Koichi Mizuta

Jichi Medical University, Totigi, Tochigi, Japan

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Publications (139)259.19 Total impact

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    ABSTRACT: Purpose: We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy. Methods: The data was collected retrospectively. SFSG was used in 14LDLTs (5.7 %) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient. Results: The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1 %, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14-88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively). Conclusions: Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.
    No preview · Article · Jan 2016 · Pediatric Surgery International
  • Yukihiro Sanada · Koichi Mizuta · Fukuo Kondo

    No preview · Article · Dec 2015 · Journal of Hepato-Biliary-Pancreatic Sciences
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    ABSTRACT: Objectives: The safety and efficacy of double-balloon enteroscopy (DBE) in pediatric patients has not been well documented. We aimed to evaluate the clinical efficacy and safety of DBE in children, especially those under 10. Methods: We retrospectively analyzed our database of DBE procedures performed between September 2000 and September 2013. Procedures performed in pediatric patients (under 18) were selected from a total of 3980, including double-balloon endoscopic retrograde cholangioscopy (DBERC). Results: Two hundred and fifty-seven DBE procedures were performed in 117 pediatric patients (median age 12.5 years). Antegrade (oral-route) DBE was performed in 166 procedures including 104 DBERC procedures (lowest body weight 13.5 kg, youngest age 3 years), and retrograde (anal-route) DBE in 91 (lowest body weight 12.0 kg, youngest age 2 years). The overall diagnostic yield for obscure gastrointestinal bleeding and abdominal pain was 58.8%. The purpose of DBERC was achieved in 76.9% of procedures. The overall complication rate in our series was 5.4% (1.9% with the DBERC cases removed); in patients under 10, it was 10.4% (7/67). No severe complications associated with enteroscope insertion and sedation were observed. Serum amylase levels tended to be elevated in patients who underwent oral-route DBE. Conclusion: DBE is safe and feasible for diagnostic evaluation of small bowel disorders in pediatric patients, even those younger than 10 years. However, special attention for possible complications must be paid during therapeutic DBE procedures, including DBERC, especially for patients under 10.
    No preview · Article · Nov 2015 · Journal of Pediatric Gastroenterology and Nutrition
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    ABSTRACT: The serum ferritin (SF) concentration is a widely available and objective laboratory parameter. SF is widely also recognized as an acute phase reactant. The purpose of the present study was to identify the chronological changes in the recipient SF concentration during liver transplantation (LT) and clarify factors having an effect on the recipient's intraoperative SF level. In addition, the study retrospectively evaluated the usefulness of measuring SF during LT. Ninety-eight pediatric recipients were retrospectively analyzed. The data were analyzed and compared according to the SF level in the recipient. Patients were classified into two groups based on the intraoperative peak SF levels (ng/mL) of ≤1000 (low SF group) or >1000 (high SF group). The SF value increased dramatically after reperfusion and fell to normal levels within the early postoperative period. The warm ischemia time (WIT) was significantly longer in the high SF group (47.0 vs 58.5 min, p=0.003). In addition, a significant positive correlation was observed between the peak SF value and the WIT (r = 0.35, p<0.001). There were significant positive correlations between the peak SF value and the donors' preoperative laboratory data, including transaminases, cholinesterase, hemoglobin, transferrin saturation and SF, of which SF showed the strongest positive correlation (r = 0.74, p<0.001). The multivariate analysis revealed that WIT and donor's SF level were a significant risk factor for high SF level in the recipient (p=0.007 and 0.02, respectively). The SF measurement can suggest the degree of ischemia-reperfusion injury (IRI). A high SF level in the donor is associated with the risk of further acute reactions, such as IRI, in the recipient. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    No preview · Article · Jul 2015 · Liver Transplantation
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    ABSTRACT: Studies suggest that prophylactic intra-abdominal drains are unnecessary for cadaveric liver transplantation using whole liver grafts because there is no benefit from drainage. However, no studies have investigated on the necessity of prophylactic drains after LDLT using split-liver grafts or reduced-liver grafts, which may present a high risk of post-transplant intra-abdominal infections. This retrospective study investigated whether the ascitic data on POD 5 after LDLT can predict intra-abdominal infections and on the post-transplant management of prophylactic drains. Between March 2008 and March 2013, 90 LDLTs were performed. We assessed the number of ascitic cells, biochemical examinations, and cultivation tests at POD1 and POD5. The incidence rates of post-transplant intra-abdominal infections were 24.4%. The multivariate analysis showed that left lobe and S2 monosegment grafts were a significant risk factor for intra-abdominal infections (p = 0.006). The patients with intra-abdominal infections had significantly higher acsitic LDH levels and the positive rate of ascitic culture at POD5 in comparison with patients without infections (p < 0.001 and p = 0.014, respectively). LDLT using left lobe and S2 monosegment grafts yields a high risk for post-transplant intra-abdominal infections, and ascitic LDH and cultivation tests at POD5 via prophylactic drains can predict intra-abdominal infections. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    No preview · Article · Jul 2015 · Pediatric Transplantation
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    ABSTRACT: Hepatocellular nodules caused by congenital extrahepatic portosystemic shunts (CEPS) occur as a result of abnormal portal blood flow, and are mostly cases of benign focal nodular hyperplasia (FNH). However, hepatocellular adenomas (HCA) and hepatocellular carcinomas have been documented in the CEPS patients. HCA can now be immunohistochemically diagnosed; therefore, the concept of hepatocellular nodules resulting from CEPS should be revisited. In this study, we performed a retrospective immunohistochemical investigation of hepatocellular nodules from livers isolated from the CEPS patients undergoing living donor liver transplantation (LDLT). Hepatocellular nodules from livers of five patients with CEPS who underwent LDLT between June 2004 and October 2012 at our institution were immunohistochemically investigated. HCA were classified into four subtypes (HNF1α-inactivated HCA, H-HCA; inflammatory HCA, I-HCA; β-catenin-activated HCA, b-HCA; unclassified HCA, u-HCA). Sixteen hepatocellular nodules were collected from livers of five patients with CEPS who underwent LDLT. Ten hepatocellular nodules were categorized as FNH (62.5%), five were categorized as b-HCA (31.3%), and one was categorized as H-HCA (6.2%). Some of the hepatocellular nodules resulting from CEPS were indicative of HCAs, especially the b-HCA subtype which has a potential of malignant transformation. Surgical or interventional treatments might have to be performed when hepatocellular nodules appear in the CEPS patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Hepato-Biliary-Pancreatic Sciences
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    ABSTRACT: A 12-year-old female patient with biliary atresia underwent living donor liver transplantation (LDLT). Twelve months after the LDLT, she developed acute hepatitis (alanine aminotransferase 584 IU/L) and was diagnosed with disseminated varicella-zoster virus (VZV) infection with high level of serum VZV-DNA (1.5 × 10(5) copies/mL) and generalized vesicular rash. She had received the VZV vaccination when she was 5-years-old and had not been exposed to chicken pox before the LDLT, and her serum was positive for VZV immunoglobulin G at the time of the LDLT. Although she underwent treatment with intravenous acyclovir, intravenous immunoglobulin, and withdrawal of immunosuppressants, her symptoms worsened and were accompanied by disseminated intravascular coagulation, pneumonia, and encephalitis. These complications required treatment in the intensive care unit for 16 days. Five weeks later, her clinical findings improved, although her VZV-DNA levels remained high (8.5 × 10(3)copies/mL). Oral acyclovir was added for 2 weeks, and she was eventually discharged from our hospital on day 86 after admission; she has not experienced a recurrence. In conclusion, although disseminated VZV infection with multiple organ failure after pediatric LDLT is a life-threatening disease, it can be cured via an early diagnosis and intensive treatment.
    Preview · Article · Jun 2015 · Virology Journal
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    ABSTRACT: A merit of subnormothermic perfusion has been reported to preserve grafts from ischemic injury in animal models. The split liver technique is commonly performed to solve the shortage of liver grafts. However, there has been no study showing the effect of a split liver graft on subnormothermic perfusion. We herein investigated the split liver protocol using a subnormothermic oxygenated circuit system (SOCS). Auxiliary liver transplantation was performed in a porcine marginal donor model by using a SOCS. In the SOCS group, the portal vein and hepatic artery of the graft were cannulated, and the graft was perfused by SOCS. In the cold storage (CS) group, the graft was placed in cold preservation solution. In the preservation phase, the graft was split. There were no significant differences in the biochemical markers between the SOCS and CS groups. In terms of the histology, the sinusoidal spaces were widened in the CS group 12 hours after implantation. We have demonstrated a possibility to use SOCS with the split liver protocol by using a porcine model. This split liver protocol using SOCS will extend the split liver criteria and rescue more patients from hepatic failure, including pediatric patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Mar 2015 · Transplantation Proceedings
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    ABSTRACT: PC is produced in the liver and inhibits blood coagulation by catalyzing active factors V and VIII. PC deficiency causes abnormal blood clotting that is difficult to regulate by anticoagulative treatments. Four reports of PC deficiency treated with LTx have been published; however, no report of DLT as a therapy for PC deficiency is available. We describe a case of a 23-month-old girl who received DLT for compound heterozygous PC deficiency. Her PC activity was below 5%. She developed intracranial lesion and frequent refractory purpura fulminans. Both her parents had heterozygous mutations of PC genes and were excluded as living donors. Furthermore, she was a low priority on the waiting list of deceased-donor transplantation. We performed living DLT using the liver from a patient with MSUD. Activated PC concentrate safely supported the perioperative period. After DLT, she maintained normal PC activities and BCAA levels. This is the first case of PC deficiency successfully treated by living DLT with MSUD. We propose that DLT using liver from patients with MSUD is a treatment option for PC deficiency. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    No preview · Article · Feb 2015 · Pediatric Transplantation
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    ABSTRACT: Previous studies have demonstrated the safety of ABO-incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO-incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO-incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m(2) in two cases; second period: 50 mg/m(2) in two cases; and 200 mg/m(2) in eight cases). Two patients who received 375 mg/m(2) rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m(2) rituximab required retransplantation as a consequence of antibody-mediated complications. All eight patients administered 200 mg/m(2) survived, and the mean CD20(+) lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO-incompatible LDLT, the administration of 200 mg/m(2) rituximab three wk prior to LDLT was safe and effective. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    No preview · Article · Feb 2015 · Pediatric Transplantation
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    ABSTRACT: To evaluate the sensitivity and specificity of a stool color card used for a mass screening of biliary atresia conducted over 19 years. In addition, the age at Kasai procedure and the long-term probabilities of native liver survival were investigated. From 1994 to 2011, the stool color card was distributed to all pregnant women in Tochigi Prefecture, Japan. Before or during the postnatal 1-month health checkup, the mothers returned the completed stool color card to the attending pediatrician or obstetrician. All suspected cases of biliary atresia were referred for further examination. Diagnosis was confirmed by laparotomy or operative cholangiography for high-risk cases before the Kasai procedure. Patients with biliary atresia were followed from the date of their Kasai procedure until liver transplantation, death, or October 31, 2013, whichever comes sooner. A total of 313 230 live born infants were screened; 34 patients with biliary atresia were diagnosed. The sensitivity and specificity of stool color card screening at the 1-month check-up was 76.5% (95% CI 62.2-90.7) and 99.9% (95% CI 99.9-100.0), respectively. Mean age at the time of Kasai procedure was 59.7 days. According to Kaplan-Meier analysis, the native liver survival probability at 5, 10, and 15 years was 87.6%, 76.9%, and 48.5%, respectively. The sensitivity and specificity of the stool color card have been demonstrated by our 19-year cohort study. We found that the timing of Kasai procedure and long-term native liver survival probabilities were improved, suggesting the beneficial effect of stool color card screening. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · Journal of Pediatrics
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    ABSTRACT: Few studies have examined HRQOL in pediatric Tx recipients’ parents. This study investigated HRQOL in these parents and relationships between HRQOL and perceived burden of nurturing, family functioning, and social support. Self-report anonymous questionnaires and a survey of medical records were completed between September and December 2013. The SF-36v2, which evaluates physical, psychological, and social health, was used to measure HRQOL. While values for physical and psychological health were higher than standard values (Cohen's d = 0.34 and 0.17, respectively), social health scores were lower (d = 0.21). “Parental consultation unrelated to donation” (standardized partial regression coefficient: β = −0.52) was associated with physical health. “Family functioning” and “Commuting time between home and primary follow-up hospital” (β = 0.57 and −0.31) were related to psychological health. “Total score for perceived burden of nurturing” (β = −0.31) was related to social health. Regarding parental HRQOL, while physical and psychological health was favorable, social health was impaired. In clinical practice, interventions targeting parents’ physical conditions and facilitation of community and family understanding and support to share recipients’ nurturing are important in improving parental HRQOL.
    No preview · Article · Feb 2015 · Pediatric Transplantation

  • No preview · Article · Jan 2015 · Pediatric Transplantation
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    ABSTRACT: Cytomegalovirus (CMV) infection is known to be the most frequently viral infection among patients after liver transplantation. This is especially true in pediatric living-donor liver transplantation because the recipients have often not been infected with CMV and postoperative primary infection with CMV frequently occurs. Of 93 patients who underwent pediatric liver transplantation at our department, 33 patients (36.3%) were diagnosed with CMV infection using the antigenemia method (C7-HRP). Retrospective review and statistical analysis were conducted to confirm risk factors of post-transplantation CMV infection. Positive lymphocytes were diagnosed between postoperative days 8 and 111 after transplantation. Ganciclovir or foscavir were administrated to 21 patients. The other 10 patients who had one positive lymphocyte were observed and the cell disappeared on follow-up examination. We did not observe any cases of positive lymphocytes with C7-HRP in patients who received a graft from a CMV antibody-negative donor. Independent predictors associated with CMV infection in the multivariable analysis were administration of OKT3 and grafts from CMV antibody-positive donors. In CMV infection after pediatric liver transplantation, cases with CMV antibody-positive donors and with OKT3 administration for acute rejection are considered high risk, and cases with CMV antibody-negative donors are considered low risk. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · Transplantation Proceedings
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    ABSTRACT: Background In the field of pediatric living donor liver transplantation (LDLT), physicians soetimes must reduce the volume of left lateral segment (LLS) grafts to prevent large-for-size syndrome. There are two established methods for decreasing the size of an LLS graft: the use of a segment 2 (S2) monosegment graft or that of a reduced-LLS graft. However, no procedure for selecting the proper graft type has been established. In this study, we conducted a retrospective investigation of LDLT and examined the strategy of graft selection for patients weighing <6kg.Patients and Methods Among 225 LDLTs conducted between May 2001 and December 2012, 15 were performed in patients weighing <6kg. We selected S2 monosegment grafts and reduced-LLS grafts if the preoperative computed tomography (CT)-volumetry value of the LLS graft was >5% and 4-5% of the graft recipient weight ratio, respectively. The mean follow-up period was 3.9 ± 2.2 years.ResultsWe used LLS grafts in 7 recipients, S2 monosegment grafts in 5, reduced-S2 monosegment grafts in 2, and a reduced-LLS graft in 1. The reduction rate of S2 monosegment graft for use as an LLS graft was 48.3%. The overall recipient and graft survival rates were both 93.3%; and 1 patient died of a brain hemorrhage. Major surgical complications included hepatic artery thrombosis in 2 recipients, bilioenteric anastomotic stricture in 2, and portal vein thrombosis in 1.Conclusion Our graft selection strategy based on preoperative CT-volumetry is highly useful in patients weighing <6kg. S2 monosegment grafts are effective and safe in very small infants, particularly neonates. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2014 · Liver Transplantation
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    ABSTRACT: To characterize cholesterol regulation in the liver of patients with Alagille syndrome (AGS). Serum total cholesterol (TC) and total bile acid (TBA) levels were measured in 23 AGS patients. The expressions of genes involved in cholesterol regulation, including low-density lipoprotein receptor (LDLR), scavenger receptor class B type I (SR-BI), 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), cholesterol 7α-hydroxylase (CYP7A1), ATP-binding cassette transporter (ABC) A1, and ABCG1/5/8, were measured in liver tissues from five of these patients. Expression of regulators for these genes, including farnesoid X receptor/small heterodimer partner (SHP), liver X receptor α (LXRα) and mature Sterol regulatory element-binding protein 2 (SREBP2) was measured. The expression of mature SREBP2 protein was also examined. Serum TC and TBA levels were correlated in the AGS patients. Liver cholesterol was also increased compared with controls, and correlated with bile acid contents. LDLR, SR-BI, HMGCR, and ABCGs mRNA expression were upregulated, while CYP7A1 mRNA expression was downregulated in AGS livers. SHP and LXRα mRNA expression was also increased, but maturation of SREBP2 was not suppressed in the patients. The major upregulators of liver cholesterol might be increased in AGS patients, indicating an impaired negative feedback mechanism and accelerated liver cholesterol accumulation. Copyright © 2014 Elsevier B.V. All rights reserved.
    Full-text · Article · Oct 2014 · Clinica Chimica Acta
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    ABSTRACT: The use of donors with coagulation FIX deficiency is controversial, and there are no current protocols for peri-transplant management. We herein describe the first reported case of a pediatric LDLT from an asymptomatic donor with mild coagulation FIX deficiency. A 32-yr-old female was evaluated as a donor for her 12-month-old daughter with biliary atresia. The donor's pretransplant coagulation tests revealed asymptomatic mild coagulation FIX deficiency (FIX activity 60.8%). Freeze-dried human blood coagulation FIX concentrate was administered before the dissection of the liver and 12 h afterwards by bolus infusion (40 U/kg) and was continued on POD 1. The bleeding volume at LDLT was 590 mL. On POD 1, 3, 5, and 13, the coagulation FIX activity of the donor was 121.3%, 130.6%, 114.6%, and 50.2%, respectively. The donor's post-transplant course was uneventful, and the recipient is currently doing well at 18 months after LDLT. The FIX activity of the donor and recipient at nine months after LDLT was 39.2% and 58.0%, respectively. LDLT from donors with mild coagulation FIX deficiency could be performed effectively and safely using peri-transplant short-term coagulation FIX replacement and long-term monitoring of the plasma FIX level in the donor.
    No preview · Article · Sep 2014 · Pediatric Transplantation
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    ABSTRACT: Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC. Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (≥20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively). It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
    Preview · Article · Jul 2014 · Journal of Hepato-Biliary-Pancreatic Sciences
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    ABSTRACT: β-D glucan in the portal vein blood is processed by the hepatic reticuloendothelial system, and therefore, it is possible that the β-D glucan kinetics of the peripheral vein blood may be useful as a biological index. In this study, the β-D glucan levels in the peripheral and portal vein blood during liver transplantation were measured in order to study the clinical significance of the molecule. The subjects comprised 20 patients who underwent living donor liver transplantation. In the perioperative period, the β-D glucan levels were measured before liver transplantation, during surgical procedure, then on postoperative days 5, 14 and 21. The portal vein blood showed a significantly higher level of β-D glucan than the peripheral blood (p<0.001). A significant difference of β-D glucan levels was observed between the pre-liver transplantation and postoperative days 5 (p=0.048). There was a significant positive correlation between the preoperative β-D glucan level and the period of postoperative hospitalization (p<0.001). The patients with fungal infections (35.0%) had a significantly longer period of hospitalization (p=0.019). The β-D glucan kinetics accurately reflects the liver function and fungal infections. The β-D glucan level before liver transplantation can be used to
    No preview · Article · Jul 2014 · Hepato-gastroenterology
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    ABSTRACT: Background/Aims: (beta-D glucan in the portal vein blood is processed by the hepatic reticuloendothelial system, and therefore, it is possible that the beta-D glucan kinetics of the peripheral vein blood may be useful as a biological index. In this study, the beta-D glucan levels in the peripheral and portal vein blood during liver transplantation were measured in order to study the clinical significance of the molecule. Methodology: The subjects comprised 20 patients who underwent living donor liver transplantation. In the perioperative period, the beta-D glucan levels were measured before liver transplantation, during surgical procedure, then on postoperative days 5, 14, and 21. Results: The portal vein blood showed a significantly higher level beta-D glucan than the peripheral blood (p<0.001). A significant difference of beta-D glucan levels was observed between the pre-liver transplantation and postoperative days 5 (p=0.048). There was a significant positive correlation between the preoperative beta-D glucan level and the period of postoperative hospitalization (p<0.001). The patients with fungal infections (35.0%) had a significantly longer period of hospitalization.(p=0.019). Conclusions: The beta-D glucan kinetics accurately reflects the liver function and fungal infections. The beta-D glucan level before liver transplantation can be used to predict the period of hospitalization.
    No preview · Article · Jul 2014 · Hepato-gastroenterology

Publication Stats

943 Citations
259.19 Total Impact Points

Institutions

  • 1999-2015
    • Jichi Medical University
      • • Division of Transplant Surgery
      • • Division of Renal Surgery and Transplantation
      • • Division of Pediatric Surgery
      • • Center for Molecular Medicine
      • • Division of Clinical Pharmacology
      Totigi, Tochigi, Japan
  • 1999-2011
    • The University of Tokyo
      • • Division of Surgery
      • • Department of Pediatric Surgery
      白山, Tōkyō, Japan