- Email: [email protected]
Impact of the Great Eastern Japan Earthquake on Transplant Renal Function in Iwaki City, Fukushima
Impact of the Great Eastern Japan Earthquake on Transplant Renal Function in Iwaki City, Fukushima H. Shimmura, H. Kawaguchi, M. Tokiwa, and K. Tanabe ABSTRACT Tokiwa-kai group is a urologic and dialysis institution complex located in Iwaki city, Fukushima, Japan, and has performed renal transplantation since 1997. Although water is mandatory for renal transplant recipients, the water supply did not work for approximately a month after the earthquake in Iwaki city. Moreover, after the Fukushima Daiichi nuclear accident struck Iwaki city, there was a critical shortage of food and medical supplies, including immunosuppressant drugs. Therefore, we investigated the impact of the Great Eastern Japan Earthquake on transplant renal function. We followed 30 patients who underwent renal transplantation before the Great Eastern Japan Earthquake. There were 19 males and 11 females with a mean age of 47 years. All recipients were not injured by the earthquake or the tsunami. Of the 30 recipients, 1 lost his renal graft at 12 months after the earthquake, and 1 has deterioration of graft function with a serum creatinine level of 5.5 mg/dL. Their creatinine levels before the earthquake were 2.79 mg/dL and 3.78 mg/dL, respectively. The other recipients have good graft function with a mean creatinine level of 1.5 mg/dL. All recipients did not experience any rejection episode after the earthquake. The shortage of water and food after the Great Eastern Japan Earthquake exacerbated the renal graft function, especially in the recipients with the lower graft function.
O
N MARCH 11, 2011, in the early afternoon, the Great Eastern Japan Earthquake with a 9.0-magnitude quake hit the eastern coastal region in Japan [1]. The resulting tsunami caused a meltdown at the Fukushima Daiichi nuclear plant [2]. Iwaki city is located in the south-eastern Fukushima prefecture, and from 30 to 70 kilometers from the nuclear plant. After the earthquake, the water supply did not work for approximately a month after the disaster in Iwaki city. Moreover, the radioactive fallout from the nuclear plant also struck Iwaki city (Fig 1), therefore, daily necessities such as food and gasoline and pharmaceutical products, including immunosuppressant drugs, were not available in Iwaki city for a few weeks. Although water and immunosuppressants are mandatory for renal transplant recipients, the impact of these shortages and the stress of the severe situation on renal graft function is unknown. Therefore, to reveal the impact of the Great Eastern Japan Earthquake on transplant renal function of our renal transplant recipients, we investigated the data, including the results of a questionnaire, after the disaster. ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 613e615 (2014)
PATIENTS AND METHODS In the Tokiwa-kai group, which is a urologic and dialysis institution complex located in Iwaki city, Fukushima, Japan, renal transplantation has been performed since 1997. We have followed 30 patients who underwent renal transplantation before the Great Eastern Japan Earthquake. There were 19 males and 11 females with a mean age of 46.9 12.6 years (range, 27e63). Of these patients, 13 were treated with cyclosporine-based immunosuppression and 17 were treated with tacrolimus-based immunosuppression. Twenty-eight were grafted from living donors and 2 were grafted from deceased donors. The mean period after transplantation was 121.9 57.5 months (range, 36e241). Their living conditions after the earthquake were investigated using a questionnaire about evacuation place, drinking, diet, and oral administration of immunosuppressants.
From the Jyoban Hospital (H.S., H.K., M.T.), Tokiwa-kai Group, Iwaki, Fukushima, and the Department of Urology (K.T.), Tokyo Women’s Medical University, Tokyo, Japan. Address reprint requests to Hiroaki Shimmura, Jyoban Hospital, Tokiwa-kai Group, 57 Uenodai, Jyoban-kamiyunagayamachi, 9728322 Iwaki, Fukushima, Japan. E-mail: [email protected] 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.11.044 613
614
SHIMMURA, KAWAGUCHI, TOKIWA ET AL
Fig 1. Aerial measurements of Cs-134 and Cs-137 between April 6 and April 29 by Joint US-Japan AMS Data (from the US Department of Energy Web site, http://energy.gov/situation-japan-updated-12513).
RESULTS
All recipients were not injured by the earthquake or the tsunami on March 11, 2011. Of the 30 recipients, 1 lost his renal graft at 12 months after the earthquake, and 1 has deterioration of graft function with a serum creatinine level of 5.5 mg/dL (Fig 2). Their creatinine levels before
the earthquake were 2.79 mg/dL and 3.78 mg/dL, respectively. The other recipients have good graft function with a mean creatinine level of 1.52 0.60 mg/dL. All recipients did not experience any rejection episode after the earthquake. Evacuation Place
Of the 30 recipients, 20 (67%) stayed at Iwaki-city and 10 (33%) evacuated outside Iwaki-city. Three of those ten (10%) evacuated inside Fukushima prefecture and 7 (23%) evacuated outside Fukushima prefecture. The average duration of evacuation was 28.1 34.6 days (range, 4e106). Drinking Water
Fig 2. Changes in creatinine level after the earthquake disaster.
Twenty-six of the thirty recipients (87%) could drink water of normal quantity. The 4 remaining patients (13%) had access to less water than before the earthquake for a mean duration of 4.3 days after the earthquake. One patient drank only from a mountain stream for 4 days.
GREAT EASTERN JAPAN EARTHQUAKE
Diet
Sixteen of the thirty recipients (53%) could eat normal meals after the disaster. For a mean duration of 16.2 days after the earthquake, the 16 remaining patients (47%) could eat only preserved meals. One patient could not eat any meal from March 11 to the daytime of March 12. Oral Administration of Immunosuppressants
All patients took immunosuppressants at their usual dosages after the earthquake because they had enough immunosuppressants, fortunately. DISCUSSION
In the Tokiwa-kai group, 30 renal transplant recipients were followed before the earthquake disaster. One of those recipients lost his renal graft, and the transplant renal function of 1 patient turned worse after the earthquake. The transplant renal function of these 2 patients was not good before the disaster. The remaining patients who had good transplant renal function before the earthquake disaster maintain good transplant renal function after the earthquake disaster. The 2 recipients who developed worse transplant renal function stayed in Iwaki-city after the earthquake disaster. The impacts of stress due to remaining in the disasterstricken area and the shortage of water and food on the transplant renal function were uncertain. However, several investigators reported that the influence of stress of the disaster on health, even in physically unimpaired people,
615
was found [3,4]. Therefore, it may not be denied that the influence of the earthquake disaster might be related to the deterioration of the transplant renal function of these 2 recipients. All of the transplant kidney recipients could take their immunosuppressive medication every day after the disaster. Because immunosuppressive drugs could not be obtained for a few weeks after the nuclear plant accident in Iwaki city, it is important to always keep enough immunosuppressive drugs for transplant recipients in case of disaster. The Great Eastern Japan Earthquake could exacerbate renal graft function, especially in recipients with lower graft function. In patients with worse transplant renal function, more careful transplant management is necessary for protection of the transplant renal function under such a severe environment. REFERENCES [1] Shibahara S. The 2011 Tohoku earthquake and devastating tsunami. Tohoku J Exp Med 2011;223(4):305e7. [2] Hirose K. 2011 Fukushima Dai-ichi nuclear power plant accident: summary of regional radioactive deposition monitoring results. J Environ Radioact 2012. [3] Tsubokura M, Takita M, Matsumura T, et al. Changes in metabolic profiles after the Great East Japan Earthquake: a retrospective observational study. BMC Public Health 2013;13:267. [4] Ohkouchi S, Shibuya R, Yanai MK, et al. Deterioration in regional health status after the acute phase of a great disaster: respiratory physicians’ experiences of the Great East Japan Earthquake. Respir Investig 2013.
O
N MARCH 11, 2011, in the early afternoon, the Great Eastern Japan Earthquake with a 9.0-magnitude quake hit the eastern coastal region in Japan [1]. The resulting tsunami caused a meltdown at the Fukushima Daiichi nuclear plant [2]. Iwaki city is located in the south-eastern Fukushima prefecture, and from 30 to 70 kilometers from the nuclear plant. After the earthquake, the water supply did not work for approximately a month after the disaster in Iwaki city. Moreover, the radioactive fallout from the nuclear plant also struck Iwaki city (Fig 1), therefore, daily necessities such as food and gasoline and pharmaceutical products, including immunosuppressant drugs, were not available in Iwaki city for a few weeks. Although water and immunosuppressants are mandatory for renal transplant recipients, the impact of these shortages and the stress of the severe situation on renal graft function is unknown. Therefore, to reveal the impact of the Great Eastern Japan Earthquake on transplant renal function of our renal transplant recipients, we investigated the data, including the results of a questionnaire, after the disaster. ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 613e615 (2014)
PATIENTS AND METHODS In the Tokiwa-kai group, which is a urologic and dialysis institution complex located in Iwaki city, Fukushima, Japan, renal transplantation has been performed since 1997. We have followed 30 patients who underwent renal transplantation before the Great Eastern Japan Earthquake. There were 19 males and 11 females with a mean age of 46.9 12.6 years (range, 27e63). Of these patients, 13 were treated with cyclosporine-based immunosuppression and 17 were treated with tacrolimus-based immunosuppression. Twenty-eight were grafted from living donors and 2 were grafted from deceased donors. The mean period after transplantation was 121.9 57.5 months (range, 36e241). Their living conditions after the earthquake were investigated using a questionnaire about evacuation place, drinking, diet, and oral administration of immunosuppressants.
From the Jyoban Hospital (H.S., H.K., M.T.), Tokiwa-kai Group, Iwaki, Fukushima, and the Department of Urology (K.T.), Tokyo Women’s Medical University, Tokyo, Japan. Address reprint requests to Hiroaki Shimmura, Jyoban Hospital, Tokiwa-kai Group, 57 Uenodai, Jyoban-kamiyunagayamachi, 9728322 Iwaki, Fukushima, Japan. E-mail: [email protected] 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.11.044 613
614
SHIMMURA, KAWAGUCHI, TOKIWA ET AL
Fig 1. Aerial measurements of Cs-134 and Cs-137 between April 6 and April 29 by Joint US-Japan AMS Data (from the US Department of Energy Web site, http://energy.gov/situation-japan-updated-12513).
RESULTS
All recipients were not injured by the earthquake or the tsunami on March 11, 2011. Of the 30 recipients, 1 lost his renal graft at 12 months after the earthquake, and 1 has deterioration of graft function with a serum creatinine level of 5.5 mg/dL (Fig 2). Their creatinine levels before
the earthquake were 2.79 mg/dL and 3.78 mg/dL, respectively. The other recipients have good graft function with a mean creatinine level of 1.52 0.60 mg/dL. All recipients did not experience any rejection episode after the earthquake. Evacuation Place
Of the 30 recipients, 20 (67%) stayed at Iwaki-city and 10 (33%) evacuated outside Iwaki-city. Three of those ten (10%) evacuated inside Fukushima prefecture and 7 (23%) evacuated outside Fukushima prefecture. The average duration of evacuation was 28.1 34.6 days (range, 4e106). Drinking Water
Fig 2. Changes in creatinine level after the earthquake disaster.
Twenty-six of the thirty recipients (87%) could drink water of normal quantity. The 4 remaining patients (13%) had access to less water than before the earthquake for a mean duration of 4.3 days after the earthquake. One patient drank only from a mountain stream for 4 days.
GREAT EASTERN JAPAN EARTHQUAKE
Diet
Sixteen of the thirty recipients (53%) could eat normal meals after the disaster. For a mean duration of 16.2 days after the earthquake, the 16 remaining patients (47%) could eat only preserved meals. One patient could not eat any meal from March 11 to the daytime of March 12. Oral Administration of Immunosuppressants
All patients took immunosuppressants at their usual dosages after the earthquake because they had enough immunosuppressants, fortunately. DISCUSSION
In the Tokiwa-kai group, 30 renal transplant recipients were followed before the earthquake disaster. One of those recipients lost his renal graft, and the transplant renal function of 1 patient turned worse after the earthquake. The transplant renal function of these 2 patients was not good before the disaster. The remaining patients who had good transplant renal function before the earthquake disaster maintain good transplant renal function after the earthquake disaster. The 2 recipients who developed worse transplant renal function stayed in Iwaki-city after the earthquake disaster. The impacts of stress due to remaining in the disasterstricken area and the shortage of water and food on the transplant renal function were uncertain. However, several investigators reported that the influence of stress of the disaster on health, even in physically unimpaired people,
615
was found [3,4]. Therefore, it may not be denied that the influence of the earthquake disaster might be related to the deterioration of the transplant renal function of these 2 recipients. All of the transplant kidney recipients could take their immunosuppressive medication every day after the disaster. Because immunosuppressive drugs could not be obtained for a few weeks after the nuclear plant accident in Iwaki city, it is important to always keep enough immunosuppressive drugs for transplant recipients in case of disaster. The Great Eastern Japan Earthquake could exacerbate renal graft function, especially in recipients with lower graft function. In patients with worse transplant renal function, more careful transplant management is necessary for protection of the transplant renal function under such a severe environment. REFERENCES [1] Shibahara S. The 2011 Tohoku earthquake and devastating tsunami. Tohoku J Exp Med 2011;223(4):305e7. [2] Hirose K. 2011 Fukushima Dai-ichi nuclear power plant accident: summary of regional radioactive deposition monitoring results. J Environ Radioact 2012. [3] Tsubokura M, Takita M, Matsumura T, et al. Changes in metabolic profiles after the Great East Japan Earthquake: a retrospective observational study. BMC Public Health 2013;13:267. [4] Ohkouchi S, Shibuya R, Yanai MK, et al. Deterioration in regional health status after the acute phase of a great disaster: respiratory physicians’ experiences of the Great East Japan Earthquake. Respir Investig 2013.