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ABSTRACT: Although acute portal venous thrombosis (PVT) is a potentially life-threatening complication that occurs after hepatobiliary surgery with portal vein (PV) reconstruction or splenectomy, no effective or universal treatments have yet been established. Transjugular or transhepatic catheter-directed thrombolysis has recently been reported to be effective for treating acute PVT. However, the efficiency of this treatment for complete PV occlusion might be limited because a poor portal venous flow prevents thrombolytic agents from reaching and dissolving thrombi. Moreover, the use of the transjugular or transhepatic route might not be suitable in patients who have undergone major hepatectomy or in those with ascites due to an increased risk of residual liver injury or intra-abdominal bleeding following puncture to the residual liver. We herein describe the cases of two patients with almost total PV occlusion caused by massive thrombi that formed after hepatobiliary surgery, who were successfully treated with catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route. This treatment should be considered beneficial for treating selected patients such as the two patients described herein.
Surgery Today 09/2012; · 1.22 Impact Factor
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ABSTRACT: In the last decade, a superior mesenteric-intrahepatic left portal shunt (Rex shunt) has been reported for successful management of extrahepatic portal vein obstruction in children. However, in adults, a mesocaval shunt has been generally performed for the surgical management of extrahepatic portal vein obstruction because of the complexity of the underlying disease and the difficulty of the superior mesenteric-intrahepatic left portal shunt. We herein report an adult patient who was successfully treated by splenic-intrahepatic left portal shunt with an artificial graft (6-mm polytetrafluoroethylene) for complete obstruction of the extrahepatic portal vein following pancreaticoduodenectomy. The shunt procedure not only relieved portal hypertension but also restored hepatic portal flow. In the near future, the Rex shunt should be considered for a beneficial management of extrahepatic portal vein obstruction, even in adults.
Journal of Hepato-Biliary-Pancreatic Surgery 01/2009; 16(1):86-9. · 1.60 Impact Factor
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ABSTRACT: To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction.
A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively.
The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049).
Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.
World Journal of Gastroenterology 09/2007; 13(31):4236-41. · 2.47 Impact Factor
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ABSTRACT: Use of the inferior mesenteric vein (IMV) for partial portal decompression has not been recommended as a first-line option for intractable gastroesophageal variceal bleeding because of the thin diameter of the vein. Although these indications remain relevant, few reports have compared partial portal decompression using the IMV with other therapies. We propose that partial portal decompression using the IMV is a useful alternative treatment for intractable variceal bleeding.
We performed partial portal decompression using the IMV in eight patients with intractable variceal bleeding that had been uncontrolled using medical and endoscopic therapies. All patients were classified into Child's class B or C. The surgical data, morbidity, and mortality were assessed.
Mean portal venous pressure significantly decreased from 26.9 +/- 2.0 mmHg before the surgery to 19.8 +/- 3.9 mmHg after the surgery. The operative mortality rate was 0%. The mean duration of hospital stay was 25.5 +/- 13.3 days. Although one patient experienced recurrent bleeding, shunt patency was well maintained in all patients during the follow-up period (mean 28.9 +/- 14.1 months). Six patients are still alive and well without ascites or hepatic encephalopathy. Two of the Child's class C patients who underwent emergency shunt died owing to hepatic decompensation.
Partial portal decompression using the IMV can be a safe, effective way to treat intractable variceal bleeding in patients with liver cirrhosis. However, use of the shunt procedure may have the most survival benefits for cirrhotic patients with preserved liver function.
World Journal of Surgery 07/2007; 31(6):1264-9. · 2.36 Impact Factor
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ABSTRACT: Postoperative biliary tract complications remain one of the most serious problems facing patients who undergo living-donor liver transplantation. The aim of this study was to analyze the clinical implications of three different methods of biliary reconstruction in left-lobe adult living-donor liver transplantation.
We retrospectively compared three groups of patients: those who had Roux-en-Y hepaticojejunostomy (HJ; n = 11) biliary reconstruction, those who had duct-to-duct hepaticohepaticostomy (HH) with external stent (n = 11), and those who had HH with a T-tube (n = 6). Median follow-up for each group was 31, 30, and 10 months, respectively.
Bile leaks were observed in 45.5% of the patients in both the HJ group and the HH with external stent group. Biliary anastomotic strictures occurred in 9% of the Roux-en-Y HJ patients and in 27.2% of those who had HH with external stent. No biliary complications were observed in the HH with a T-tube group (P = 0.049).
Biliary reconstruction using HH with a T-tube may decrease the incidence of biliary complications. Despite the relatively short follow-up period, these encouraging preliminary results may warrant further studies of this biliary reconstruction technique in left-lobe adult living-donor liver transplantation.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2007; 14(2):177-82. · 1.60 Impact Factor
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ABSTRACT: Partial hepatectomy causes hemodynamic changes that increase portal blood flow in the remaining lobe, where the expression of immediate-early genes, including plasminogen activator inhibitor-1 (PAI-1), is induced. We hypothesized that a hyperdynamic circulatory state occurring in the remaining lobe induces immediate-early gene expression. In this study, we investigated whether the mechanical force generated by flowing blood, shear stress, induces PAI-1 expression in hepatocytes. When cultured rat hepatocytes were exposed to flow, PAI-1 mRNA levels began to increase within 3 h, peaked at levels significantly higher than the static control levels, and then gradually decreased. The flow-induced PAI-1 expression was shear stress dependent rather than shear rate dependent and accompanied by increased hepatocyte production of PAI-1 protein. Shear stress increased PAI-1 transcription but did not affect PAI-1 mRNA stability. Functional analysis of the 2.1-kb PAI-1 5'-promoter indicated that a 278-bp segment containing transcription factor Sp1 and Ets-1 consensus sequences was critical to the shear stress-dependent increase of PAI-1 transcription. Mutations of both the Sp1 and Ets-1 consensus sequences, but not of either one alone, markedly prevented basal PAI-1 transcription and abolished the response of the PAI-1 promoter to shear stress. EMSA and chromatin immunoprecipitation assays showed binding of Sp1 and Ets-1 to each consensus sequence under static conditions, which increased in response to shear stress. In conclusion, hepatocyte PAI-1 expression is flow sensitive and transcriptionally regulated by shear stress via cooperative interactions between Sp1 and Ets-1.
AJP Gastrointestinal and Liver Physiology 08/2006; 291(1):G26-34. · 3.43 Impact Factor
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ABSTRACT: There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT.
For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used.
VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure.
We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.
Surgery 06/2006; 139(5):695-703. · 3.10 Impact Factor
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ABSTRACT: Atherosclerotic plaques preferentially localize at arterial regions exposed to turbulent low-shear flow. Urokinase-type plasminogen activator (uPA) plays a role in vascular remodeling by facilitating smooth muscle cell migration and proliferation in addition to the proteolysis of extracellular matrix, and the expression of uPA is elevated in atherosclerotic lesions. In this study, we analyzed the effects of laminar and turbulent shear stress on uPA expression in cultured human coronary artery endothelial cells. The application of laminar shear stress (1.5 or 15 dyn/cm2) significantly decreased the amount of uPA mRNA as well as the secretion of uPA protein. In contrast, turbulent shear stress (average intensity, 1.5 dyn/cm2) markedly increased uPA gene expression and protein secretion. Laminar shear stress downregulated uPA gene expression transcriptionally and posttranscriptionally; laminar shear stress activated transcription factor GATA6, which binds to a GATA consensus element located between -692 and -687 bp in the uPA promoter, thereby inhibiting uPA gene transcription. Laminar shear stress also accelerated the degradation of uPA mRNA; the half-life of uPA mRNA decreased to about half of the static control's half-life. Although turbulent shear stress had no effect on the transcription of uPA, it significantly increased uPA mRNA stability; the half-life of uPA mRNA increased by about two times the static control's half-life. Our results suggest that endothelial uPA expression is flow sensitive and differentially regulated by laminar and turbulent shear stress in vitro. We speculate that this effect may contribute to the local nature of atherosclerosis.
AJP Heart and Circulatory Physiology 12/2004; 287(5):H2027-34. · 3.71 Impact Factor
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Transplantation 10/2003; 76(5):882-4. · 4.00 Impact Factor
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ABSTRACT: The mechanisms by which flow-imposed shear stress elevates intracellular Ca2+ in cultured endothelial cells (ECs) are not fully understood. Here we report finding that endogenously released ATP contributes to shear stress-induced Ca2+ responses. Application of flow of Hanks' balanced solution to human pulmonary artery ECs (HPAECs) elicited shear stress-dependent increases in Ca2+ concentrations. Chelation of extracellular Ca2+ with EGTA completely abolished the Ca2+ responses, whereas the phospholipase C inhibitor U-73122 or the Ca2+-ATPase inhibitor thapsigargin had no effect, which thereby indicates that the response was due to the influx of extracellular Ca2+. The Ca2+ influx was significantly suppressed by apyrase, which degrades ATP, or antisense oligonucleotide targeted to P2X4 purinoceptors. A luciferase luminometric assay showed that shear stress induced dose-dependent release of ATP. When the ATP release was inhibited by the ATP synthase inhibitors angiostatin or oligomycin, the Ca2+ influx was markedly suppressed but was restored by removal of these inhibitors or addition of extracellular ATP. These results suggest that shear stress stimulates HPAECs to release ATP, which activates Ca2+ influx via P2X4 receptors.
AJP Heart and Circulatory Physiology 09/2003; 285(2):H793-803. · 3.71 Impact Factor
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Norihiko Ohura,
Kimiko Yamamoto,
Sigeru Ichioka,
Takaaki Sokabe, Hideki Nakatsuka,
Atsushi Baba,
Masahiro Shibata,
Takashi Nakatsuka,
Kiyonori Harii,
Youichiro Wada,
Takahide Kohro,
Tatsuhiko Kodama,
Joji Ando
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ABSTRACT: DNA microarray gene expression analysis was conducted in human umbilical vein endothelial cells (HUVECs) and coronary artery endothelial cells (HCAECs) exposed to laminar or turbulent shear stress. Approximately 3% of the total 5600 gene in HUVECs and HCAECs increased their expression more than two-fold or decreased it to less than half the static control in response to an arterial level of laminar shear stress (15 dynes/cm(2) for 24 hours). The proportions of shear-stress-responsive genes decreased to around 2% under the venous level of laminar shear stress (1.5 dynes/cm(2)) in both cell lines. Turbulent shear stress of 1.5 dynes/cm(2) altered the expression of 1.1% of all genes in the HCAECs. Laminar shear stress, but not turbulent shear stress, decreased the expression of a number of genes involved in DNA synthesis and the cell cycle in both HUVECs and HCAECs. Clustering analysis showed a variety of temporal profiles of gene expression in HUVECs exposed to laminar shear stress of 15 dynes/cm(2) for 3, 6, 12, 24, and 48 hours. Turbulent shear stress affected expression of many genes that play a role in vascular remodeling, including genes encoding plasminogen activators and their inhibitor, endothelin-1, transforming growth factor-beta, collagen type IV, and ephrin A1.
Journal of atherosclerosis and thrombosis 02/2003; 10(5):304-13. · 2.69 Impact Factor
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ABSTRACT: Thrombopoietin is the primary hematopoietic growth factor. Thrombopoietin deficiency may cause thrombocytopenia in advanced liver disease. The aim of our study was to investigate the relevance of thrombopoietin levels to peripheral platelet counts in patients with liver disease who underwent LRDLT (living related donor liver transplantation).
We divided the six patients who underwent LRDLT into two groups. Group 1 had thrombocytopenia and group 2 had normal platelet counts. We measured serum thrombopoietin and peripheral platelet counts before and after LRDLT.
Pre-LRDLT thrombopoietin and peripheral platelet counts were lower in group 1 than in group 2. Thrombopoietin in group 1 significantly increased on the first day after LRDLT and peripheral platelet counts in group 1 increased following the rise in thrombopoietin (p < 0.05). Moreover, a marked increase in thrombopoietin and peripheral platelet counts was found in splenectomized patients during LRDLT.
These findings suggested inadequate thrombopoietin production in advanced stage liver disease which caused thrombocytopenia. Improvement of thrombopoietin production in graft liver function may contribute to increase of peripheral platelet counts.
Hepato-gastroenterology 50(49):227-30. · 0.66 Impact Factor
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Takashi Kato,
Yoshinobu Sato,
Isao Kurosaki,
Satoshi Yamamoto,
Kenichiro Hirano, Hideki Nakatsuka,
Takashi Kobayashi,
Hitoshi Kameyama,
Takaoki Watanabe,
Yoshio Shirai,
Katsuyoshi Hatakeyama
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ABSTRACT: We investigated the influence of FK506 which has been used frequently after transplant surgery as an immunosuppressant, on liver injury after partial hepatectomy by comparing laboratory data from donors and recipients after liver transplantation.
Seventeen donors and respective recipients who underwent living related donor liver transplantation were included in the present study. Serum levels of transaminases and cytokines were measured and compared preoperatively and in the early period after the operation.
Serum level of asparaginic acid aminotransferase in the postoperative day 1 was significantly higher in the donor group. Serum levels of alanine aminotransferase in the early period after the operation were significantly higher in the donor group. Serum levels of interferon y and soluble Fas ligand in the early period after the operation were significantly higher in the donor group. Steroid doses administered were significantly higher in the recipient group.
FK506 administration and steroid administration in larger doses were thought to reduce serum transaminase levels of the recipient group. These findings might suggest that cell-mediated immunity weigh heavier than the operation time of ischemia-reperfusion injury as a cause of liver injury after partial hepatectomy.
Hepato-gastroenterology 53(70):580-3. · 0.66 Impact Factor
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ABSTRACT: Acute renal failure after liver transplantation can occur in some and is an important postoperative complication. Our goal is to clarify the risk factors of acute renal failure after living-related donor liver transplantation (LDLT).
From March 1999 to August 2000, ten consecutive patients were investigated the changes of the systemic hemodynamics and the renal function. They were classified into Group A (Creatinine (Cre) was over 2.0 mg/dL) and B (Cre was below 2.0 mg/dL). Retrospective variables were examined with two groups A and B being compared.
In both groups, Cardiac Index (CI) was above standard levels. However, the CI levels in Group B were significantly higher than those in Group A (p=0.031). The early postoperative transaminase levels were significantly higher in Group A than in Group B (p=0.049) and graft liver volume/recipient body weight ratio was significantly smaller in Group A than in Group B (p=0.016).
Our study suggests that small-for-size graft or hypovolemia, resulting in the delay of the recovery of graft liver function, may be an important cause of acute renal failure during the early postoperative period in adult LDLT.
Hepato-gastroenterology 51(60):1815-9. · 0.66 Impact Factor
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ABSTRACT: We investigated the effects of splenectomy on the reduction of excessive portal hypertension immediately after adult living-related donor liver transplantation, paying particular attention to peritransplanted portal pressure in seven adult patients.
We studied the relationship between portal hypertension and hyperbilirubinemia in small-for-size graft liver transplantation.
In the three cases, the portal pressures increased beyond 30 cmH2O after living-related donor liver transplantation, despite the right lobe graft, and these patients underwent splenectomy. After splenectomy, their portal pressures decreased below 25 cmH2O. The portal pressure underwent auxiliary orthotopic partial liver transplantation due to the hypercitrullinemia and did not change after surgery (9.5 to 11.5 cmH2O). Interestingly, the hyperbilirubinemia occurring after living-related donor liver transplantation were as the primary result of direct bilirubin except for the patient with citrullinemia. The posttransplanted portal pressures were controlled below 25 cmH2O in all patients, with their peak serum total bilirubin levels not exceeding 15 mg/dL, and the patients were discharged without major complications. Three patients underwent splenectomy, and did not suffer from serious infection. The reduction in excessive portal hypertension after living-related donor liver transplantation might prevent liver injury and post-transplant hyperbilirubinemia.
However, splenectomy remains a life-threatening factor. Therefore, transplant surgeons encountering living-related donor liver transplantation must continue to seek out additional solutions to problems with excessive portal hypertension.
Hepato-gastroenterology 49(48):1652-5. · 0.66 Impact Factor
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ABSTRACT: Hemeoxygenase-1 produces carbon monoxide as a byproduct of hemoglobin metabolism. The present study examines the relationship between carbon monoxide production and hyperbilirubinemia following adult living-related liver transplantation with special attention to the contribution of shear stress in retarding regeneration.
Case records from 16 patients who underwent adult living-related liver transplantation from March 1999 to May 2001 were reviewed. Patients were divided into group A (graft weight: recipient body weight ratio > or = 1) and group B (graft weight: recipient body weight ratio < 1). Clinical characteristics and outcome in the two groups were compared.
Total serum bilirubin concentration and the direct: total serum bilirubin concentration were higher in group B than group A (p < 0.01). Further, the carbon monoxide-hemoglobin concentration correlated with the total serum bilirubin concentration (r = 0.81, p < 0.0001) and also was higher in group B than group A (p < 0.05). The arterial: ketone body ratio rose similarly during the first week in both groups.
Persistent hyperbilirubinemia in small-for-size grafts and concomitant carbon monoxide-hemoglobinemia reflect both parenchymal and Kupffer cell dysfunction. The role of shear stress in the portal system and its relationship to portal hypertension are discussed.
Hepato-gastroenterology 50(54):1745-8. · 0.66 Impact Factor
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ABSTRACT: Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy.
Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16).
The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe).
The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.
Hepato-gastroenterology 50(49):196-200. · 0.66 Impact Factor
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ABSTRACT: Oral or portal administration of allogeneic antigens downregulates the alloimmune response and prolongs graft survival following organ transplantation. However, the effect of donor-specific transfusion via the portal vein has been reported in rodent models, but has not been reported in human cases. We investigated whether donor-specific transfusion via the portal vein would bring up the clinical and immunological benefits in living-related donor liver transplantation.
Eighteen patients who underwent living-related donor liver transplantation from March 1999 to December 2001, were investigated. Seven patients were given the Tac + steroid regimen (IP(-) group: n = 7, mean age 54 +/- 9 yo). Eleven patients had postoperative repeated donor specific transfusion performed via a portal venous catheter inserted from vena colica media besides from the Tac + steroid (IP(+) group: n = 11, mean age 45 +/- 15 yo). The clinical effects of the reduction of immunosuppression and the rejection, and the immunological analysis were studied in the two groups.
Total amount of methylprednisolone and prednisolone within one month in the IP(+) group was smaller than that in the IP(-) group with statistical significance. Amount of Tac within one month and Trough level of Tac was statistically smaller in the IP(+) group than that in the IP(-) group. Minimum dose of Tac in the IP(+) group was clearly smaller than that in the IP(-) group with statistical significance. The frequency of acute cellular rejection within one month and after one month or total frequency of acute cellular rejection in the IP(+) group tended to be less than that in the IP(-) group. Macrochimerism of donor type CD56+ T cells in a graft were confirmed in patients with donor-specific transfusion via the portal vein. Conversely recipient type CD56+ T cells increased in the graft liver in patients without donor-specific transfusion. IL-10 production of the donor-specific transfusion(+) group was higher than that of the donor-specific transfusion(-) group on day 1 after living-related donor liver transplantation.
The repeated donor-specific transfusion via the portal vein has brought the rapid reduction of immunosuppressants. Donor type natural killer T cells especially CD56+ T cells, may induce tolerance by Veto mechanism and anti-idiotype network mechanism. These benefits might introduce more advantages in frequency of complications and cost of transplantation.
Hepato-gastroenterology 50(51):601-6. · 0.66 Impact Factor
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Yoshinobu Sato,
Satoshi Yamamoto,
Hiroshi Oya, Hideki Nakatsuka,
Takashi Kobayashi,
Toshiyuki Takeishi,
Kenichiro Hirano,
Yoshiaki Hara,
Takaoki Watanabe,
Nobuo Waguri,
Takeshi Suda,
Takafumi Ichida,
Yutaka Aoyagi,
Katsuyoshi Hatakeyama
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ABSTRACT: In this study we evaluated the potential role of preoperative h-TERT mRNA expression in peripheral blood as a tool for predicting prognosis and tumor recurrence after living-related liver donor transplantation (LRLDT).
The study included patients with unresectable HCC who underwent LRLDT from July 1999 to May 2003.
There was no significant difference between the survival curves of those patients who met the Milan criteria and those who did not. However, there was a statistically significant difference (p=0.032) between the survival curves of those patients with positive preoperative h-TERT mRNA expression, and those who either had an initially negative preoperative h-TERT mRNA or who converted from positive to negative after neoadjuvant immunochemotherapy.
In conclusion, the presence or absence of h-TERT mRNA in the peripheral blood may be a useful criterion in evaluating HCC patients for transplantation, as well as a valuable method of assessing anti-tumor therapy and tumor relapse.
Hepato-gastroenterology 52(65):1325-8. · 0.66 Impact Factor
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Yoshinobu Sato,
Hisami Watanabe,
Takafumi Ichida,
Satoshi Yamamoto, Hideki Nakatsuka,
Hiroshi Oya,
Hiroshi Kameyama,
Takaoki Watanabe,
Kazuhiko Shimamura,
Toru Abo,
Katsuyoshi Hatakeyama
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ABSTRACT: We investigated the influence of HTK solution against natural killer T cells and thymic T cells in liver graft before and after perfusion in adult living related donor liver transplantation.
Graft samples were obtained before liver resection, after perfusion, and one hour after liver transplantation. Flowcytometry analysis was conducted using several human natural killer markers; CD16, CD56, CD57, and CD161.
Natural killer T cells existed prominently in the liver leukocytes compared with their presence in peripheral blood lymphocytes, and the difference was significant. CD56+ T and CD161+ T cells, in comparison with CD16+ T cells and CD57+ T cells, were especially numerous in the liver. The proportion of CD56+ T and CD161+ T cells increased in the graft immediately after perfusion with HTK solution. However, CD16+ T cells and CD57+ T cells decreased in the graft immediately after perfusion and reperfusion of portal blood flow. Thymus-derived cells also decreased significantly after perfusion. The proportion of CD56+ T cells among CD3+ cells showed a significant increase immediately after perfusion. All types of natural killer cells in the graft immediately increased after perfusion by HTK solution and reperfusion of portal blood flow. Compared with CD57+ NKT cells, CD56+ NKT cells showed a significant tendency to stay in the liver graft against the perfusion. CD57+ NKT cells tended to wash out from the liver into the systemic circulation. Moreover, thymus-derived T cells showed the strongest tendency to wash out from the liver graft.
CD56+ NKT cells and natural killer cells are more involved in local immunity, whereas thymus-derived cells and CD57+ NKT cells are involved in regulation of systemic immunity. Alloimmunity between local and systemic systems may be affected by the dynamic changes in hepatic circulation associated with living related donor liver transplantation.
Hepato-gastroenterology 51(56):329-33. · 0.66 Impact Factor
