Unusual case of tacrolimus vascular toxicity after deceased donor renal transplantation.

We report a case of tacrolimus vascular toxicity found on a protocol biopsy shortly after a deceased donor renal transplantation. The patient was immunologically high-risk and acute antibody-mediated rejection during post-transplant dialysis phase was suspected on the protocol biopsy. Although the patient was stable after treatment of rejection, a further examination showed a very rare but specific side-effect of tacrolimus. It is sometimes difficult to make a differential diagnosis during postoperative dialysis period among AMR, primary non-functioning, drug toxicity, infection or just prolonged recovery from the damage of a long agonal phase on the non-heart beating donor. Although the possibilities of coexistence of rejection or other causes such as infection have not been completely excluded, it is important to be aware of this unusual side effect of tacrolimus.

Biopsy findings on a stable recipient after secondary donor specific antibody (DSA) positive and ABO incompatible kidney transplantation.

Using desensitization protocol, we performed a secondary donor specific antibody (DSA) positive and ABO incompatible kidney transplantation. One-hour biopsy showed no C4d deposition. The protocol biopsy after 2 weeks showed diffuse C4d deposition with peritubulitis. After 12 weeks, however, the protocol biopsy showed disappearance of tubulitis in spite of remaining C4d deposition. The recipient was in stable condition with excellent graft function despite high titer of the DSA. Monitoring of protocol biopsy is critical while antibody titer and the interpretation of the histological findings correlating with clinical markers must be considered.

[Usefulness of low-dose and long-term administration of imatinib in patients with liver metastases of rectal GIST and GIST of stomach].

Imatinib is an effective drug for KIT positive GIST, and the usual dose is 400 mg/day. On the other hand, imatinib sometimes causes leucopenia and it is hard to maintain a dosage of 400 mg/day. We reported here the two cases with a remarkable response of unresectable GIST using a low-dose and long-term administration of imatinib. It seems that a low dose and long-term administration of imatinib will be an important therapy for unresectable GIST.

[Usefulness of hepatic arterial infusion chemotherapy for the patients with synchronous liver metastases from colorectal cancer].

We analyzed the results of hepatic arterial infusion chemotherapy (HAIC) for 24 patients with synchronous liver metastases from colorectal cancer for the last twelve years in order to investigate the usefulness of HAIC for those patients. In 8 cases with resection of liver metastases, the median survival time (MST) was 45 months, mean survival time was 53 months and a 5-year survival rate was 44%. In 16 cases without resection of liver metastases, 2 cases had complete response (CR), 10 cases had partial response (PR), 4 cases had stable disease (SD), and the response rate was 75%. There was a significant difference in the survival time of each response. MST was 25 months, and mean survival time was 38 months. According to the usefulness of HAIC for the patients with synchronous liver metastases from colorectal cancer, it seems that HAIC with effective general chemotherapy will have better results than HAIC.

[Usefulness of hepatic arterial infusion chemotherapy for the patients with synchronous liver metastases from colorectal cancer].

We analyzed the results of hepatic arterial infusion chemotherapy (HAIC) for 21 patients with synchronous liver metastases from colorectal cancer for the last ten years to investigate the usefulness of HAIC for those patients. In 7 cases with resection of liver metastases, the median survival time (MST) was 49 months, mean survival time was 56.3 months and a 5-year survival rate was 43%. In 14 cases without resection of liver metastases, 2 cases had complete response (CR), 8 cases had partial response (PR), 4 cases had stable disease (SD), and the response rate was 71%. There was a significant difference in the survival time of each response. MST was 27 months, and mean survival time was 38.5 months. According to the usefulness of HAIC for the patients with synchronous liver metastases from colorectal cancer, it seems that HAIC with effective general chemotherapy will have better results than HAIC.

[A case of hepatocellular carcinoma of the caudate lobe relapsing with variable patterns after hepatectomy].

A 61-year-old man was referred for evaluation of positive HBs-Ag and an unusually high level (28,396 ng/mL) of serum alpha-fetoprotein in serum. Computed tomography of the abdomen revealed a huge extrahepatically growing tumor which was originating from the caudate lobe and extended to the posterior segment of the right lobe of the liver and encircled the anterior half of inferior vena cava. Biochemical examination showed a good liver function with 8% of ICG R15 and 103% of prothrombin time. Total resection of the caudate lobe with posterior segmentectomy was performed. Relapsing tumors, which metastasized to the liver in 9 months, the right lung in 15 months and the left lung in 20 months after initial surgery, were totally resected, respectively. Radiation therapy was effective to mediastinal lymph nodes metastasized in 25 months after the initial surgery. He survived with good quality of life for 46 months until he died from brain metastasis. Therefore, the multidisplinary therapy combined with radiation and surgery for hepatocellular carcinoma of the caudate lobe may have improved a long-term survival.