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.

Expression of dihydropyrimidine dehydrogenase in cancer cells but not in stromal cells predicts the efficacy of fluorouracil treatment in patients with gastric carcinoma.

BACKGROUND: It is not known whether immunohistochemical quantification of dihydropyrimidine dehydrogenase (DPD) in cancer cells, stromal mononuclear cells and normal glands predicts the efficacy of fluorouracil (FU) derivatives inpatients with T3 gastric adenocarcinoma. MATERIALS AND METHODS: The levels of DPD in cancer cells, stromal cells and normal glands were measured immunohistochemically in 111 patients with T3 gastric carcinoma. Adjuvant chemotherapy with oral UFT (uracil/tegafur[4:1]) was administered to 95 patients for more than 1 year after surgery. RESULTS: Forty-two (37.8%) patients demonstrated high DPD expression in the cytoplasm of their cancer cells. In patients with low DPD expression in cancer cells, the 5-year survival rates were 64.5% in patients given FU and 42.8% in those not given FU (p=0.014). Neither stromal cells nor normal glands affected the efficacy of FU treatment in relation to their DPD expression. CONCLUSION: DPD expression in cancer cells but not in stromal cells could be a predictor of the efficacy of FU chemotherapy in patients with T3 gastric carcinoma.