッシュを用いた根治術を行う。穿孔し腹膜炎になっている場合や閉鎖孔ヘルニアで嵌頓解除時に穿孔した場合などは，腸管切除と腹膜炎手術を優先し，二期的にヘルニア根治手術をメッシュを用いて行う。われわれの診断治療の方針を概略する。

DOI： 10.11231/jaem.34.51

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