Y Ogura

Nagoya University, Nagoya, Aichi, Japan

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Publications (251)677.6 Total impact

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    ABSTRACT: Purpose Tissue plasminogen activator (tPA) is a fibrinolytic compound, utilized originally to treat embolic or thrombotic stroke and as an adjuvant for displacement of submacular hemorrhage. The purpose of this study is to investigate anti-angiogenic effects of tPA on experimental laser-induced choroidal neovascularization (CNV) in mice.Methods CNV was induced by laser injury in C57BL/6J mice, and intravitreal injection of tPA (4 or 40 IU/µl) or PBS was performed immediately after laser injury. Fluorescein angiography was performed 7 days after laser treatment to grade fluorescein leakage. And CNV volumes were measured by confocal evaluation of Isolectin B4 staining of RPE-choroid flatmounts. The expression of fibrin on day 3 was observed by immunostaining.Results Fluorescein leakage was inhibited by tPA in a dose-dependent manner, and a significant difference was found with tPA (40 IU/ µl) compared with PBS (p=0.02). A dose-dependent suppression of CNV volume was also observed by tPA, and there was a significant differences between tPA (40 IU/µl) (208988  52456 µm3) and PBS (386902  103060 µm3, p<0.01). The expression of fibrin was reduced in eyes treated with tPA.Conclusion Intravitreal injection of tPA reduced the expression of fibrin and significantly suppressed laser-induced CNV in mice. These findings suggested that tPA might be anti-angiogenic and have a potential as an adjuvant to anti-vascular endothelial growth factor therapy.
    Acta ophthalmologica 09/2014; 92(s253). · 2.44 Impact Factor
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    ABSTRACT: Hepatic arterial reconstruction during living donor liver transplantation (LDLT) is a very delicate and technically complicated procedure. Post-LDLT hepatic arterial complications are associated with significant morbidity and mortality.
    Clinical Transplantation 06/2014; · 1.63 Impact Factor
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    ABSTRACT: (Background and Aims) The combination of nucleos(t)ide analogue (NA) and anti-hepatitis B immunoglobulin (HBIg) is established as safe and effective prophylaxis against hepatitis B virus (HBV) reactivation after liver transplantation. However, essential weak point of this regimen is high cost. The hepatitis B (HB) vaccine is one of the attractive alternatives that costs lower, and enables some patients to have a sufficiently high titer of anti-hepatitis B surface antibodies (HBsAb). Almost no data exist on whether NA can be stopped safely in such successfully vaccinated patients. We investigated the incidence of HB vaccine escape mutants in liver recipients who could get sufficient HBsAb titer after liver transplantation and stopped NA.(Patients and Methods) Among 18 HBV carriers and 7 non-HBV patients received grafts from anti-hepatitis core antibody (HBcAb) positive donors, 2 HBV carriers and 6 non-HBV patients who could get HBsAb titers >100 IU/l for >3 months after posttransplant vaccination were weaned from NA. In the patients who showed viremia, we analyzed amino acid sequences of the HB envelope protein and performed statistical analysis for the factors associated with viremia.(Results) Among 8 patients who could get sufficient HBsAb after vaccination and stopped NA, HBV-DNA appeared in 4 patients after a median of 12 months. Sequence analysis showed various amino acid mutations in the HB envelope region, including the a-determinant. Frequent vaccination was shown as a statistically significant risk factor for inducing viremia.(Conclusions) Although HB vaccine is an effective substitute for prophylaxis against HBV reactivation in some patients after liver transplantation, frequent vaccination could be a risk factor for producing escape mutants. Our data demonstrated not only that caution must be exercised in stopping NA in effectively vaccinated patients, especially in whom were administered frequently, but also the importance for setting stopping rule of vaccination in transplanted patients. Liver Transpl , 2014. © 2014 AASLD.
    Liver Transplantation 06/2014; · 3.94 Impact Factor
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    ABSTRACT: The goal of this study was to examine whether the lower limit of the graft-to-recipient weight ratio (GRWR) can be safely reduced to make better use of the left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control. Beginning December 2007, the acceptable limit for GRWR was lowered to ≥0.7% and by April 2009, it was further lowered to ≥0.6%. A portal pressure control program targeting a final portal pressure <15 mm Hg was also introduced. The donor complication rate decreased from 13.8% to 9.3%. The overall survival of recipients with GRWR <0.8% did not differ from recipients with a GRWR ≥0.8%. In conclusion, the lower limit of the GRWR can be safely reduced to 0.6% using a left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control.
    Transplantation 04/2014; 97 Suppl 8:S30-2. · 3.78 Impact Factor
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    ABSTRACT: Living donor liver transplantation (LDLT) using a right liver graft with additional vein reconstructions has not been previously reported in a situs inversus (SI) patient. A 60-year-old man with SI was referred for LDLT for end-stage cirrhosis secondary to hepatitis B. The calculated regional volumes of the individual hepatic vein territories in the right liver graft suggested that the middle hepatic vein (MHV) tributaries and the inferior right hepatic veins (IRHVs) should be reconstructed in addition to the right hepatic vein (RHV). On the back-table, the recipient's recanalized umbilical vein graft was anastomosed to the V5 opening, and the other side of vein graft was anastomosed to the RHV and V8 opening to create a large single orifice. After total hepatectomy, the right liver graft was placed in the left subphrenic space at the reversed position. The common orifice of hepatic venous drainage from RHV, V8 and V5 was anastomosed to the anatomical RHV conduit of the recipient, followed by IRHV anastomosis to the inferior vena cava. Postoperative course was almost uneventful, and no vascular complications were experienced. Even for SI patients, LDLT using a right liver graft with reconstructions of the MHV tributaries and the IRHVs is feasible.
    American Journal of Transplantation 04/2014; · 6.19 Impact Factor
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    ABSTRACT: Liver transplant outcomes using grafts donated after cardiac death (DCD) remain poor. We investigated the effects of ex vivo reconditioning of DCD grafts with venous systemic oxygen persufflation using nitric oxide gas (VSOP-NO) in rat liver transplants. Orthotopic liver transplants were performed in Lewis rats, using DCD grafts prepared using static cold storage alone (group-control) or reconditioning using VSOP-NO during cold storage (group-VSOP-NO). Experiment I: In a 30-min warm ischemia model, graft damage and hepatic expression of inflammatory cytokines, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and endothelin-1 (ET-1) were examined, and histologic analysis was performed 2, 6, 24, and 72 hr after transplantation. Experiment II: In a 60-min warm ischemia model, grafts were evaluated 2 hr after transplantation (6 rats/group), and survival was assessed (7 rats/group). Experiment I: Group-VSOP-NO had lower alanine aminotransferase (ALT) (P<0.001), hyaluronic acid (P<0.05), and malondialdehyde (MDA) (P<0.001), hepatic interleukin-6 expression (IL-6) (P<0.05), and hepatic tumor necrosis factor-alpha (TNF-α) expression (P<0.001). Hepatic eNOS expression (P<0.001) was upregulated, whereas hepatic iNOS (P<0.01) and ET-1 (P<0.001) expressions were downregulated. The damage of hepatocyte and sinusoidal endothelial cells (SECs) were lower in group-VSOP-NO.Experiment II: VSOP-NO decreased ET-1 and 8-hydroxy-2'deoxyguanosine (8-OHdG) expression and improved survival after transplantation by 71.4% (P<0.01). These results suggest that VSOP-NO effectively reconditions warm ischemia-damaged grafts, presumably by decreasing ET-1 upregulation and oxidative damage.
    Transplantation 02/2014; · 3.78 Impact Factor
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    ABSTRACT: Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7 %, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9 %; 3 years: 58.9 vs. 77.7 %; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.
    Surgery Today 02/2014; · 0.96 Impact Factor
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    ABSTRACT: Introduction Right posterior segmental graft (RPSG) is an alternative procedure for living-donor liver transplantation (LDLT). Although the first case of RPSG was reported in 2001, it has not been disseminated because of the lack of popularity, technical concerns, and surgical difficulties. Presentation of Case: A 37-year-old man with primary sclerosing cholangitis. His spouse was the only transplantation candidate, although she was ABO incompatible. Preoperative investigations revealed that left-lobe graft was insufficient for the recipient and that right-lobe graft was accompanied by donor risk. In RPSG, estimated graft-to-recipient weight ratio (GRWR) and estimated ratio of liver remnant were reasonable. In the donor operation, the right hepatic vein (RHV) and demarcation line were confirmed, and intraoperative cholangiography was performed. The cut line was carefully considered based on the demarcation line and RHV. The RPSG was harvested. Actual GRWR was 0.54. Unfortunately, this recipient showed a poor course and outcome after LDLT. Discussion Segmental branches of vessels and biliary duct may be not suitable for reconstruction, and surgeons must exercise some ingenuity in the recipient operation. Segmental territory based on inflow and that based on outflow never overlap completely, even in the same segment. The selection of RPSG based only on liver volume may be unfeasible. Liver resection should be carefully considered based on preoperative imaging, and demarcation line and RHV during surgery. Conclusion RPSG is a useful tool for LDLT. However, detailed studies before surgery and careful consideration during surgery are important for RPSG harvest.
    International Journal of Surgery Case Reports. 01/2014;
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    ABSTRACT: We report a first pediatric liver transplantation from a brain-dead donor under 6-year-old in Japan. A 9-month-old girl suffered from graft failure after living donor liver transplantation for biliary atresia. The deceased donor liver transplantation (DDLT) from under 6-year-old was performed. It was important to select appropriate surgical devices for the pediatric organ recovery based on the preoperative evaluation. Sufficient vessel grafts were procured because of difficult vascular reconstruction. She discharged on 172 days after DDLT. There have been few cases of pediatric organ donation in Japan. Therefore we should make careful preparation for both of donor and recipient.
    Nippon Geka Gakkai zasshi 11/2013; 114(6):340-4.
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    ABSTRACT: Plasma cell hepatitis (PCH) is an idiopathic disorder characterized by plasma cell infiltration in the allografts of patients who underwent liver transplantation. Although an increasing number of cases of PCH have been reported in liver transplant recipients with hepatitis C recurrence treated with interferon, it is unclear whether PCH is induced by interferon itself. Here, we describe the cases of 2 patients who developed PCH just after the termination of antiviral therapy for recurrent hepatitis C after living donor liver transplantation. Liver dysfunction appeared at 1 month in 1 patient and 2 months in the other patient after pegylated interferon plus ribavirin therapy, and liver histology showed interface hepatitis with plasma cell-rich lymphoid aggregates. Both patients recovered after steroid therapy and achieved sustained virological response. These cases suggest that PCH could be induced by the alteration of the immune condition resulting from the termination of antiviral therapy. PCH should be considered when the transaminase levels increase after antiviral therapy, and it should be carefully distinguished from hepatitis C relapse.
    Hepatology Research 09/2013; · 2.07 Impact Factor
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    ABSTRACT: Background. Balancing donor safety and graft volume is difficult. We previously reported that intentional modulation of portal venous pressure (PVP) during living-donor liver transplantation (LDLT) is crucial to overcoming problems with small-for-size grafts; however, detailed studies of portal venous flow (PVF) and a reliable parameter are still required. Patients and Methods. The elimination rate (k) of indocyanine green (ICG) was measured in 49 adult LDLT recipients. PVP was controlled during LDLT, with a target of <20 mm Hg. ICG reflects hepatocyte volume and effective PVF. The kICG value is divided by the graft weight to calculate PVF. Recipients were divided into 2 groups: those with severe and/or fatal complications within 1 month after LDLT and those without. Results. Survival rates and postoperative profiles were significantly different between the 2 groups. Univariate analysis showed significant differences in ABO blood group, final PVP, final kICG, and the final kICG/graft weight value; however, multivariate analysis showed that only the kICG/graft weight value was significant. The cutoff level for the final kICG/graft weight value for predicting successful LDLT was 3.1175 × 10(-4)/g. Conclusion. Accurate evaluation and monitoring of optimal PVF during LDLT should overcome the use of small-for-size grafts and improve donor safety and recipient outcomes.
    Surgical Innovation 05/2013; · 1.54 Impact Factor
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    ABSTRACT: Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r = -0.254, p = 0.005) and body cell mass (r = 0.636, p < 0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p < 0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p = 0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.
    American Journal of Transplantation 04/2013; · 6.19 Impact Factor
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    ABSTRACT: Given the limited efficacy and high adverse event rate associated with treatment of recurrent hepatitis C after liver transplantation, an individualized treatment strategy should be considered. The aim of this study was to identify predictors of response to antiviral therapy for hepatitis C after living donor liver transplantation (LDLT) and to study the associated adverse events. A retrospective chart review was performed on 125 hepatitis C virus (HCV)-positive LDLT recipients who received interferon plus ribavirin and/or peginterferon plus ribavirin therapy at Kyoto University between January 2001 and June 2011. Serum HCV RNA reached undetectable levels within 48 weeks in 77 (62%) of 125 patients, and these patients were defined as showing virological response (VR). Of 117 patients, 50 (43%) achieved sustained VR (SVR). Predictive factors associated with both VR and SVR by univariate analysis included low pretransplant serum HCV RNA levels, a non-1 HCV genotype, and low pretreatment serum HCV RNA levels. In addition, LDLT from ABO-mismatched donors was significantly associated with VR, and white cell and neutrophil counts before interferon therapy were associated with SVR. Multivariate analysis showed that 2 variables-pretransplant serum HCV RNA level less than 500 kIU/mL and a non-1 HCV genotype-remained in models of both VR and SVR and that an ABO mismatch was associated with VR. No variables with a significant effect on treatment withdrawal were found. Virological response to antiviral therapy in patients with hepatitis C recurring after LDLT can be predicted prior to transplant, based on pretransplant serum HCV-RNA levels and HCV genotype. LDLT from ABO-mismatched donors may contribute to more efficacious interferon therapy. UMIN-CTR UMIN000003286.
    PLoS ONE 01/2013; 8(3):e58380. · 3.53 Impact Factor
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    ABSTRACT: Purpose Despite improvements in immunosuppressive therapy, acute cellular rejection (ACR) remains an important cause of graft loss in patients undergoing liver transplantation. Recently, associations between cytokine gene polymorphisms in recipients and the occurrence of ACR have been reported. However, most studies did not investigate gene polymorphisms in donors or were limited by the number of cases investigated. Methods We examined 155 living donor liver transplantation (LDLT) patients treated at Nagoya University or Kyoto University from 2004 to 2009. The following gene polymorphisms in recipients and donors were analyzed: tumor necrosis factor A (TNF-A) T-1031C, interleukin 2 (IL-2) T-330G, IL-10C-819T, IL-13C-1111T, and transforming growth factor B (TGF-B) T29C. Results Forty-seven recipients (30.3 %) developed early ACR. Of the investigated gene polymorphisms, the IL-13 −1111C/C genotype in recipients was significantly associated with a higher incidence of ACR relative to the other two genotypes (OR = 2.64, 95 % CI 1.19–5.86, p = 0.017), while we showed the lack of association between investigated gene polymorphisms in donors and ACR incidence. Conclusion The IL-13 −1111C/C genotype in recipients might be a risk factor for ACR in LDLT, and this might contribute to individualized immunosuppression strategies for recipients. On the other hand, the current study showed no associations of cytokine gene polymorphisms in donors with ACR incidence.
    Hepatology International 01/2013; · 2.64 Impact Factor
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    ABSTRACT: Living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) presents a unique challenge as it does not involve replacement of the hepatic inferior vena cava (IVC). We report a case of successful LDLT in a patient with BCS associated with occlusion of the hepatic veins as well as the IVC. A 34-year-old woman with a history of two open pericardial procedures had decompensated liver failure and portal hypertension. Venography showed complete obstruction of the hepatic IVC and well-developed collateral vessels. We performed LDLT via sternotomy and laparotomy, with an end-to-end anastomosis between the left hepatic vein of the donor and the patient's suprahepatic vena cava in the pericardium. The patient recovered uneventfully and has been doing well for 5 years. LDLT without caval replacement for BCS in a patient with hepatic IVC obstruction is feasible if the patient has good functional collaterals before liver transplantation.
    Surgery Today 11/2012; · 0.96 Impact Factor
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    ABSTRACT: It has previously been demonstrated that glutathione S-transferase T1 (GSTT1) genetic mismatch between recipient and donor is a risk factor for developing immune-mediated hepatitis following liver transplantation and for antibody-mediated rejection in renal transplantation. Little is known whether the GSTT1 gene polymorphism affects the incidence of acute cellular rejection (ACR) following living donor liver transplantation (LDLT). Patients underwent LDLT at Nagoya University or Kyoto University, Japan, between 2004 and 2009. Genotyping of GSTT1 genes (null or present genotype) was conducted in recipients and donors. A total of 155 LDLT cases were examined. Forty-seven recipients (30.3%) developed early ACR. There was no association of recipient GSTT1 genotype with ACR incidence. However, ACR incidence was significantly higher in recipients transplanted from GSTT1 present genotype donors than in those transplanted from GSTT1 null genotype donors [odds ratio (OR)=2.64, 95% confidence interval (CI)=1.12-5.83, p=0.016]. Moreover, GSTT1 recipient/donor genotype mismatch (present/null or null/present) was significantly associated with ACR development (OR=2.28, 95% CI=1.12-4.61, p=0.022). The genotyping of GSTT1 in recipients and donors might be useful to stratify the liver transplant recipients according to risk of ACR.
    Transplant Immunology 11/2012; · 1.52 Impact Factor
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    ABSTRACT: Infectious complications, including sepsis, that often occur after liver transplantation (LT) comprise the most frequent causes of in-hospital death. This study investigated the predictors of post-transplantation infectious complications to establish a strategy with which to improve short-term outcomes after LT. We used univariate and multivariate analyses to assess pre- and perioperative risk factors for post-transplantation infectious complications in 100 consecutive patients who underwent living donor LT from February 2008 through February 2010 at our institute. Multivariate analysis showed that low preoperative body cell mass and the absence of preoperative supplementation with branched-chain amino acids were of prognostic significance for post-transplantation sepsis. In addition, Child-Pugh classification C and massive operative blood loss were independent risk factors for post-transplantation bacteremia, and preoperative low body cell mass was an independent risk factor for in-hospital death from infection. Pretransplantation nutritional intervention and decreases in operative blood loss would help prevent post-transplantation infectious complications from developing during living donor LT. Branched-chain amino acid supplementation before LT affects the occurrence of infectious complications.
    Nutrition 11/2012; 28(11-12):1104-8. · 2.86 Impact Factor
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    ABSTRACT: Few studies have examined the long-term outcomes and prognostic factors associated with pediatric living living-donor liver transplantation (LDLT) using reduced and hyper-reduced left lateral segment grafts. We conducted a retrospective, single-center assessment of the outcomes of this procedure, as well as clinical factors that influenced graft and patient survival. Between September 2000 and December 2009, 49 patients (median age: 7 months, weight: 5.45 kg) underwent LDLT using reduced (partial left lateral segment; n = 5, monosegment; n = 26), or hyper-reduced (reduced monosegment grafts; n = 18) left lateral segment grafts. In all cases, the estimated graft-to-recipient body weight ratio of the left lateral segment was more than 4%, as assessed by preoperative computed tomography volumetry, and therefore further reduction was required. A hepatic artery thrombosis occurred in two patients (4.1%). Portal venous complications occurred in eight patients (16.3%). The overall patient survival rate at 1, 3 and 10 years after LDLT were 83.7%, 81.4% and 78.9%, respectively. Multivariate analysis revealed that recipient age of less than 2 months and warm ischemic time of more than 40 min affected patient survival. Pediatric LDLT using reduced and hyper-reduced left lateral segment grafts appears to be a feasible option with acceptable graft survival and vascular complication rates.
    American Journal of Transplantation 09/2012; · 6.19 Impact Factor
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    ABSTRACT: Small-for-size grafts are an issue in liver transplantation. Portal venous pressure (PVP) was monitored and intentionally controlled during living-donor liver transplantation (LDLT) in 155 adult recipients. The indocyanine green elimination rate (kICG) was simultaneously measured in 16 recipients and divided by the graft weight (g) to reflect portal venous flow (PVF). The target PVP was <20 mmHg. Patients were divided by the final PVP (mmHg): Group A, PVP < 12; Group B, 12 ≤ PVP < 15; Group C, 15 ≤ PVP < 20; and Group D, PVP ≥ 20. With intentional PVP control, we performed splenectomy and collateral ligation in 80 cases, splenectomy in 39 cases, and splenectomy, collateral ligation, and additional creation in five cases. Thirty-one cases received no modulation. Groups A and B showed good LDLT results, while Groups C and D did not. Final PVP was the most important factor for the LDLT results, and the PVP cutoffs for good outcomes and clinical courses were both 15.5 mmHg. The respective kICG/graft weight cutoffs were 3.5580 × 10(-4) /g and 4.0015 × 10(-4) /g. Intentional PVP modulation at <15 mmHg is a sure surgical strategy for small-for-size grafts, to establish greater donor safety with good LDLT results. The kICG/graft weight value may have potential as a parameter for optimal PVF and a predictor for LDLT results.
    Clinical Transplantation 05/2012; 26(3):E324-34. · 1.63 Impact Factor
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    ABSTRACT: Aim:  Hepatitis B recurrence after liver transplantation can be reduced to less than 10% by combination therapy with lamivudine (LAM) and hepatitis B immunoglobulin (HBIG). The aim of this study was to evaluate the efficacy and safety of prophylaxis with entecavir (ETV), which has higher efficacy and lower resistance rates than LAM, combined with HBIG in preventing hepatitis B recurrence after living-donor liver transplantation (LDLT). Methods:  Twenty-six patients who received ETV plus HBIG (ETV group) after LDLT for hepatitis B virus (HBV)-related end-stage liver disease were analyzed by comparing with 63 control patients who had received LAM plus HBIG (LAM group). Results:  The survival rates of the patients treated with ETV plus HBIG was 73% after both 1 and 3 years, and there was no statistical difference between the patients in the ETV group and LAM group. No HBV recurrence was detected during the median follow-up period of 25.1 months in the ETV group, whereas the HBV recurrence rate was 4% at 3 years and 6% at 5 years in the LAM group. No patients had adverse effects related to ETV administration. Conclusion:  ETV combined with HBIG provides effective and safe prophylaxis in preventing hepatitis B recurrence after LDLT.
    Hepatology Research 04/2012; · 2.07 Impact Factor

Publication Stats

4k Citations
677.60 Total Impact Points


  • 2001–2014
    • Nagoya University
      • Division of Ophtalmology
      Nagoya, Aichi, Japan
  • 1990–2012
    • Kyoto University
      • • Department of Pharmacy
      • • Department of Hepato-pancreato-biliary Surgery and Transplantation
      • • Graduate School of Medicine / Faculty of Medicine
      • • Department of Ophthalmology and Visual Sciences
      Kyoto, Kyoto-fu, Japan
  • 2010
    • Miyazaki Prefectural Wood Utilization Research Center
      Миядзаки, Miyazaki, Japan
  • 2009
    • Kyoto Prefectural University of Medicine
      • Division of Transplantation and General Surgery
      Kioto, Kyōto, Japan
  • 2005
    • Shiga University of Medical Science
      Ōtu, Shiga, Japan
  • 1999–2002
    • Nagoya City University
      • Department of Ophthalmology
      Nagoya, Aichi, Japan
  • 1988–1995
    • University of Illinois at Chicago
      • Department of Ophthalmology and Visual Sciences (Chicago)
      Chicago, IL, United States