Faculty Profiles - MIYOSHI Kentaroh

Donor-derived cell-free DNA is associated with acute rejection and decreased oxygenation in primary graft dysfunction after living donor-lobar lung transplantation. Reviewed International journal

Shin Tanaka, Seiichiro Sugimoto, Takeshi Kurosaki, Kentaroh Miyoshi, Shinji Otani, Ken Suzawa, Shinsuke Hashida, Masaomi Yamane, Takahiro Oto, Shinichi Toyooka

Scientific reports 8 ( 1 ) 15366 - 15366 2018.10

Language：English Publishing type：Research paper (scientific journal)

Donor-derived cell-free DNA (dd-cf-DNA) has been shown to be an informative biomarker of rejection after lung transplantation (LT) from deceased donors. However, in living-donor lobar LT, because small grafts from blood relatives are implanted with short ischemic times, the detection of dd-cf-DNA might be challenging. Our study was aimed at examining the role of dd-cf-DNA measurement in the diagnosis of primary graft dysfunction and acute rejection early after living-donor lobar LT. Immediately after LT, marked increase of the plasma dd-cf-DNA levels was noted, with the levels subsequently reaching a plateau with the resolution of primary graft dysfunction. Increased plasma levels of dd-cf-DNA were significantly correlated with decreased oxygenation immediately (p = 0.022) and at 72 hours (p = 0.046) after LT. Significantly higher plasma dd-cf-DNA levels were observed in patients with acute rejection (median, 12.0%) than in those with infection (median, 4.2%) (p = 0.028) or in a stable condition (median, 1.1%) (p = 0.001). Thus, measurement of the plasma levels of dd-cf-DNA might be useful to monitor the severity of primary graft dysfunction, and plasma dd-cf-DNA could be a potential biomarker for the diagnosis of acute rejection after LT.

DOI： 10.1038/s41598-018-33848-3

Low-risk donor lungs optimize the post-lung transplant outcome for high lung allocation score patients. Reviewed

Takeshi Kurosaki, Kentaroh Miyoshi, Shinji Otani, Kentaro Imanishi, Seiichiro Sugimoto, Masaomi Yamane, Motomu Kobayashi, Shinichi Toyooka, Takahiro Oto

Surgery today 48 ( 10 ) 928 - 935 2018.10

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: The lung allocation score (LAS) has been generally recognized as a contributor to the overall survival in lung transplant candidates. However, donor-related risks have never been taken into consideration in previous research that validated the LAS. This study aimed to determine whether or not the role of the LAS as a predictor of the posttransplant outcome is influenced by the quality of the donor lungs. METHODS: We retrospectively reviewed 108 patients who underwent lung transplantation at Okayama University Hospital since 1998. The cohort was divided into two groups based on the lung donor score (DS; ≤ 4/> 4). Correlations between the LAS and posttransplant outcomes were investigated in both groups. RESULTS: In the high-DS group, an elevated LAS was strongly associated with posttransplant PaO2/FiO2 (p = 0.018). However, in the low-DS group, no correlation was found between them. There was no significant difference in the long-term survival according to the LAS in the low-DS group. The LAS effectively predicted the posttransplant outcome only when lungs with DS > 4 were transplanted; the LAS was not reliable if high-quality lungs were transplanted. CONCLUSION: Lung transplantation can be feasible and provides a survival benefit even for high-LAS patients if lungs from a low-risk donor are transplanted.

DOI： 10.1007/s00595-018-1670-7

Favorable survival in lung transplant recipients on preoperative low-dose, as compared to high-dose corticosteroids, after hematopoietic stem cell transplantation. Reviewed

Seiichiro Sugimoto, Kentaroh Miyoshi, Takeshi Kurosaki, Shinji Otani, Masaomi Yamane, Motomu Kobayashi, Takahiro Oto

International journal of hematology 107 ( 6 ) 696 - 702 2018.6

Language：English Publishing type：Research paper (scientific journal)

Although the number of patients developing pulmonary complications after hematopoietic stem cell transplantation (HSCT) necessitating lung transplantation (LT) is increasing, a little information is available about factors influencing the prognosis after LT in these patients. Corticosteroids represent the first-line therapy for pulmonary complications after HSCT; however, prolonged corticosteroid treatment prior to LT increases the potential risks of LT. In this study, we assessed the effect of preoperative corticosteroid therapy on long-term survival in patients undergoing LT after HSCT. We retrospectively investigated data from 13 patients who had received high-dose corticosteroid therapy and nine who had received low-dose corticosteroid therapy prior to LT for pulmonary complications after HSCT. Other than the preoperative corticosteroid dose, patient clinical characteristics did not differ. The incidence of postoperative complications within the first year after LT was significantly lower in the low-dose corticosteroid group (p = 0.026). Survival after LT was also significantly better in the low-dose corticosteroid group than in the high-dose corticosteroid group (p = 0.034). In recipients of LT after HSCT, preoperative low-dose corticosteroid use, as compared to preoperative high-dose corticosteroid use, could limit the risks of postoperative complications developing within the first year after the LT, leading to improved long-term survival after LT.

DOI： 10.1007/s12185-018-2417-3

Pneumatosis intestinalis after lung transplantation for pulmonary graft-versus-host disease. Reviewed International journal

Kumi Mesaki, Seiichiro Sugimoto, Shinji Otani, Takeshi Kurosaki, Kentaroh Miyoshi, Masaomi Yamane, Takahiro Oto

Journal of thoracic disease 10 ( 1 ) E42-E45 - E45 2018.1

Language：English

Pneumatosis intestinalis, which could complicate a spectrum of clinical conditions ranging from benign to life-threatening, is a rarely encountered complication after lung transplantation (LT). We describe two cases in which PI developed as a complication following LT for pulmonary graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). In addition to the long-term immunosuppression administered for pulmonary GVHD, the intense immunosuppression needed after LT might increase the risk of PI in lung transplant recipients after HSCT. Conservative therapy should be considered for the treatment of PI developing after LT.

DOI： 10.21037/jtd.2017.11.121

Prolonged Administration of Twice-Daily Bolus Intravenous Tacrolimus in the Early Phase After Lung Transplantation. Reviewed International journal

Yutaka Hirano, Seiichiro Sugimoto, Toshifumi Mano, Takeshi Kurosaki, Kentaroh Miyoshi, Shinji Otani, Masaomi Yamane, Motomu Kobayashi, Shinichiro Miyoshi, Takahiro Oto

Annals of transplantation 22 484 - 492 2017.8

Language：English Publishing type：Research paper (scientific journal) Publisher：INT SCIENTIFIC LITERATURE, INC

BACKGROUND Although administration of tacrolimus, whether by the enteric, sublingual, or continuous intravenous routes, has some limitations, twice-daily bolus intravenous tacrolimus administration has been shown to be beneficial in optimizing efficacy and safety after lung transplantation. However, at present, the duration of bolus intravenous tacrolimus administration is limited, and the effects of prolonged bolus intravenous tacrolimus administration remain unknown. Our study was aimed at assessing the safety and efficacy of prolonged twice-daily bolus intravenous tacrolimus administration in the early phase after lung transplantation. MATERIAL AND METHODS We retrospectively investigated the data of 62 recipients of lung transplantation who had received twice-daily bolus intravenous administration of tacrolimus, followed by oral tacrolimus, after lung transplantation at our institution between January 2011 and October 2015. RESULTS The median duration of bolus intravenous tacrolimus administration was 19 days (4-72 days). The target trough level was achieved in 89% of the patients by day 3. Acute kidney injury occurred in 27% of the patients during bolus intravenous tacrolimus. Two patients (3%) had neurotoxicity, necessitating discontinuation of tacrolimus. Suspected acute rejection requiring steroid pulse therapy occurred in 21% of patients during the follow-up period. Eight patients (13%) developed chronic lung allograft dysfunction during the follow-up period. The 1-year and 5-year survival rates after lung transplantation were 95% and 76%, respectively. CONCLUSIONS These results suggest that prolonged bolus intravenous tacrolimus administration in the early phase after lung transplantation is a safe and effective alternative to enteric, sublingual, or continuous intravenous administration.

DOI： 10.12659/AOT.904225

High Frequency of Acute Adverse Cardiovascular Events After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Receiving Preoperative Long-Term Intravenous Prostacyclin. Reviewed

Satoshi Akagi, Takahiro Oto, Motomu Kobayashi, Kentaroh Miyoshi, Seiichiro Sugimoto, Masaomi Yamane, Kazufumi Nakamura, Toshihiro Sarashina, Shinichiro Miyoshi, Hiroshi Ito

International heart journal 58 ( 4 ) 557 - 561 2017.8

Language：English Publishing type：Research paper (scientific journal)

Adverse cardiovascular events after lung transplantation (LT) increase the mortality in patients with pulmonary arterial hypertension (PAH). Long-term intravenous prostacyclin is the usual treatment in severe patients with PAH, but it may increase the risk of hemorrhage due to its antiplatelet aggregation effect or thrombocytopenia. We investigated the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events including hemorrhagic complication after LT. We retrospectively compared the incidence of adverse events (death, intrathoracic hematoma and bleeding, cardiac congestion or shock, cerebral infarction and pulmonary embolism) within 30 days after LT between no/short-term (median 0.6 years, n = 13) and long-term (median 3.7 years, n = 15) intravenous prostacyclin groups. There were no differences in the dose of intravenous prostacyclin and pulmonary artery pressure between the two groups. Among 22 adverse events (0.8 ± 1.1 events/patient), 4 events occurred in the no/short-term intravenous prostacyclin group and 18 occurred in the long-term intravenous prostacyclin group. The event rate per patient in the long-term intravenous prostacyclin group (1.2 ± 1.3 events/patient) was significantly higher than that in the no/short-term intravenous prostacyclin group (0.3 ± 0.5 events/patient) (P < 0.05). Intrathoracic hematoma and bleeding was the most frequent adverse event (9 events, 41%). Preoperative long-term intravenous prostacyclin therapy increases acute adverse cardiovascular events after LT in patients with PAH.

DOI： 10.1536/ihj.16-389

Successful Lung Transplantation Using a Deceased Donor Mechanically Ventilated for Ten Months. Reviewed International journal

Shin Tanaka, Kentaroh Miyoshi, Seiichiro Sugimoto, Masaomi Yamane, Motomu Kobayashi, Takahiro Oto

The Annals of thoracic surgery 104 ( 2 ) e177-e179 - E179 2017.8

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

A successful outcome after lung transplant was achieved using lungs donated from a teenage boy who underwent prolonged mechanical ventilation. The donor experienced hypoxic brain damage and was declared brain dead 324 days after tracheal intubation. At the time of referral, the donor's lungs revealed diffuse radiologic infiltration and atelectasis but excellent function, with a PaO2/FiO2 ratio of 450. The lungs were transplanted to a 10-year-old girl with bronchiolitis obliterans. She developed grade 2 primary graft dysfunction, but recovered quickly. She is doing well and has not experienced any other critical adverse events 12 months after lung transplantation.

DOI： 10.1016/j.athoracsur.2017.03.019

Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list

Hisao Higo, Takeshi Kurosaki, Eiki Ichihara, Toshio Kubo, Kentaroh Miyoshi, Shinji Otani, Seiichiro Sugimoto, Masaomi Yamane, Nobuaki Miyahara, Katsuyuki Kiura, Shinichiro Miyoshi, Takahiro Oto

RESPIRATORY INVESTIGATION 55 ( 4 ) 264 - 269 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER

Background: Lung transplants have produced very favorable outcomes for patients with interstitial lung disease (ILD) in Japan. However, because of the severe donor lung shortage, patients must wait approximately 2.5 years before they can undergo transplantation and many candidates die before allocation. We reveal the clinical characteristics of Japanese patients with ILD who are candidates for lung transplants and the risk factors for early death while on the waiting list.Methods: We retrospectively reviewed the clinical data of patients registered in the Japan Organ Transplant Network from Okayama University Hospital who are candidates for cadaveric lung transplants for ILD between 1999 and 2015.Results: Fifty-three patients with ILD were included (24 patients with idiopathic pulmonary fibrosis and 29 others). They had severe pulmonary dysfunction and low exercise tolerability. The median waiting time for transplantation was 462 days, and 22 patients died before allocation. Patients who died before 462 days without undergoing transplantation had more severe dyspnea, shorter 6-minute walk distance (6MWD), and lower performance status than those who waited >= 462 days.Conclusions: Japanese candidates for cadaveric lung transplants for ILD have severe pulmonary dysfunction. Severe dyspnea, short 6MWD, and low performance status are risk factors for early death while on the waiting list. (C) 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.resinv.2017.03.002

Successful Lung Transplantation for Pulmonary Disease Associated With Erdheim-Chester Disease. Reviewed International journal

Kohei Hashimoto, Kentaroh Miyoshi, Hisao Mizutani, Shinji Otani, Seiichiro Sugimoto, Masaomi Yamane, Takahiro Oto

The Annals of thoracic surgery 104 ( 1 ) e13-e15 - E15 2017.7

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

A 53-year-old man with pulmonary fibrosis associated with Erdheim-Chester disease achieved long-term survival after lung transplantation. Major clinical manifestations included lung and bone injuries, and other vital organs were functionally unaffected by the disease. After a careful observation for the disease progression, he underwent bilateral deceased-donor lung transplantation. He has returned to his normal social life and is doing well without recurrence of Erdheim-Chester disease in the lung allograft or progression in other organs 5 years after transplant. Lung transplantation is a potentially reasonable treatment option for Erdheim-Chester disease involving the lungs if the functions of other vital organs remain stable.

DOI： 10.1016/j.athoracsur.2017.02.020

Lung retransplantation in an adult 13 years after single lobar transplant in childhood Reviewed

Seiichiro Sugimoto*,Shinji Otani*,Takashi Ohki,Takeshi Kurosaki*,Kentaroh Miyoshi *,Masaomi Yamane*,Shinichiro Miyoshi*,Takahiro Oto*

General Thoracic and Cardiovascular Surgery, Japanese Journal of Thoracic and Cardiovascular Surgery, [Zasshi] [Journal]. Nihon Kyobu Geka Gakkai, Journal of the Japanese Association for Thoracic Surgery 1 - 3 2017.1

Visualization of bronchial circulation at bronchial anastomotic site using bronchial fluorescein angiography technique Reviewed

Norichika Iga,Kentaroh Miyoshi*,Katsuyoshi Takata,Yutaka Hirano,Yusuke Konishi,Shinji Otani*,Seiichiro Sugimoto*,Masaomi Yamane*,Shinichiro Miyoshi*,Takahiro Oto*

Interactive Cardiovascular and Thoracic Surgery 23 ( 5 ) 716 - 721 2016.11

腸型肺腺癌の1切除例

清水大, 三好健太郎, 目崎久美, 枝園和彦, 杉本誠一郎, 山本寛斉, 宗淳一, 豊岡伸一, 大藤剛宏, 三好新一郎

肺癌 56 ( 6 ) 682 - 682 2016.11

Overview of Clinical Issues after Lung Transplantation Reviewed

Kentaroh Miyoshi*,Takahiro Oto*

Japanese Journal of Thoracic Surgery, Kyobu geka. The Japanese journal of thoracic surgery 69 ( 11 ) 915 - 918 2016.10

Pulmonary artery patch for an inadequate donor atrial cuff in the absence of donor pericardium in lung transplantation Reviewed

Seiichiro Sugimoto*,Masaomi Yamane*,Kentaroh Miyoshi*,Takeshi Kurosaki*,Shinji Otani*,Shinichiro Miyoshi*,Takahiro Oto*

Japanese Journal of Surgery, Surgery Today, The Japanese Journal of Surgery 1 - 3 2016.6

Lung transplantation for diffuse panbronchiolitis Reviewed

Seiichiro Sugimoto*,Kentaroh Miyoshi*,Masaomi Yamane*,Takahiro Oto*

Interactive Cardiovascular and Thoracic Surgery 22 ( 5 ) 679 - 681 2016.5

Therapeutic Effect of Sirolimus for Lymphangioleiomyomatosis Remaining in the Abdominopelvic Region After Lung Transplantation: A Case Report Reviewed

T. Ito, M. Suno, K. Sakamoto, Y. Yoshizaki, K. Yamamoto, R. Nakanishi, Y. Hirano, M. Irie, T. Kurosaki, S. Otani, M. Yamane, S. Sugimoto, K. Miyoshi, T. Oto

Transplantation Proceedings 48 ( 1 ) 271 - 274 2016.1

Balloon-expandable metallic stents for airway diseases Reviewed

Takashi Ohki,Seiichiro Sugimoto*,Takeshi Kurosaki*,Shinji Otani*,Kentaroh Miyoshi*,Masaomi Yamane*,Shinichiro Miyoshi*,Takahiro Oto*

Acta Medica Okayama, Acta. Medica Okayama, Acta medicinae Okayama, Acta medica Okayama 70 ( 5 ) 421 - 424 2016.1

A neutrophil elastase inhibitor improves lung function during ex vivo lung perfusion. Reviewed

Masaaki Harada, Takahiro Oto, Shinji Otani, Kentaroh Miyoshi, Masanori Okada, Norichika Iga, Hitoshi Nishikawa, Seiichiro Sugimoto, Masaomi Yamane, Shinichiro Miyoshi

General thoracic and cardiovascular surgery 63 ( 12 ) 645 - 51 2015.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Ex vivo lung perfusion (EVLP) has been used not only for graft evaluation but also for graft reconditioning prior to lung transplantation. Inflammatory cells such as neutrophils may cause additional graft injury during EVLP. Neutrophil elastase inhibitors protect lungs against neutrophil-induced lung injury, such as acute respiratory distress syndrome. This study aimed to investigate the effect of a neutrophil elastase inhibitor during EVLP. METHODS: EVLP was performed for 4 h in bilateral pig lungs that had previously experienced warm ischemia for 2 h with or without a neutrophil elastase inhibitor (treated and control groups, respectively; n = 6). Following EVLP, the left lung was transplanted into a recipient pig, and this was followed by observation for 4 h. Pulmonary functions were observed both during EVLP and during the early post-transplant stage. RESULTS: During EVLP, decreases in neutrophil elastase levels (P < 0.001), the wet-dry weight ratio (P < 0.05), and pulmonary vascular resistance (P < 0.01) and increases in the PaO2/FiO2 ratio (P < 0.01) and pulmonary compliance (P < 0.05) were observed in the treated group. After transplantation, decreased pulmonary vascular resistance (P < 0.05) was observed in the treated group. CONCLUSIONS: A neutrophil elastase inhibitor attenuated the inflammatory response during EVLP and may decrease the incidence of lung reperfusion injury after transplantation.

DOI： 10.1007/s11748-015-0585-0

Extended sleeve lobectomy after induction chemoradiotherapy for non-small cell lung cancer. Reviewed

Shinichi Toyooka, Junichi Soh, Hiromasa Yamamoto, Masaomi Yamane, Shigeru Hattori, Kazuhiko Shien, Kentaroh Miyoshi, Seiichiro Sugimoto, Takahiro Oto, Shinichiro Miyoshi

Surgery today 45 ( 9 ) 1121 - 6 2015.9

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

PURPOSE: Extended sleeve lobectomy is a challenging surgery. While induction chemoradiotherapy (ChRT) followed by surgery is one of the therapeutic strategies used for locally advanced non-small cell lung cancer (NSCLC), ChRT can impair the anastomotic healing potential. We herein present our experience with cases who underwent an extended sleeve lobectomy after induction ChRT. METHODS: The medical records of patients who underwent a surgery for NSCLC after ChRT were reviewed. RESULTS: Between December 2007 and January 2013, nine patients underwent an extended sleeve lobectomy; the left lingular division and lower lobe in four patients, the right upper lobe and trachea in one patient, the carina and trachea in one patient, the right middle and lower lobes in one patient, the right upper and middle lobes and carina in one patient and the right upper lobe and superior segment of the lower lobe in one patient. While no postoperative 90-day deaths occurred, one case developed a bronchopleural fistula on postoperative day (POD) 25 and one case developed a bronchovascular fistula on POD 163. No cases of local recurrence developed. CONCLUSIONS: Our experience suggests that an extended sleeve lobectomy after induction ChRT is feasible, but careful patient selection and perioperative management are mandatory.

DOI： 10.1007/s00595-014-1025-y