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Y Sanada,
K Ushijima,
K Mizuta,
T Urahashi,
Y Ihara,
T Wakiya,
N Okada,
N Yamada,
S Egami,
S Hishikawa,
S Otomo, K Sakamoto,
Y Yasuda,
H Kawarasaki
[show abstract]
[hide abstract]
ABSTRACT: Acute cellular rejection (ACR) is a common cause of morbidity following liver transplantation. Several reports have evaluated the predictive value of peripheral blood eosinophilia as a simple noninvasive diagnostic marker for ACR. This study examined whether the relative eosinophil counts (REC) predicted ACR in pediatric living donor liver transplantation (LDLT).
One hundred three patients underwent LDLT between May 2001 and December 2007. ACR were diagnosed based on the pathological findings.
The incidence of ACR was 46.6% (48/103); ACR was diagnosed an average of 13.5 days after LDLT. The average REC at 4 and 2 days before the onset ACR (n = 39) within 30 postoperative day (POD) was 4.3% and 7.3%, respectively, and 9.0% at the onset. Patients with ACR showed significantly higher levels of REC compared with those free of ACR (P = .039). REC thresholds of 10% at POD 7 displayed a sensitivity and specificity of ACR detection of 80% and 75%, respectively. Moreover, the accumulated morbidity ratio of ACR within 30 POD was significantly higher with REC >10% at POD 7 (P = .007).
ACR within POD 30 should be considered when REC is >10% at POD 7 after LDLT.
Transplantation Proceedings 06/2012; 44(5):1341-5. · 1.00 Impact Factor
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T Wakiya,
Y Sanada,
T Urahashi,
Y Ihara,
N Yamada,
N Okada,
S Egami, K Sakamoto,
K Murayama,
K Hakamada,
Y Yasuda,
K Mizuta
[show abstract]
[hide abstract]
ABSTRACT: Liver transplantation (LT) has been adopted as a radical treatment for ornithine transcarbamylase deficiency (OTCD), yielding favorable outcomes. Despite the fact that it is an inheritable disease, a blood relative who is heterozygous for the disorder must sometimes be used as a liver donor for living donor LT. There is ongoing discussion regarding the use of heterozygous donors, however, to our knowledge, no cases where donation was determined based on the Ornithine transcarbamylase (OTC) activity before LT have been reported. Between May 2001 and April 2011, 17 patients were indicated for living donor LT because of OTCD at our facility. There were three cases with heterozygous donor candidate (17.6%). All heterozygous candidates underwent a liver biopsy to measure their OTC activity before LT and made efforts to secure the safety of the both donor and recipient. Two of 3 candidates had headaches sometimes, and their activity was less than 40%, and thus they were not employed as the donor. One candidate with 104.4% activity was employed, yielding favorable outcomes. Our current experience supported the effectiveness of our donation criteria, however it is necessary to collect sufficient data on a large number of patients to confirm the safety of the procedure.
Pediatric Transplantation 05/2012; 16(6):E196-200. · 1.48 Impact Factor
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Y Sanada,
K Mizuta,
T Urahashi,
Y Ihara,
T Wakiya,
N Okada,
N Yamada,
S Egami,
S Hishikawa,
K Ushijima,
S Otomo, K Sakamoto,
Y Yasuda,
H Kawarasaki
[show abstract]
[hide abstract]
ABSTRACT: Excessive portal pressure at an early stage after living-donor liver transplantation (LDLT) can damage sinusoidal endothelial cells and hepatocytes through shear stress leading to graft failure, or hepatic arterial complications due to low hepatic artery flow from a hepatic arterial buffer response. We encountered a case in which excessive portal vein flow was observed from an early stage after pediatric LDLT. The hepatic artery flow decreased due to a hepatic arterial buffer response.
A 6-month-old boy with biliary atresia showed excessive portal vein flow early after LDLT with a decreasing hepatic artery flow without anastomotic stenosis from postoperative day 3. The PV flow gradually exhibited a decrease at approximately postoperative day 8 and, similtaneously, hepatic artery flow exhibited improvement.
Because excessive portal pressure after LDLT is reversible, it has been suggested that it may be possible to prevent the progress of hepatic arterial complications if temporary portal pressure modulation can be performed for cases among the high-risk group for hepatic arterial complications.
Transplantation Proceedings 12/2011; 43(10):4019-24. · 1.00 Impact Factor
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K Mizuta,
Y Sanada,
T Wakiya,
T Urahashi,
M Umehara,
S Egami,
S Hishikawa,
N Okada,
Y Kawano,
T Saito, [......],
K Sugimoto,
M Ohmori,
S Ohtomo, K Sakamoto,
M Nakata,
T Yano,
H Yamamoto,
E Kobayashi,
Y Yasuda,
H Kawarasaki
[show abstract]
[hide abstract]
ABSTRACT: To describe our experience with 126 consecutive living-donor liver transplantation (LDLT) procedures performed because of biliary atresia and to evaluate the optimal timing of the operation.
Between May 2001 and January 2010,126 patients with biliary atresia underwent 130 LDLT procedures. Mean (SD) patient age was 3.3 (4.2) years, and body weight was 13.8 (10.7) kg. Donors included 64 fathers, 63 mothers, and 3 other individuals. The left lateral segment was the most commonly used graft (75%). Patients were divided into 3 groups according to body weight: group 1, less than 8 kg (n = 40); group 2,8 to 20 kg (n = 63); and group 3, more than 20 kg (n = 23). Medical records were reviewed retrospectively. Follow up was 4.5 (2.7) years.
All group 3 donors underwent left lobectomy, and all group 1 donors underwent left lateral segmentectomy. No donors required a second operation or died. Comparison of the 3 groups demonstrated that recipient Pediatric End-Stage Liver Disease score in group 1 was highest, operative blood loss in group 2 was lowest (78 mL/kg), and operative time in group 3 was longest (1201 minutes). Hepatic artery complications occurred more frequently in group 1 (17.9%), and biliary stenosis (43.5%) and gastrointestinal perforation (8.7%) occurred more frequently in group 3. The overall patient survival rates at 1, 5, and 9 years was 98%, 97%, and 97%, respectively. Five-year patient survival rate in groups 1,2, and 3 were 92.5%, 100%, and 95.7%, respectively. Gastrointestinal perforation (n = 2) was the primary cause of death.
Living-donor liver transplantation is an effective treatment of biliary atresia, with good long-term outcome. It seems that the most suitable time to perform LDLT to treat biliary atresia is when the patient weighs 8 to 20 kg.
Transplantation Proceedings 12/2010; 42(10):4127-31. · 1.00 Impact Factor
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Y Sanada,
K Mizuta,
T Urahashi,
M Umehara,
T Wakiya,
N Okada,
M Hayashida,
S Egami,
S Hishikawa,
Y Kawano,
K Ushijima,
S Otomo, K Sakamoto,
T Fujiwara,
Y Sakuma,
M Hyodo,
Y Yasuda,
H Kawarasaki
[show abstract]
[hide abstract]
ABSTRACT: There have been few reports on the management of intra-abdominal drains after living donor liver transplantation (LDLT). We retrospectively investigated changes in ascitic data related to management of an intra-abdominal drain.
Between March 2008 and June 2009, we performed 28 LDLT. On the first and the fifth postoperative day (POD) after LDLT, we examined the number of ascites cells and cell fractions as well as performed biochemical examination and cultures.
The day of removal of the drain for massive ascites (10 mL/kg/d or more) was 14.2 ± 5.4 POD; for less than 10 mL/kg/d it was 8.7 ± 1.9 POD (P < .001). Nine patients were ascites culture positive; long-term placement of the drain caused an infection in two patients.
When the amount of ascitic fluid on the fifth POD after LDLT was small, it was important to assess the properties of the ascitic fluid because of the possibility of a drain infection or of poor drainage. If the ascitic neutrophil count is less than 250/mm(3) or the examined ascites is normal, intra-abdominal drains should be removed.
Transplantation Proceedings 12/2010; 42(10):4555-9. · 1.00 Impact Factor
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K Mizuta,
Y Yasuda,
S Egami,
Y Sanada,
T Wakiya,
T Urahashi,
M Umehara,
S Hishikawa,
M Hayashida,
M Hyodo,
Y Sakuma,
T Fujiwara,
K Ushijima, K Sakamoto,
H Kawarasaki
[show abstract]
[hide abstract]
ABSTRACT: The prognosis of liver transplantation for neonates with fulminant hepatic failure (FHF) continues to be extremely poor, especially in patients whose body weight is less than 3 kg. To address this problem, we have developed a safe living donor liver transplantation (LDLT) modality for neonates. We performed LDLTs with segment 2 monosubsegment (S2) grafts for three neonatal FHF. The recipient age and body weight at LDLT were 13-27 days, 2.59-2.84 kg, respectively. S2 or reduced S2 grafts (93-98 g) obtained from their fathers were implanted using temporary portacaval shunt. The recipient portal vein was reconstructed at a more distal site, such as the umbilical portion, to have the graft liver move freely during hepatic artery (HA) reconstruction. The recipient operation time and bleeding were 11 h 58 min-15 h 27 min and 200-395 mL, respectively. The graft-to-recipient weight ratio was 3.3-3.8% and primary abdominal wall closure was possible in all cases. Although hepatic artery thrombosis occurred in one case, all cases survived with normal growth. Emergency LDLT with S2 grafts weighing less than 100 g can save neonates with FHF whose body weight is less than 3 kg. This LDLT modality using S2 grafts could become a new option for neonates and very small infants requiring LT.
American Journal of Transplantation 11/2010; 10(11):2547-52. · 6.39 Impact Factor
