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ABSTRACT: Bile leakage is still a common cause of major morbidity after hepatectomy for hepatocellular carcinoma (HCC). The purpose of this study was to identify characteristics and risk factors for intractable bile leakage after hepatectomy for HCC.
Risk factors for bile leakage were analyzed in 359 patients who underwent hepatectomy for HCC between 2001 and 2010. The causes, management and outcomes of intractable bile leakage which needed endoscopic therapy or percutaneous transhepatic biliary drainage were investigated.
A total of 296 patients (82.5%) underwent an anatomic hepatectomy, and a repeat hepatectomy was carried out in 59 patients (16.4%). The prevalence of bile leakage was 12.8%, and 8 patients had intractable bile leakage. An operative time ≥ 300 min was an independent risk factor for bile leakage after hepatectomy for HCC. The main causes of intractable bile leakage were a latent stricture of the biliary anatomy caused by previous treatments for HCC and intraoperative injury of the hepatic duct related to repeat hepatectomy.
To help prevent intractable bile leakage, a preoperative assessment of the biliary anatomy and surgical procedures to decrease the incidence of major bile leakage should be considered for selected patients with a high risk for intractable bile leakage.
Digestive surgery 05/2012; 29(2):149-56. · 1.37 Impact Factor
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ABSTRACT: We report 4 cases of surgical resection of metachronous lymph node (LN) metastases from hepatocellular carcinoma (HCC) following hepatectomy. Clinicopathological features and results of LN dissection were investigated in the 4 patients. One patient was found to have a single metastasis in the mediastinal LNs, another had multiple metastases in the mediastinal and abdominal LNs, and the other 2 had single metastases in the abdominal LN. The locations of the abdominal LN metastases were behind the pancreas head in 2 patients and around the abdominal aorta in 1 patient. They all underwent surgical resection of metastatic LNs and had no postoperative complications. The 3 patients whose LN metastases were solitary have been alive for more than 2 years after LN resection, and one of them is free from recurrence. The patient with multiple LN metastases died 13 months after LN resection due to carcinomatosis. With the expectation of long-term survival, a single metachronous LN metastasis from HCC after hepatectomy should be resected in patients without uncontrollable intrahepatic or extrahepatic tumors.
Acta medica Okayama 04/2012; 66(2):177-82. · 0.84 Impact Factor
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Ryuichi Yoshida,
Takahito Yagi,
Hiroshi Sadamori, Hiroaki Matsuda,
Susumu Shinoura,
Yuzo Umeda,
Daisuke Sato,
Masashi Utsumi,
Takeshi Nagasaka,
Nami Okazaki,
Ai Date,
Ayako Noguchi,
Akemi Tanaka,
Yuko Hasegawa,
Yachiyo Sakamoto,
Toshiyoshi Fujiwara
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ABSTRACT: Malnutrition and metabolic disorder of patients undergoing living donor liver transplantation (LDLT) can affect post-transplant prognosis. The aim of this study was to establish whether perioperative usage of branched-chain amino-acid (BCAA)-enriched nutrients improve metabolic abnormalities of patients undergoing LDLT.
We designed a randomized pilot study (UMIN registration number; 000004323). Twenty-five consecutive adult elective LDLT recipients were enroled and divided into two groups: the BCAA group (BCAA-enriched nutrients, n = 12) and the control group (standard diet, n = 13). Metabolic and nutritional parameters, including BCAA-to-tyrosine ratio (BTR), retinol binding protein (RBP), and prealbumin were regularly measured from 1 week before to 4 weeks after LDLT. Non-protein respiratory quotient (npRQ) was measured before and 4 weeks after LDLT.
BTR and RBP improved considerably in the BCAA group compared with the controls. npRQ significantly increased from 1 week before LDLT to 4 weeks after LDLT in the BCAA group (0.77 ± 0.05 to 0.84 ± 0.06, P = 0.002), but not in the control group (0.78 ± 0.04 to 0.81 ± 0.05).
Supplementation with BCAA-enriched nutrients might improve persistent nutritional and metabolic disorders associated with end-stage liver disease in the early post-transplant period, and consequently shorten the post-transplant catabolic phase after LDLT. A larger multicenter trial is needed to confirm these findings.
Journal of hepato-biliary-pancreatic sciences. 09/2011; 19(4):438-48.
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ABSTRACT: Background/Aims: An omental flap covering the splanchnic vessels might reduce postoperative intraabdominal hemorrhage after pancreaticoduodenectomy. However, the efficiency of such a procedure remains to be verified. The purpose of this study was to determine the effect of omental flap placement in pancreaticoduodenectomy on the incidence of postoperative pseudoaneurysms. Methodology: Of 229 consecutive patients who underwent pancreaticoduodenectomy, the most recent 157 patients received the omental flap, while the initial 72 patients had no omental flap placement. Various preoperative factors were considered in the evaluation (age, gender, body mass index, primary disease and concurrent disease), as well as operative factors (operation time, blood loss, operative procedures, pancreatic texture, size of pancreatic duct and surgeon's experience). Results: Eighty-one patients (35.4%) developed pancreatic fistula. Nine patients (3.9%) developed postoperative pseudoaneurysm. Among the patients with pancreatic fistula, those without omental flap developed pseudoaneurysms more frequently (21.7%) than those with omental flap placement (5.2%). Multivariate analysis identified pancreatic fistula, no use of omental flap and hypertension, in that order, as predisposing factors for a pseudoaneurysm. The omental flap significantly prevented pseudoaneurysms (p=0.021; OR=0.151; 95% CI, 0.030-0.751). Conclusions: Omental flap placement over splanchnic vessels could be a feasible and efficient surgical procedure to prevent postoperative pseudoaneurysms following pancreaticoduodenectomy.
Hepato-gastroenterology 08/2011; 59(114):578-83. · 0.66 Impact Factor
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ABSTRACT: Leukoencephalopathy syndrome is a neurologic complication after organ transplantation caused predominantly by the neurotoxic effects of immunosuppressive agents on cerebral white matter. We determined the incidence and features of leukoencephalopathy syndrome in recipients after living-donor liver transplantations.
We retrospectively investigated 205 patients who had a living-donor liver transplantation performed at our institution between August 1998 and October 2008.
Leukoencephalopathy syndrome developed in 7 of 205 patients (3.9%) and in 4.7% of the 150 patients treated with tacrolimus-based immunosuppression after their living-donor liver transplantation. The underlying diseases were alcoholic cirrhosis in 3 cases, viral cirrhosis in 2, biliary atresia in 1, and Wilson disease in 1. Time to clinical onset after tacrolimus medication was 15.6 days (range, 6-30 days). The neurologic symptoms included headache, confusion, myoclonus, seizures, and visual disturbances. The mean serum trough level of tacrolimus at clinical onset was not very high (11.7 ng/mL [range, 6.0-14.2 ng/mL]). T2-weighted magnetic resonance imaging in all cases showed diffuse high signal in the white matter of the frontal, parieto-occipital, and temporal lobes. Treatment with antihypertensives, anticonvulsants, and withdrawal of tacrolimus resulted in amelioration of symptoms and magnetic resonance imaging abnormalities. Six patients showed complete recovery, while the seventh had residual rigidity and cognitive impairment caused by hypoxia during a convulsion.
Tacrolimus neurotoxicity can occur despite low trough levels; it depends on variations in pharmacokinetics, such as absorption and maximum concentration level. Early diagnosis and treatment of leukoencephalopathy syndrome should contribute to complete remission.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 04/2011; 9(2):139-44.
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Tetsuya Yasunaka,
Akinobu Takaki,
Takahito Yagi,
Yoshiaki Iwasaki,
Hiroshi Sadamori,
Kazuko Koike,
Satoshi Hirohata,
Masashi Tatsukawa,
Daisuke Kawai,
Hidenori Shiraha,
Yasuhiro Miyake,
Fusao Ikeda,
Haruhiko Kobashi, Hiroaki Matsuda,
Susumu Shinoura,
Ryuichi Yoshida,
Daisuke Satoh,
Masashi Utsumi,
Teppei Onishi,
Kazuhide Yamamoto
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ABSTRACT: PURPOSE: The combination of hepatitis B immunoglobulin (HBIg) and nucleos(t)ide analogues has been accepted as the best treatment to control hepatitis B recurrence after orthotopic liver transplantation (OLT). However, the optimal dose of HBIg remains unclear. We have previously reported that high-dose HBIg in the early period followed by low-dose HBIg with nucleos(t)ide analogues offers reliable and cost-effective control of hepatitis B recurrence. The aim of this study was to investigate intrahepatic hepatitis B virus (HBV) reinfection status with our clinically successful protocol. METHODS: We quantified levels of intrahepatic HBV covalently closed circular (ccc) deoxyribonucleic acid (DNA) and serum hepatitis B core-related antigen (HBcrAg), a new serological marker that can estimate intrahepatic cccDNA levels. Nucleos(t)ide analogues were administered in all cases. RESULTS: No patients showed recurrence of hepatitis B surface antigen (HBsAg) or HBV-DNA. However, HBV, cccDNA, and HBcrAg were positive in 57% and 48% of patients after OLT, respectively. Pre-OLT serum HBV-DNA and HBcrAg levels correlated linearly with post-OLT cccDNA levels (r = 0.534, P < 0.05, and r = 0.634, P < 0.05, respectively). High serum HBV-DNA and HBcrAg levels, particularly with >3 log(10) copies/mL and >4 log(10) IU/mL, respectively, at the time of OLT, were associated with high levels of post-OLT cccDNA. Even with our successful protocol, nearly half of patients showed HBV reinfection. CONCLUSIONS: Patients with high serum HBV-DNA and HBcrAg levels before OLT (particularly >3 log(10) copies/mL and >4 log(10) IU/mL, respectively) should be followed with care for HBV recurrence.
Hepatology International 03/2011; · 2.64 Impact Factor
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ABSTRACT: Pituitary apoplexy occurring after surgery is a rare but life-threatening acute clinical condition that follows extensive hemorrhagenous necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority of cases or in association with various inducing factors. Reported is a case of pituitary apoplexy complicated by diabetes insipidus following living donor liver transplantation (LDLT). To the best of our knowledge, this has not been previously reported. A 56-year-old woman with nonalcoholic steatohepatitis underwent LDLT from her daughter. The patient also required dopamine support and transfusions because of massive intraoperative bleeding. Postoperatively, her coagulopathy continued, and she underwent a second laparotomy because of unknown bleeding on postoperative day 7, when she needed transfusions and dopamine support to maintain her vital signs. She complained of severe headache, excessive thirst, frequent urination, and diplopia from postoperative day 10. She also had polyuria greater than 300 ml/h and was diagnosed with pituitary apoplexy precipitating diabetes insipidus on postoperative day 13. She was treated conservatively without surgery because of the hormonally inactive status and slight mass effect of her tumor. It is important for anesthesiologists and critical care personnel in LDLT settings to take into consideration this complication as a differential diagnosis.
Journal of Anesthesia 02/2011; 25(1):108-11. · 0.83 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the prognostic factors for intrahepatic recurrence of hepatocellular carcinoma (HCC) after curative resection.
Of 297 patients with HCC who underwent curative resection between 1998 and 2007, 145 had intrahepatic recurrence, and 125 of these were enrolled in this study. We analyzed the relationships between overall survival after HCC recurrence and 20 variables at initial hepatectomy and recurrence.
Recurrent HCC was treated by repeat hepatectomy (Re-Hr, n = 29), radiofrequency ablation (RFA, n = 58), or transarterial chemoembolization (TAE, n = 38). Complete tumor control (CTC) by Re-He and RFA was selected for 70% of patients. RFA-treated patients had more tumors, smaller tumors, and poorer liver function at recurrence than the Re-Hr group. The overall 1-, 3-, and 5-year post-recurrence survival rates (SR) were 93.1, 66.8, 58.1%; 94.7, 75.1, 48.3%; and 80.1, 22.5, 0%, respectively, in the Re-Hr, RFA, and TAE groups. The SR was better for Re-Hr and RFA than for TAE (p < 0.0001). Outcomes were similar in Re-Hr and RFA, regardless of recurrent tumor size. Multivariate analysis identified Child-Pugh grade B, AFP ≥100 ng/ml at recurrence, recurrent tumor size ≥3 cm, tumor number ≥3, and CTC as significant prognostic factors for overall post-recurrence survival. A scoring system using 1 point for each patient-background factor provided a well-categorized predictive model. The overall 3-/5-year post-recurrence SRs were 83.1/59.3%, 64.1/41.9%, 42.0/18.0%, and 13.6/0% at risk number (R) R0, R1, R2, and R3/4, respectively (p < 0.05).
Significant prognostic factors for intrahepatic recurrent HCC are poor hepatic reserve, AFP, recurrent tumor size and number, and CTC. Selection of treatment modality for intrahepatic recurrence requires the clinician to be mindful of the predictive factors and to control tumors aggressively by adequate treatment, selected by balancing various conditions.
World Journal of Surgery 10/2010; 35(1):170-7. · 2.36 Impact Factor
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ABSTRACT: We present the cases of two patients with hepatocellular carcinoma (HCC) beyond the Milan criteria (MC) who underwent living-donor liver transplantation (LDLT) combined with aggressive hepatic venacaval resection and replacement of the hepatic inferior vena cava (IVC) by an artificial vascular graft. The aim of the resection and replacement of the hepatic IVC was to resect completely a latent cancer adjacent to the hepatic IVC and to avoid micrometastasis via the hepatic veins during increased manipulation of the native liver with HCC.
First, the hepatic hilus was dissected and the infrahepatic IVC was encircled. After minimum mobilization of the liver, the common orifice of the middle and left hepatic veins and suprahepatic IVC was encircled. Venovenous bypass (VVB) was started to stabilize systemic hemodynamics. After cross-clamping of the infrahepatic and suprahepatic IVC, the IVC was divided at the site just below the confluence of the common orifice of the middle and left hepatic veins and its infrahepatic site. Then, all retroperitoneal attachments of the right lobe were dissected and the native liver was resected with the retrohepatic IVC. The IVC was replaced by a ringed expanded polytetrafluoroethylene (e-PTFE) graft. Infrahepatic venous recirculation ended the VVB. An extended left-lobe graft was implanted. The e-PTFE grafts were covered with the greater omentum to avoid infection.
The operations were completed safely. The postoperative courses were free of complications related to the reconstruction of the hepatic IVC. One patient developed recurrence in the left adrenal gland.
LDLT combined with hepatic venacaval resection and replacement by an e-PTFE graft for HCC beyond the MC could be safe and feasible under VVB. Further studies are needed to confirm to what extent this procedure could prevent post-transplant recurrence in HCC beyond the MC.
Journal of hepato-biliary-pancreatic sciences. 09/2010; 17(5):719-24.
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Hideo Kohka Takahashi,
Jiyong Zhang,
Shuji Mori,
Keyue Liu,
Hidenori Wake,
Rui Liu,
Hiroshi Sadamori, Hiroaki Matsuda,
Takahito Yagi,
Tadashi Yoshino,
Masahiro Nishibori
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ABSTRACT: Posttransplant diabetes mellitus is a frequent complication among transplant recipients. Ligation of advanced glycation end products (AGEs) with their receptor on monocytes/macrophages plays a role in diabetes complications. The enhancement of adhesion molecule expression on monocytes/macrophages activates T cells, reducing allograft survival. In previous work, we found that toxic AGEs, AGE-2 and AGE-3, induced the expression of intracellular adhesion molecule-1, B7.1, B7.2, and CD40 on monocytes, production of interferon-gamma and tumor necrosis factor alpha, and lymphocyte proliferation during human mixed lymphocyte reaction. AGE-induced up-regulation of adhesion molecule expression was involved in cytokine production and lymphocyte proliferation. Prostaglandin E2 (PGE2) concentration-dependently inhibited the actions of AGE-2 and AGE-3. The effects of PGE2 were mimicked by an EP2 receptor agonist, ONO-AE1-259-01 (11,15-O-dimethyl PGE2), and an EP4 receptor agonist, ONO-AE1-329 [16-(3-methoxymethyl)phenyl-omega-tetranor-3,7dithia PGE1]. An EP2 receptor antagonist, AH6809 (6-isopropoxy-9-oxaxanthene-2-carboxylic acid), and an EP4 receptor antagonist, AH23848 [(4Z)-7-[(rel-1S,2S,5R)-5-((1,1'-biphenyl-4-yl)methoxy)-2-(4-morpholinyl)-3-oxocyclopentyl]-4-heptenoic acid], inhibited the actions of PGE2. The stimulation of EP2 and EP4 receptors is reported to increase cAMP levels. The effects of PGE2 were reversed by protein kinase A (PKA) inhibitors and mimicked by dibutyryl cAMP and an adenylate cyclase activator, forskolin. These results as a whole indicate that PGE2 inhibited the actions of AGE-2 and AGE-3 via EP2/EP4 receptors and the cAMP/PKA pathway.
Journal of Pharmacology and Experimental Therapeutics 09/2010; 334(3):964-72. · 3.83 Impact Factor
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ABSTRACT: The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC).
Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008.
Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time >or= 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies.
Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
Journal of hepato-biliary-pancreatic sciences. 09/2010; 17(5):709-18.
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Katsuhisa Ohashi,
Hideo Kohka Takahashi,
Shuji Mori,
Keyue Liu,
Hidenori Wake,
Hiroshi Sadamori, Hiroaki Matsuda,
Takahito Yagi,
Tadashi Yoshino,
Masahiro Nishibori,
Noriaki Tanaka
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ABSTRACT: Posttransplant diabetes mellitus (PTDM) is a frequent complication among transplant recipients. Ligation of advanced glycation end products (AGEs) with their receptor (RAGE) on monocytes/macrophages plays roles in the diabetes complications. The enhancement of adhesion molecule expression on monocytes/macrophages activates T-cells, leading to reduced allograft survival. We investigated the effect of four distinct AGE subtypes (AGE-2/AGE-3/AGE-4/AGE-5) on the expressions of intracellular adhesion molecule (ICAM)-1, B7.1, B7.2 and CD40 on monocytes, the production of interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha and the proliferation of T-cells during human mixed lymphocyte reaction (MLR). AGE-2 and AGE-3 selectively induced the adhesion molecule expression, cytokine production and T-cell proliferation. The AGE-induced up-regulation of adhesion molecule expression was involved in the cytokine production and T-cell proliferation. AGE-2 and AGE-3 up-regulated the expression of RAGE on monocytes; therefore, the AGEs may activate monocytes, leading to the up-regulation of adhesion molecule expression, cytokine production and T-cell proliferation.
Clinical Immunology 11/2009; 134(3):345-53. · 4.05 Impact Factor
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ABSTRACT: We evaluated the expression of hepatitis C virus (HCV) antigen on liver grafts by immunohistochemical staining (IHS) using IG222 monoclonal antibody (mAb) against HCV-envelope 2 (E2).
The study material was 84 liver biopsy specimens obtained from 28 patients who underwent living donor liver transplantation (LDLT) for HCV infection. The biopsy samples were examined histopathologically, and by IHS using IG222 mAb against HCV-E2. Serum HCV-RNA level was measured in all patients. The IHS grades were compared among the three groups classified according to the time elapsed from LDLT (at 1-30, 31-179 and > or =180 days post-LDLT) and among four post-transplant conditions, including acute cellular rejection (ACR).
Immunoreactivity to IG222 was detected in 78.6% of the specimens obtained during the first month after LDLT, and there were no significant differences on the IHS grades between the three groups classified according to the time elapsed from LDLT. The IHS grades were significantly stronger in definite recurrent HCV (n = 12) and probable recurrent HCV (n = 7) than in definite ACR (n = 7) and other complications (n = 8). There were no significant differences in serum HCV-RNA levels among the four post-transplant conditions. There was no significant correlation between the IHS grades using IG222 mAb and serum HCV-RNA levels when data of 84 liver biopsy specimens were analyzed.
Constant HCV-E2 expression was observed in liver biopsy specimens obtained 1 month or longer. The strong HCV-E2 expression on liver grafts were associated with recurrent hepatitis C after LDLT, but the serum HCV-RNA levels were not.
Journal of Gastroenterology and Hepatology 04/2009; 24(4):574-80. · 2.87 Impact Factor
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ABSTRACT: Sevelamer hydrochloride is a phosphate binder and its effectiveness to reduce the cardiovascular mortality of dialysis patients has been tested. Sevelamer hydrochloride also contains chlorine, so a decrease in bicarbonate due to chlorine load was anticipated and metabolic acidosis thought to associate with sevelamer hydrochloride has been reported in some papers. We reported that sevelamer hydrochloride exacerbated metabolic acidosis in hemodialysis patients, depending on the dosage. Also a Japanese nationwide survey suggested that sevelamer hydrochloride usage potentially aggravates acidosis in dialysis patients. A multi-institute research study by Edmung et al. has shown that metabolic acidosis, with serum CO2 below 17.5 mmol/L, is by itself associated with increased risk of death in dialysis patients. Furthermore, the Dialysis Outcomes and Practice Patterns Study (DOPPS) revealed that both high (> 27 mmol/L) and low (< or = 17 mmol/L) serum bicarbonate (total CO2) levels were associated with increased risk for mortality and hospitalization. There has not been any significant evidence to show that sevelamer hydrochloride has reduced the cardiovascular mortality of dialysis patients compared with calcium-based binder. Clinicians should check not only the level of chlorine but also the level of total CO2 or bicarbonate during the treatment with sevelamer hydrochloride, and control metabolic acidosis.
Cardiovascular & hematological disorders drug targets. 12/2008; 8(4):283-6.
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ABSTRACT: Sevelamer hydrochloride is a phosphate binder and its effectiveness to reduce the cardiovascular mortality of dialysis patients has been tested. Sevelamer hydrochloride also contains chlorine, so a decrease in bicarbonate due to chlorine load was anticipated and metabolic acidosis thought to associate with sevelamer hydrochloride has been reported in some papers. We reported that sevelamer hydrochloride exacerbated metabolic acidosis in hemodialysis patients, depending on the dosage. Also a Japanese nationwide survey suggested that sevelamer hydrochloride usage potentially aggravates acidosis in dialysis patients. A multi-institute research study by Edmung et al. has shown that metabolic acidosis, with serum CO2 below 17.5 mmol/L, is by itself associated with increased risk of death in dialysis patients. Furthermore, the Dialysis Outcomes and Practice Patterns Study (DOPPS) revealed that both high (> 27 mmol/L) and low (< or % 17 mmol/L) serum bicarbonate (total CO2) levels were associated with increased risk for mortality and hospitalization. There has not been any significant evidence to show that sevelamer hydrochloride has reduced the cardiovascular mortality of dialysis patients compared with calcium-based binder. Clinicians should check not only the level of chlorine but also the level of total CO2 or bicarbonate during the treatment with sevelamer hydrochloride, and control metabolic acidosis.
Cardiovascular & Haematological Disorders - Drug Targets(Formerly Current Drug Targets - Cardiovascular & Hematological Disorders) 11/2008; 8(4):283-286.
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Yuzo Umeda,
Takahito Yagi,
Hiroshi Sadamori,
Hiroyoshi Matsukawa, Hiroaki Matsuda,
Susumu Shinoura,
Kenji Mizuno,
Ryuichi Yoshida,
Takayuki Iwamoto,
Daisuke Satoh,
Noriaki Tanaka
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ABSTRACT: The small-for-size (SFS) syndrome is caused by excessive portal inflow into a small-sized liver graft. Various approaches for portal decompression have been used, but details of their impact on liver regeneration in SFS graft remain unclear. We examined the effect of prophylactic splenic artery modulation (SAM).
We conducted a retrospective cohort study. The study group was 39 consecutive adult-to-adult living liver transplantation recipients, with a graft-to-recipient body weight ratio of less than 0.8. Patients were assigned into the non-SAM group (n=18, without any portal inflow attenuation) or SAM group (n=21, preoperative embolization in 15 patients and intraoperative ligation in 6 patients). Hepatic hemodynamics, graft function, liver regeneration, and outcome were evaluated.
In the SAM group, the excessive portal flow was significantly reduced (P<0.01) and the effect of embolization on portal decompression was equivalent to that of ligation. In the acute postoperative phase, serum transaminases, interleukin-6, and tumor necrosis factor-alpha, were lower in the SAM group than in non-SAM group. In both groups, a negative correlation was observed between graft-to-recipient body weight ratio and liver regeneration rate at 2 weeks after living donor liver transplantation. Splenic artery modulation was advantageous for liver regeneration, and significantly improved clinical features, hyperbilirubinemia, and prolonged ascites. Small-for-size syndrome occurred in five patients of the non-SAM group, and only one of SAM group (P=0.038).
In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.
Transplantation 10/2008; 86(5):673-80. · 4.00 Impact Factor
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Ryuichi Yoshida,
Takayuki Iwamoto,
Takahito Yagi,
Daisuke Sato,
Yuzo Umeda,
Kenji Mizuno,
Susumu Shinoura,
Hiroyoshi Matsukawa, Hiroaki Matsuda,
Hiroshi Sadamori,
Noriaki Tanaka
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ABSTRACT: The purpose of this study was to analyze various risk factors and to assess the preoperative risk score, which can predict the prognosis after living donor liver transplantation (LDLT).
From February 2002 to August 2007, 84 adult to adult living donor liver transplantation donors and recipients were analyzed. First, the donor, recipient, and intraoperative factors were examined by univariate and multivariate analyses. We then gave a score of one point for each significant marginal factor (total point scores were called "risk score") and each risk score was examined by univariate analyses.
Recipients with the donor age 50 years or older, Model for End-Stage Liver Disease (MELD) score (> or =21), and hepatitis C virus-positive status had a significantly poor survival. Recipients between the risk score of 0 vs. scores of 2 + 3 (p < 0.001, log-rank) and risk score of 1 vs. scores of 2 + 3 (p = 0.003, log-rank) had significantly different survival.
Preoperative assessment of the risk score might help to predict recipient outcomes after living donor liver transplantation.
World Journal of Surgery 10/2008; 32(11):2419-24. · 2.36 Impact Factor
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Takayuki Iwamoto,
Takahito Yagi,
Yuzo Umeda,
Daisuke Sato,
Hiroyoshi Matsukawa, Hiroaki Matsuda,
Susumu Shinoura,
Hiroshi Sadamori,
Kenji Mizuno,
Ryuichi Yoshida,
Noriaki Tanaka
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ABSTRACT: The negative effects of increased donor age on liver transplantation became evident in deceased donor liver transplantation. In living donor liver transplantation (LDLT), the details remain unclear.
Initially, 137 adult LDLT recipients from August 1996 to May 2005 were divided into two groups (donors <50 years of age: n=99, donors >or= 50 years of age: n=38) for the retrospective study. Then, 24 recipients who received LDLT from June 2005 to July 2006 were divided into two groups: group 1 (donors <50 years of age, n=14) and group 2 (donors >or= 50 years of age, n=10) and enrolled in the prospective study to analyze their clinical course and prognostic factors in the aged graft.
In the retrospective study, the younger donor group had significantly better survival than that of the aged donor group (P=0.015, Log rank test). In the prospective study, the postoperative graft functions showed that the serum total bilirubin levels were significantly lower in group 1 (P<0.02, by ANOVA analysis). The phosphorylated-Signal Transducer and Activator of Transcription3 expression at 4 hr after reperfusion (RT2) in group 2 was significantly lower than that in group 1. At RT2, the expressions were up-regulated in group 1, but were down-regulated in group 2. The serum 8-hydroxydeoxyguanosine value became significantly higher in group 1 two weeks after LDLT.
In the near term, Signal Transducer and Activator of Transcription3 gene induction during cold preservation may be of great use in improving the outcome of aged grafts in LDLT.
Transplantation 06/2008; 85(9):1240-5. · 4.00 Impact Factor
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ABSTRACT: We investigated the outcome of living donor liver transplantation (LDLT) with prior spontaneous large portasystemic shunts. Thirty-three patients of 155 patients (21.2%) undergoing LDLT had spontaneous large portasystemic shunts. Portal venous hemodynamics, surgical procedures for shunts, and morbidity and mortality rates were investigated in three types of shunts: splenorenal shunt (SRS group; n = 11), shunt derived from coronary vein (CVS group; n = 6) and umbilical vein shunt (UVS group; n = 15). The two groups of patients (SRS/CVS) received prophylactic surgical repair of shunts during LDLT except for one patient in the SRS group. The flow direction of main portal vein and grade of steal of superior mesenteric vein flow by shunt were significantly different among three groups. No significant differences were observed among three groups in operative parameters, hospitalization and morbidity except for postoperative portal complication. There was no significant difference in the actuarial survival rate among three groups of SRS, CVS and UVS (81.8% vs. 83.3% vs. 86.6% at 1 year respectively). In the SRS group, two patients had postoperative steal of graft portal venous flow by residual SRS that needed further treatment. The outcome of LDLT with prior spontaneous large portasystemic shunts is satisfactory, despite the complexity of the transplant procedures.
Transplant International 03/2008; 21(2):156-62. · 2.92 Impact Factor
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Akinobu Takaki,
Hideyuki Suzuki,
Yoshiaki Iwasaki,
Tomoko Takigawa,
Keiki Ogino, Hiroaki Matsuda,
Takahito Yagi,
Motohiko Hanazaki,
Hideki Nakatsuka,
Hiroshi Katayama,
Masaki Matsumi,
Bon Shoji,
Ryo Terada,
Haruhiko Kobashi,
Kohsaku Sakaguchi
Journal of Gastroenterology 02/2008; 43(3):239-42. · 4.16 Impact Factor
