Because of the grave shortage of deceased kidney allografts in Japan, we have embarked on a new source of organs, 'Restored kidneys' from living patients. From January 1991 through September 2006, 42 kidneys (eight benign pathology, eight small renal cancers, eight ureteral cancers, six aneurysms, eight severe nephrotic syndrome from four patients and four ureteral stenosis) were obtained from 38 patients/donors after extensive discussion of treatment modalities and risks. All patients/donors agreed to undergo total nephrectomy. The lesions were removed/repaired ex vivo on the back table, then transplanted. All recipients were notified of all possible risks including donor disease recurrence. One, 5 and 10-year patient survival rates of restored transplant patients were 92.9%, 79.3% and 63.8%, respectively. One, 5 and 10-year graft survival rates of restored kidney transplant patients were 78.6%, 51.8% and 42.7%, respectively. There were no recurrences of small renal cell carcinomas. There was one recurrence of ureteral cancer in the transplanted kidney 15 months after operation.In countries where deceased donors are scarce, such as Japan, the restored kidneys can be a last resort for renal allografts.

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Hyperacute humoral rejection of ABO-incompatible kidney transplants limits the application of this procedure. We evaluated the effect of 4-week treatment with mycophenolate mofetil (MMF), a compound that inhibits antibody production by B cells, before ABO-incompatible living-donor kidney transplantation with tacrolimus as the primary immunosuppressant. In contrast with cases without MMF pretreatment, we did not observe any graft loss caused by hyperacute humoral rejection in the 18 patients who received MMF. Overall, the incidence of adverse events was comparable in the MMF-treated and -untreated groups. The administration of MMF 4 weeks before kidney transplant effectively inhibits B-cell function, suggesting a potential role for MMF in the prevention of humoral rejection.

We present a case of unilateral adrenal medullary hyperplasia in a 63-year-old woman with clinical signs and symptoms of pheochromocytoma unassociated with multiple endocrine neoplasia. The surgically removed adrenal gland revealed diffuse medullary hyperplasia with multiple micronodules measuring up to 2 mm. The micronodules were composed of enlarged chromaffin cells with atypia, histologically similar t o those of pheochromocytoma, forming small solid alveolar patterns separated by a fibrovascular stroma. Removal of the hyperplastic adrenal gland resulted in disappearance of paroxysmal nocturnal hypertension and palpitation. These results suggest that diffuse and nodular medullary hyperplasia is the precursor of pheochromocytoma. Acta Pathol Jpn 40 : 683-686,1990.A-63-year-old woman presented with a 3-year history of paroxysmal nocturnal hypertension and palpitation. Because she was a nurse, she had examined her own blood pressure during the nocturnal attack, and found it had risen to 200 mmHg. She had no positive family history of MEN. Ultrasonography and computed tomography (CT) revealed no morphological abnormalities of the thyroids and parathyroids, except for a small adenomatous goiter. The normal blood values of calcium (4.6 mEq/l), calcitonin (80 pg/ml) and carcinoembryogenic antigen (CEA) (3.3 ng/ml) also ruled out the possibility of MEN.Laboratory data under asymptomatic conditions were as follows: slight elevation of plasma norepinephrine