研究者詳細 - 田中　真

論文 - 田中　真

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肺移植後長期管理 Up to date 肺移植後の慢性腎臓病に対する長期管理 up to date

杉本誠一郎, 柳光剛志, 富岡泰章, 田中真, 石原恵, 堂口佳子, 諏澤憲, 枝園和彦, 三好健太郎, 岡崎幹生, 豊岡伸一

移植 59 ( 総会臨時 ) 173 - 173 2024年9月

再肺移植後急性期に膵頭部癌による出血性膵炎を繰り返したNightmare case

林龍也, 田中真, 石原恵, 堂口佳子, 梅田将志, 調枝治樹, 柳光剛志, 富岡泰章, 枝園和彦, 諏澤憲, 三好健太郎, 岡崎幹生, 杉本誠一郎, 豊岡伸一

移植 59 ( 総会臨時 ) 255 - 255 2024年9月

脳死片肺移植後の抗体関連型拒絶反応に対する集学的治療の経験

調枝治樹, 杉本誠一郎, 柳光剛志, 富岡泰章, 田中真, 堂口佳子, 石原恵, 枝園和彦, 諏澤憲, 三好健太郎, 岡崎幹生, 豊岡伸一

移植 59 ( 総会臨時 ) 294 - 294 2024年9月

Prophylactic effect of tissue flap in the prevention of bronchopleural fistula after surgery for lung cancer.

Tomohiro Habu, Hiromasa Yamamoto, Kentaro Nakata, Kohei Hashimoto, Shin Tanaka, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka

Surgery today 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Bronchopleural fistula (BPF) is a serious complication of lung resection. To avoid BPF, the bronchial stump/anastomotic site is often covered with a flap of surrounding tissue. One risk factor for BPF is radical lung resection after induction chemoradiotherapy for lung cancer. We retrospectively reviewed our database to elucidate the characteristics of tissue flaps that prevent BPF. METHODS: This retrospective study included 152 patients treated between 1999 and 2019. We examined the clinicopathological characteristics, including the type and thickness of the tissue flap used to cover the bronchial stump/anastomotic site, and postoperative complications, including BPF. RESULTS: BPF occurred in 5 patients (3.3%). All 5 patients had complications that could have affected delayed wound healing, such as pneumonia. The covering tissue flap thickness was significantly greater in patients without BPF than in those who developed BPF (p = 0.0290). Additionally, the tissue flap thickness was significantly greater than in those with BPF (p = 0.0077), even in high-risk patients who developed pneumonia or radiation pneumonitis on the operative side within 6 months postoperatively. CONCLUSION: Perioperative management is crucial to avoid complications affecting the healing of the bronchial stump/anastomotic site, and the covering tissue flap thickness may be an important factor in avoiding or minimizing BPF.

DOI： 10.1007/s00595-024-02927-6

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Augmented humoral response to third and fourth dose of SARS-CoV-2 mRNA vaccines in lung transplant recipients. 国際誌

Shinichi Kawana, Seiichiro Sugimoto, Kei Matsubara, Haruki Choshi, Shin Tanaka, Megumi Ishihara, Tomohiro Habu, Kohei Hashimoto, Ken Suzawa, Kazuhiko Shien, Kentaroh Miyoshi, Mikio Okazaki, Masanori Nakayama, Shinichi Toyooka

Respiratory investigation 62 ( 5 ) 804 - 810 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Since lung transplant recipients (LTRs) exhibit low immunogenicity after two doses of SARS-CoV-2 mRNA vaccines, optimal vaccine strategies for SARS-CoV-2 are required in LTRs. This study aimed to investigate the efficacy and safety of the third and fourth doses of the SARS-CoV-2 mRNA vaccines in LTRs. METHODS: We conducted a single-center study of 73 LTRs and 23 healthy controls (HCs). Participants received two-to-four doses of SARS-CoV-2 mRNA vaccines. The LTRs were divided into three groups based on the number of vaccine dose. IgG titers against SARS-CoV-2 spike protein were measured, and adverse events were assessed. Factors associated with humoral response were analyzed using univariate and multivariate analyses. RESULTS: The Dose 4 group (n = 27) had a higher humoral response rate (P = 0.018) and higher levels of anti-SARS-CoV-2 IgG antibody (P = 0.04) than the Dose 2 group (n = 14). The Dose 3 group (n = 32) had lower humoral response rates (P = 0.005) and levels of anti-SARS-CoV-2 IgG antibody (P = 0.0005) than the HCs (n = 23) even after the same dose. Systemic adverse events were milder in the LTRs than in the HCs (P < 0.05). Increased number of vaccine dose was identified as a predictor of positive humoral response (P = 0.021). CONCLUSION: Booster doses of SARS-CoV-2 mRNA vaccines may enhance humoral response with mild adverse events in LTRs. Repeated vaccination might be warranted for LTRs to prevent SARS-CoV-2 infection.

DOI： 10.1016/j.resinv.2024.07.004

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Pulmonary Vein Repair on Extracorporeal Life Support: A Potential Surgical Complication for 2-Staged Lung Transplantation: Case Report. 国際誌

Shin Tanaka, Kentaroh Miyoshi, Seiichiro Sugimoto, Shinichi Toyooka

Transplantation proceedings 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Double-lung transplantation (DLT) is favored for enhanced long-term survival despite the risk of major complications, particularly in elderly patients or those with comorbidities. Two-stage contralateral single-lung transplantation (SLT) leading to DLT is considered a valuable option to combine the advantages of less invasive SLT with DLT survival benefits. This study detailed the intraoperative challenges encountered during the procedure. A 54-year-old patient with chronic lung allograft dysfunction after right SLT underwent contralateral (left) SLT because of left lung dysfunction. During surgery, unexpected complications arose from robust adhesions on the right side, a consequence of prior transplantation, causing difficulty in manipulating the heart position. The deep bifurcation of the left pulmonary vein posed challenges, leading to damage to the left atrium, necessitating extracorporeal circulation. Despite these complexities, successful anastomosis was achieved. This case highlights the importance of recognizing potential surgical difficulties in contralateral lung transplantation, particularly in cases with adhesions, and emphasizes the need for caution when managing deep pulmonary veins. This 2-stage approach holds promise for patients with poor health but emphasizes the significance of addressing the potential challenges inherent in the surgical procedure.

DOI： 10.1016/j.transproceed.2024.05.009

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Utility of neutrophil-to-lymphocyte ratio as an indicator of tumor immune status in non-small cell lung cancer. 国際誌

Kazuma Iwata, Ken Suzawa, Kohei Hashimoto, Shin Tanaka, Kazuhiko Shien, Kentaroh Miyoshi, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka

Japanese journal of clinical oncology 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic biomarker in non-small cell lung cancer (NSCLC); however, the underlying biological rationale remains unclear. The present study aimed to explore the potential utility of NLR as a surrogate biomarker for immune response to cancer and to elucidate the underlying mechanism. METHODS: This retrospective study included the medical records of 120 patients with NSCLC who underwent surgery at the study institution in 2012. NLR in peripheral blood was determined from blood test within 30 days before surgery. Tumor immune status was evaluated using immunohistochemical staining to identify CD3+, CD8+ and FOXP3+ tumor-infiltrating lymphocytes (TILs), and the relationship of NLR, with clinicopathologic characteristics including 5-year overall survival (OS), and the tumor immune status was investigated. The median values of NLR and TIL count were used as cutoff points. RESULTS: The 5-year OS was significantly better in patients with low NLR (<2.2) than in those with high NLR (≥2.2) (70.1% vs. 56.8%, P = 0.042) and in patients with high CD3+ TIL count (≥242) than in those with low CD3+ TIL count (<242) (70% vs. 56.8%, P = 0.019). Additionally, the CD3+ TIL count was negatively correlated with preoperative NLR (P = 0.005). CONCLUSION: NLR might potentially reflect the immune status of tumor microenvironment, explaining its impact on prognosis of patients with NSCLC.

DOI： 10.1093/jjco/hyae058

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Postoperative Complications in Living Donors for Lung Transplantation. 国際誌

Shin Tanaka, Kento Fujii, Megumi Ishihara, Haruki Choshi, Kei Matsubara, Kohei Hashimoto, Shuji Okahara, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka

Transplantation direct 10 ( 5 ) e1617 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Living donor lobar lung transplantation is a life-saving procedure for critically ill patients. This requires 2 healthy donors exposed to risks and without medical benefit. Therefore, the donor's safety and minimal postoperative complications are crucial. This study aimed to investigate the short-term outcomes and identify the risk factors affecting these outcomes. METHODS: The data of 175 living donors enrolled between 1998 and 2022 were analyzed. Donors were divided into era 1 (1998-2009) and era 2 (2010-2022). RESULTS: The overall incidence of postoperative complications was 39%, of which 7% were major complications. Donors who underwent surgery on the right side had a higher incidence of delayed pulmonary fistulae (P = 0.01) and elevated liver enzyme levels (P = 0.028). Living donor surgery on the right side (P = 0.01), era 2 (P = 0.01), and the need for plasty (P = 0.04) were predictors of postoperative complications. CONCLUSIONS: Updated data on complications and their correlation with postoperative quality of life from this study could aid in the selection of potential donors and facilitate informed consent.

DOI： 10.1097/TXD.0000000000001617

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Effective division of the intersegmental plane using a robotic stapler in robotic pulmonary segmentectomy.

Mikio Okazaki, Ken Suzawa, Kazuhiko Shien, Kohei Hashimoto, Shin Tanaka, Kentaroh Miyoshi, Hiromasa Yamamoto, Seiichiro Sugimoto, Shinichi Toyooka

Surgery today 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSES: Robot-assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common because of the expanded indications for segmentectomy and the widespread adoption of robotic surgery. The precise division of the intersegmental plane is necessary to ensure oncologic margins from the tumor and to preserve the lung function. In this study, we present a strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes. METHODS: RATS portal segmentectomy was performed using the Da Vinci Xi system and the intersegmental plane was dissected using a robotic stapler. We evaluated the perioperative outcomes in 92 patients who underwent RATS portal segmentectomy between May 2020 and January 2023. These results were compared with those of 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period. RESULTS: The operative and console times were 162 and 97 min, respectively. No intraoperative complications occurred, and postoperative complications were observed in four cases (4.3%). The operative time, blood loss, postoperative complications, and maximum incision size were significantly lower in the RATS group than in the CVATS group. However, RATS requires a significantly higher number of staplers than CVATS. CONCLUSIONS: The division of the intersegmental plane using a robotic stapler in RATS portal segmentectomy was, therefore, found to be safe and effective.

DOI： 10.1007/s00595-024-02840-y

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Reconstruction method for massive lateral chest wall sarcoma using titanium plates and mesh: a case report. 国際誌

Shin Tanaka, Eiji Nakata, Toshifumi Ozaki, Shinichi Toyooka

Journal of cardiothoracic surgery 19 ( 1 ) 245 - 245 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Very large chest wall resections can lead to acute thoracic insufficiency syndrome due to the interdependence of lung expansion and thoracic volume. Chest wall tumor surgeries often encounter complications, with the size of the chest wall defect being a significant predictor. Several methods for large chest wall reconstruction have been described, aiming to provide stability, prevent flail chest, and ensure airtight closure. However, no single method fulfills all requirements. Composite chest wall reconstruction using titanium plates and Gore-Tex patches has shown the potential to minimize physiologic abnormalities caused by extensive defects. CASE PRESENTATION: A 42-year-old man with myxofibrosarcoma underwent multiple surgeries, chemotherapies, and radiation therapies due to repeated local recurrences. After right arm amputation and resection of the right third to fifth ribs, a local recurrence was detected. A 30 × 40 cm chest wall defect was resected en bloc, and a titanium plate was used for three-dimensional formability, preventing flail chest and volume loss. The Gore-Tex patch was then reconstructed into an arch shape, allowing lateral thoracic mobility. The patient recovered well and did not experience respiratory dysfunction or local recurrence but later succumbed to distant metastasis. CONCLUSIONS: In this case, the combination of a titanium plate and a Gore-Tex patch proved effective for reconstructing massive lateral chest wall defects. The approach provided stability, preserved thoracic volume, and allowed for lateral mobility. While the patient achieved a successful outcome in terms of local recurrence and respiratory function, distant metastasis remained a challenge for myxofibrosarcoma patients, and its impact on long-term prognosis requires further investigation. Nevertheless, the described procedure offers promise for managing extensive chest wall defects.

DOI： 10.1186/s13019-024-02639-5

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Impact of the neutrophil-to-lymphocyte ratio on patients with locally advanced non-small cell lung cancer who suffer radiation pneumonitis during the course of induction chemoradiotherapy followed by surgery.

Yujiro Kubo, Hiromasa Yamamoto, Kei Matsubara, Kohei Hashimoto, Shin Tanaka, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Mikio Okazaki, Seiichiro Sugimoto, Kuniaki Katsui, Takao Hiraki, Katsuyuki Kiura, Shinichi Toyooka

Surgery today 2024年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Radiation pneumonitis (RP) is an obstacle for patients after surgery following induction chemoradiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). We performed a comparative analysis of the association between clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and prognosis, in LA-NSCLC patients with or without RP during induction chemoradiotherapy followed by surgery. METHODS: The subjects of this analysis were 168 patients undergoing trimodality therapy for LA-NSCLC between January, 1999 and May, 2019. Patients were divided into two groups: the RP group (n = 41) and the non-RP group (n = 127). We compared the clinicopathological factors including the NLR between the groups and analyzed the association between the NLR and prognosis. RESULTS: The RP group had more patients with tumors located in the lower lobe, more bilobar resections, shorter operative times, no implementation of postoperative adjuvant chemotherapy, and a higher postoperative NLR than the non-RP group. There were no significant differences in serious postoperative complications and the prognosis. Patients with a low postoperative NLR had a significantly better prognosis in the non-RP group, and a trend toward a better prognosis even in the RP group. CONCLUSION: Postoperative NLR may be a useful prognostic factor, even for patients who suffer RP after trimodality therapy for LA-NSCLC.

DOI： 10.1007/s00595-024-02816-y

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Transmanubrial approachを応用して切除した乳腺悪性葉状腫瘍術後左内胸リンパ節転移の1例

妹尾知哉, 山本寛斉, 岡田和大, 古川真一, 藤原亮太, 俣野貴慶, 久松加寿也, 調枝治樹, 橋本好平, 田中真, 枝園和彦, 諏澤憲, 三好健太郎, 岡崎幹生, 杉本誠一郎, 豊岡伸一

日本臨床外科学会雑誌 85 ( 3 ) 460 - 460 2024年3月

Plasma concentrations of histidine-rich glycoprotein in primary graft dysfunction after lung transplantation. 国際誌

Toshio Shiotani, Seiichiro Sugimoto, Yasuaki Tomioka, Shin Tanaka, Toshiharu Mitsuhashi, Ken Suzawa, Kazuhiko Shien, Kentaroh Miyoshi, Hiromasa Yamamoto, Mikio Okazaki, Shinichi Toyooka

Interdisciplinary cardiovascular and thoracic surgery 2024年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: Histidine-rich glycoprotein has been reported as an anti-inflammatory glycoprotein that inhibits acute lung injury in mice with sepsis and as a prognostic biomarker in patients with sepsis. We investigated the relationship between plasma concentrations of histidine-rich glycoprotein and the risk of occurrence of primary graft dysfunction. METHODS: According to the primary graft dysfunction grade at post-transplant 72 hours, patients who underwent lung transplantation were divided into three groups: non-primary graft dysfunction group (grade 0-1), moderate primary graft dysfunction group (grade 2), and severe primary graft dysfunction group (grade 3). The plasma concentrations of histidine-rich glycoprotein measured daily during the first post-transplant 7 days were compared among the three groups. Appropriate cutoff values of the concentrations were set for survival analyses after lung transplantation. RESULTS: A total of 68 patients were included. The plasma histidine-rich glycoprotein concentration at post-transplant 72 hours was significantly lower in the severe primary graft dysfunction group (n = 7) than in the other two groups (non-primary graft dysfunction group (n = 43), P = 0.042; moderate primary graft dysfunction group (n = 18), P = 0.040). Patients with plasma histidine-rich glycoprotein concentration ≥34.4 µg/mL at post-transplant 72 hours had significantly better chronic lung allograft dysfunction-free survival (P = 0.012) and overall survival (P = 0.037) than those with the concentration <34.4 µg/mL. CONCLUSIONS: Plasma histidine-rich glycoprotein concentrations at post-transplant 72 hours might be associated with the risk of development of primary graft dysfunction.

DOI： 10.1093/icvts/ivae021

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Long-term outcomes of lung transplantation requiring renal replacement therapy: A single-center experience. 国際誌

Yasuaki Tomioka, Seiichiro Sugimoto, Toshio Shiotani, Kei Matsubara, Haruki Choshi, Megumi Ishihara, Shin Tanaka, Kentaroh Miyoshi, Shinji Otani, Shinichi Toyooka

Respiratory investigation 62 ( 2 ) 240 - 246 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Life-long immunosuppressive therapy after lung transplantation (LT) may lead to end-stage renal disease (ESRD), requiring renal replacement therapy (RRT). We aimed to investigate the characteristics and long-term outcomes of patients undergoing LT and requiring RRT. METHODS: This study was a single-center, retrospective cohort study. The patients were divided into the RRT (n = 15) and non-RRT (n = 170) groups. We summarized the clinical features of patients in the RRT group and compared patient characteristics, overall survival, and chronic lung allograft dysfunction (CLAD)-free survival between the two groups. RESULTS: The cumulative incidences of ESRD requiring RRT after LT at 5, 10, and 15 years were 0.8 %, 7.6 %, and 25.2 %, respectively. In the RRT group, all 15 patients underwent hemodialysis but not peritoneal dialysis, and two patients underwent living-donor kidney transplantation. The median follow-up period was longer in the RRT group than in the non-RRT group (P < 0.001). The CLAD-free survival and overall survival did not differ between the two groups. The 5-year survival rate even after the initiation of hemodialysis was 53.3 %, and the leading cause of death in the RRT group was infection. CONCLUSIONS: Favorable long-term outcomes can be achieved by RRT for ESRD after LT.

DOI： 10.1016/j.resinv.2024.01.001

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Successful Living-donor Lobar Lung Transplantation With BK Virus-related Hemorrhagic Cystitis Throughout the Perioperative Period. 国際誌

Yasuaki Tomioka, Shinji Otani, Shin Tanaka, Kentaroh Miyoshi, Mikio Okazaki, Seiichiro Sugimoto, Masaomi Yamane, Shinichi Toyooka

Transplantation direct 10 ( 1 ) e1556 2024年1月