研究者詳細 - 嶋田　圭太

論文 - 嶋田　圭太

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Portal vein stenting blocked the inflow tract and completely resolved bile duct varices, formed by cavernous transformation of the portal vein

Matsubara D.

Clinical Journal of Gastroenterology ( Clinical Journal of Gastroenterology ) 2024年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

There is no established treatment for bleeding bile duct varices (BDVs). We report the first case of portal vein (PV) stenting completely eradicating bleeding BDVs. A 70-year-old male with malignant lymphoma developed BDVs due to PV obstruction, which had caused compression and stricture of the distal bile duct. Endoscopic retrograde cholangiography was performed to evaluate the stricture and bleeding from the ruptured BDV was observed. Endoscopic hemostasis was difficult, requiring reopening of the extra-hepatic PV and reducing the blood flow to the BDVs for hemostasis. Therefore, PV stenting was performed. During the procedure, portal angiography confirmed an inflow tract to the BDVs. Therefore, covered stents were placed in the PV and adjusted to block the inflow tract to the BDVs at the distal end. After stenting, the BDVs were successfully blocked and all PV blood flowed through the stent placed in the extra-hepatic PV. Two weeks after stenting, the BDVs had disappeared completely and the bleeding has not recurred for months. We experienced a case in which PV stenting not only reopened an obstructed PV but also successfully occluded the inflow tract. This case demonstrates the potential of PV stenting for the treatment of hemorrhagic BDVs.

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Corrigendum to 'A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure' American Journal of Transplantation, Available online 29 April 2024, In Press, Corrected Proof.

Shimata K, Yoon YI, Hibi T, Morinaga J, Narayanan AK, Toshima T, Ito T, Akamatsu N, Kotera Y, Hong SK, Hasegawa Y, Umeda Y, Reddy MS, Ong AL, Sivaprasadan S, Varghese J, Sugawara Y, Chen CL, Nakayama N, Mochida S, Tanaka A, Suh KS, Ikegami T, Lee KW, Lee SG, Vanguard Multicenter Study of International Living Donor Liver Transplantation (iLDLT) Group

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons ( American Journal of Transplantation ) 2024年08月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

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Feasible living donor liver transplantation for patients on chronic hemodialysis: a multicenter study in East Asian countries.

Kenei Furukawa, Kwang-Woong Lee, Keita Shimata, Takashi Ito, Takeo Toshima, Nobuhisa Akamatsu, Taizo Hibi, Suk Kyun Hong, Jong Man Kim, Etsuro Hatano, Tomoharu Yoshizumi, Toru Ikegmi, Kyung-Suk Suh

Surgery today 54 ( 5 ) 471 - 477 2024年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

PURPOSES: End-stage liver and kidney disease is an indication for simultaneous liver and kidney transplantation. However, in countries where deceased donor transplantation is not well established, living donor liver transplantation (LDLT) is a realistic option for patients on hemodialysis (HD). We investigated the outcomes of LDLT for patients on HD. METHODS: We conducted a retrospective multicenter survey of patients on chronic HD who underwent LDLT in East Asian countries. The characteristics of donors and recipients and the short and long-term outcomes were analyzed. RESULTS: Between 2001 and 2021, 45 patients on HD underwent LDLT and 11 of these patients also underwent kidney transplantation (KT). The overall survival rate at 5 years of the 34 patients who underwent only LDLT was 44.5%. Multivariate analysis identified a low graft recipient weight ratio (< 1%) (p = 0.048) and long HD duration (≥ 10 years) (p = 0.046) as independent predictors of poor overall survival. The major complication was posttransplant bleeding, which occurred in12 patients (35%). CONCLUSION: It is important to establish the indications for LDLT, taking into consideration graft size and HD duration in candidate patients on HD.

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A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure.

掲載種別: 研究論文（学術雑誌）

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Excess mortality in COVID-19-affected solid organ transplant recipients across the pandemic

Shigeyoshi Yamanaga, Keita Shimata, Satoko Ohfuji, Mikiko Yoshikawa, Yoichiro Natori, Taizo Hibi, Kenji Yuzawa, Hiroto Egawa, Kohei Unagami, Hideki Ishida, Kazuya Omoto, Mureo Kasahara, Hajime Uchida, Seisuke Sakamoto, Kenta Futamura, Kenta Nishikawa, Ryoichi Imamura, Shigeaki Nakazawa, Etsuro Hatano, Takashi Ito, Yuki Masano, Morikuni Nishihira, Yuta Hirata, Yasunaru Sakuma, Yasuharu Onishi, Naoki Yokoyama, Shingo Yamamoto, Yusuke Yamada, Yasuhiro Ogura, Nobuhiko Kurata, Junji Uchida, Kazuya Kabei, Hitoshi Iwamoto, Chie Ikeda, Kazunobu Shinoda, Miki Yoshiike, Kiyohiko Hotta, Yuji Hidaka, Daiki Iwami, Yasuo Ishii, Manabu Kamiyama, Tomoharu Yoshizumi, Yukiko Kosai-Fujimoto, Takaaki Kobayashi, Kentaro Motoyama, Megumi Yamamoto, Toshihiro Asai, Masayuki Tasaki, Takashi Kenmochi, Taihei Ito, Kazuaki Tokodai, Atsushi Fujio, Yasumasa Tsukamoto, Takuya Watanabe, Nobuhisa Akamatsu, Sachi Yamashina, Daisuke Ishii, Kazuki Kitajima, Yasutoshi Yamada, Akihiko Mitsuke, Takashi Sakaguchi, Michio Nakamura, Yusuke Tomita, Yuki Nakamura, Tatsuro Ishimoto, Hideki Ohdan, Naoki Tanimine, Takuzo Fujiwara, Mitsuki Yanagihara, Shingo Hatakeyama, Manabu Takai, Kazuhiro Nose, Takashi Kikuchi, Yasunori Mori, Motoo Araki, Takanori Sekito, Shingo Nishimura, Tatsu Tanabe, Yuto Igarashi, Sumi Hidaka, Masaaki Watanabe, Yuichi Ariyoshi, Yasushi Hasegawa, Masato Kamiyama, Tatsuo Yoneda, Tomokazu Shimizu, Kouhei Nishikawa, Takumi Fukumoto, Kaoru Kuramitsu, Masashi Kato, Mitsuru Saito, Makoto Shinkai, Hidehito Usui, Masaaki Sato, Hidetoshi Eguchi, Hiroki Imamura, Shogo Kobayashi, Yuji Soejima, Atsuyoshi Mita, Takashi Kobayashi, Kenji Nakamura, Masayuki Ohtsuka, Shinichiro Nakada, Takahito Yagi, Kazuya Yasui, Naoto Matsuno, Chiharu Mizuno, Mikio Sugimoto, Nobufumi Ueda, Yoshinori Okada, Takashi Hirama, Shinichi Toyooka, Seichiro Sugimoto, Kei Matsubara, Toru Ikegami, Kenei Furukawa, Hiroyuki Nitta, Hirokatsu Katagiri, Toru Onita, Takeshi Shiraishi, Shugo Mizuno, Eisuke Amiya, Yasushi Shintani, Takashi Kanou, Soichiro Funaki, Yoshifumi Miura, Daisuke Nakajima, Taizen Urahashi, Goro Matsumiya, Michiko Watanabe, Yosuke Ebisu, Ryosuke Osawa, Minoru Ono, Hiroshi Sogawa, Harumi Gomi, Toyofumi Chen-Yoshikawa, Kazunari Yoshida, Naoko Ogawa

American Journal of Transplantation 2024年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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The First Successful Living Donor Liver Transplantation for Acute-on-Chronic Liver Failure Caused by Severe Acute Necrotizing Pancreatitis: A Case Report.

Masatsugu Ishii, Kazuya Hirukawa, Keita Shimata, Yoko Yoshimaru, Katsuyuki Sagishima, Yuto Sakurai, Masahiro Tomita, Kaori Isono, Masaki Honda, Yasuhiko Sugawara, Naoyuki Hirata, Yasuhito Tanaka, Taizo Hibi

Transplantation proceedings 2024年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Liver transplantation (LT) is the only life-saving option when acute-on-chronic liver failure (ACLF) does not improve with conservative therapy. Acute pancreatitis (AP) can cause chronic liver disease progression to ACLF. However, deceased donor LT for patients with AP has had mixed results, and no consensus has been established regarding the indication for LT. We report the first successful living donor LT (LDLT) for ACLF caused by severe AP. The 38-year-old patient with alcoholic liver disease was transferred to our institute with worsening refractory ascites. During the pretransplant workup, she developed severe acute necrotizing pancreatitis, resulting in grade 3 ACLF. The patient's clinical course was further complicated by high levels of donor-specific antibodies and immune thrombocytopenia. The AP gradually improved after intensive care combined with artificial liver support. The patient successfully underwent urgent LDLT with upfront splenectomy and desensitization therapy, including plasm exchange, high-dose intravenous immunoglobulin, and anti-thymocyte globulin. No infection or recurrence of AP was observed postoperatively. We conclude that LDLT is a feasible option for ACLF patients caused by severe AP if a deceased donor is not readily available.

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Hepatic venous outflow obstruction after adult living donor liver transplantation

Yuzuru Sambommatsu, Keita Shimata, Masaki Honda, Kazuya Hirukawa, Yuto Sakurai, Masatsugu Ishii, Sho Ibuki, Kaori Isono, Tomoaki Irie, Seiichi Kawabata, Hiroki Hirao, Yasuhiko Sugawara, Yoshitaka Tamura, Osamu Ikeda, Toshinori Hirai, Yukihiro Inomata, Jun Morinaga, Taizo Hibi

Liver Transplantation ( Ovid Technologies (Wolters Kluwer Health) ) 2023年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Hepatic venous outflow obstruction (HVOO) is a rare but critical vascular complication after adult living donor liver transplantation. We categorized HVOOs according to their morphology (anastomotic stenosis, kinking, intrahepatic stenosis) and onset (early-onset < 3 mo vs. late-onset ≥ 3 mo). Overall, 16/324 (4.9%) patients developed HVOO between 2000 and 2020. Fifteen patients underwent interventional radiology. Of the 16 hepatic venous anastomoses within these 15 patients, 12 were anastomotic stenosis, 2 were kinking, and 2 were intrahepatic stenoses. All of the kinking and intrahepatic stenoses required stent placement, but most of the anastomotic stenoses (11/12, 92%) were successfully managed with balloon angioplasty, which avoided stent placement. Graft survival tended to be worse for patients with late-onset HVOO than early-onset HVOO (40% vs. 69.3% at 5 y, p = 0.162) despite successful interventional radiology. In conclusion, repeat balloon angioplasty can be considered for simple anastomotic stenosis, but stent placement is recommended for kinking or intrahepatic stenosis. Close follow-up is recommended in patients with late-onset HVOO even after successful treatment.

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Short-term and long-term outcomes of donor and recipient in living donor liver transplantation using variant grafts.

Suk Kyun Hong, Nobuhisa Akamatsu, Takashi Ito, Young-In Yoon, Jinsoo Rhu, Takeo Toshima, Keita Shimata, Jae Geun Lee, Kwang-Woong Lee, Toru Ikegami, Sung-Gyu Lee, YoungRok Choi, Nam-Joon Yi, Kyung-Suk Suh

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 29 ( 8 ) 900 - 905 2023年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Elevated Alfa-Fetoprotein and Des-Gamma-Carboxy Prothrombin Levels Predict Poor Outcomes After Liver Transplantation for Hepatocellular Carcinoma Beyond the Japan Criteria

Masatsugu Ishii, Sho Ibuki, Jun Morinaga, Keita Shimata, Kazuya Hirukawa, Kaori Isono, Masaki Honda, Yasuhiko Sugawara, Yukihiro Inomata, Taizo Hibi

Transplantation Proceedings ( Elsevier BV ) 2023年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Recent advances in surgical strategies and liver transplantation for hepatoblastoma.

Masaki Honda, Koushi Uchida, Tomoaki Irie, Kazuya Hirukawa, Masashi Kadohisa, Keita Shimata, Kaori Isono, Naoki Shimojima, Yasuhiko Sugawara, Taizo Hibi

Cancer medicine 12 ( 4 ) 3909 - 3918 2023年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Hepatoblastoma (HB) is the most common malignant liver tumor in children. Although the development of treatment strategies with advances in chemotherapy has greatly improved the prognosis of HB, surgical resection and liver transplantation still play a vital role in the treatment of HB. In recent years, technological innovations have led to the development of new surgical approaches for HB. In this review, we describe the latest research on the surgical management of HB, including new imaging technologies, minimally invasive approaches, and the application of associating liver partition portal vein ligation for staged hepatectomy. We also discuss the current role of liver transplantation, use of ante-situm or ex-situ liver resection with auto-transplantation, and management of metastatic HB.

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Impact of COVID-19 on living donor liver and kidney transplantation programs in Japan in 2020.

Kaori Kuramitsu, Shigeyoshi Yamanaga, Ryosuke Osawa, Taizo Hibi, Mikiko Yoshikawa, Mariko Toyoda, Keita Shimata, Ebisu Yosuke, Minoru Ono, Takashi Kenmochi, Hiroshi Sogawa, Yoichiro Natori, Harumi Yano, Toyofumi Chen-Yoshikawa, Kazunari Yoshida, Takumi Fukumoto, Kenji Yuzawa, Hiroto Egawa

Transplant infectious disease : an official journal of the Transplantation Society 24 ( 3 ) e13845 2022年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

BACKGROUND: Although many transplant programs have been forced to suspend living donor transplants due to the emergence of coronavirus disease (COVID-19), there are relatively few real-time databases to assess center-level transplant activities. We aimed to delineate the actual impact of COVID-19 on living donor transplant programs and the resumption process in Japan. METHODS: In a nationwide survey, questionnaires were sent to 32 liver transplant programs that had performed at least more than one case of living donor liver transplantation in 2019 and 132 kidney transplant programs that had performed more than one living donor kidney transplantation in 2018. RESULTS: Thirty-one (96.9%) and 125 (94.7%) liver and kidney transplant programs responded, respectively. In the early pandemic period, 67.7% (21/31) of liver programs and 29.8% (37/125) of kidney programs were able to maintain transplant activities similar to those during the pre-pandemic period. After temporal suspension, 58.1% of kidney programs resumed their transplant activity after the number of local COVID-19 cases peaked. Establishing institutional COVID-19 screening, triage, and therapeutic management protocols was mandatory to resume transplant activity for 64.5% and 67.7% of liver and kidney programs, respectively. In the future wave of COVID-19, 67.7% of liver programs would be affected by institutional COVID-19 intensive care unit-bound patient numbers, and 55.7% of kidney programs would stop if hospital-acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection spreads. CONCLUSIONS: THIS NATIONWIDE SURVEY REVEALED FOR THE FIRST TIME HOW LIVING DONOR LIVER AND KIDNEY: transplant programs changed in response to the COVID-19 pandemic in a country where living donor transplantations are predominant.

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SOX9 contributes to the progression of ductular reaction for the protection from chronic liver injury.

Daiki Yoshii, Keita Shimata, Yuji Yokouchi, Yoshihiro Komohara, Hiroko Suda, Masaki Honda, Kenichi Yamamura, Taizo Hibi, Yukihiro Inomata

Human cell 35 ( 2 ) 721 - 734 2022年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

The transcription factor sex-determining region Y-box 9 (SOX9) is a biliary epithelial marker ectopically expressed in hepatocytes (SOX9 + hepatocytes). SOX9 + hepatocytes are believed to function in ductular reaction (DR), recognized as an essential phenomenon related to liver regeneration; however, the functional role of SOX9 and clinical implications of SOX9 + hepatocytes in DR progression are unclear. Human and mouse liver samples were subjected to immunohistochemical and gene functional analyses to investigate the functional role of SOX9 and the clinical significance of SOX9 + hepatocytes. SOX9 + hepatocytes were observed in a bile duct ligation (BDL) mouse model. Forced Sox9 expression in mouse hepatocytes by hydrodynamic injection converted them into cholangiocyte-like cells. DR progression was slower in liver epithelium-specific Sox9-knockout BDL mice than in wild-type BDL mice. SOX9 + hepatocytes were also observed in rare pediatric liver disease biliary atresia (BA). In patients with BA who underwent liver transplantation (LT), the median number of SOX9 + hepatocytes at LT was significantly lower than that at Kasai portoenterostomy (KP) performed prior to LT (P < 0.001). The high SOX9 + hepatocyte group at KP demonstrated significantly better native liver survival rates than the low SOX9 + hepatocyte group at a cut-off of 390 cells/mm2 (P = 0.019, log-rank test). Ectopic expression of SOX9 in hepatocytes of chronically injured livers may exert protective effects in DR progression. To our knowledge, this is the first study showing that SOX9 + hepatocyte count at KP can be a promising biomarker to predict native liver survival after KP in patients with BA.

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Intellectual development of patients with biliary atresia who underwent living donor liver transplantation in infancy.

Seiichi Kawabata, Rieko Sakamoto, Keiichi Uto, Tomoaki Irie, Masashi Kadohisa, Keita Shimata, Yasuko Narita, Kaori Isono, Masaki Honda, Shintaro Hayashida, Yuki Ohya, Hidekazu Yamamoto, Hirotoshi Yamamoto, Miwako Nakano, Yasuhiko Sugawara, Yukihiro Inomata, Taizo Hibi

Pediatric surgery international 38 ( 2 ) 201 - 208 2022年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

BACKGROUND: The impact of pediatric liver transplantation on intellectual development has yet to be determined. We investigated the intellectual outcomes of school-aged patients after living donor liver transplantation for biliary atresia in infancy. METHODS: The Wechsler Intelligence Scale for Children-fourth edition test was administered to 20 patients who survived [Formula: see text] 5 years after living donor liver transplantation. Borderline full scale intelligence quotient was defined as ≤ 85. Pre-, peri-, and postoperative data were compared between patients with > 85 and ≤ 85 to identify predictive factors of borderline performance. RESULTS: The one-sample t test demonstrated that the mean full scale intelligence quotient of patients after transplantation for biliary atresia was significantly lower than that of the general population (91.8 vs. 100.0, p = 0.026) and 7 (35%) were classified as intellectual borderline functioning. Multivariable logistic regression models were unable to identify any factors predictive of full scale intelligence quotients of ≤ 85. CONCLUSION: This is the first study to indicate that the mean full scale intelligence quotient among school-aged patients who underwent living donor liver transplantation for biliary atresia in infancy is significantly lower than that of the general population.

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Surgical outcomes of domino liver transplantation using grafts from living donors with familial amyloid polyneuropathy.

Hidekazu Yamamoto, Yuzuru Sambommatsu, Masatsugu Ishii, Keita Shimata, Kaori Isono, Masaki Honda, Yasuhiko Sugawara, Yukihiro Inomata, Taizo Hibi

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 28 ( 4 ) 603 - 614 2022年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Domino liver transplantation (DLT) using grafts from donors with familial amyloid polyneuropathy is an acceptable procedure for expanding the donor pool. The vascular and biliary reconstructions in living donor DLT (LDDLT) are technically demanding, and data on the short- and long-term surgical outcomes of domino donors and recipients in LDDLT are limited. In this study, we identified 25 domino recipients from our LT program (1999-2018), analyzed the vascular and biliary reconstructions performed, and evaluated the surgical outcomes, including graft survival. Piggyback technique was adopted in all 25 domino donors. The only surgical complication in domino donors was HV stenosis with an incidence rate of 4%. In 22 domino recipients, right hepatic vein (HV) and middle/left HV were reconstructed separately. Ten recipients had two arteries anastomosed, and 18 underwent duct-to-duct biliary anastomosis. HV stenosis and biliary stricture had incidence rates of 8% and 24%, respectively, in the recipients, but none of them developed hepatic artery thrombosis. The 1- and 5-year graft survival rates were 100% each in the domino donors, and 84.0% and 67.3% in the domino recipients, respectively. In conclusion, LDDLT has acceptable outcomes without increasing the operative risk in donors despite the demanding surgical technique involved.

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MRI diffusion-weighted imaging detects a fresh portal vein thrombus as a high intensity lesion in a patient with a liver transplant: A case report.

Yasuyoshi Kuroiwa, Kazunori Kusumoto, Keita Shimata, Atsushi Yamashita, Taizo Hibi, Yujiro Asada, Takuroh Imamura

Acta radiologica open 10 ( 12 ) 20584601211069557 - 20584601211069557 2021年12月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Portal vein thrombosis is one of the most serious complications after liver transplantation. It is important to determine the age of the thrombus for management of portal vein thrombosis. We present a case report of histologically confirmed heterogenous fresh portal vein thrombus which was depicted heterogenous high signal intensity on magnetic resonance diffusion weighted imaging. The sequence may be a useful imaging tool for detecting fresh thrombus components in the portal vein thrombosis.

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Hungry Bone Syndrome After Living Donor Liver Transplant for Biliary Atresia.

Masaki Honda, Keita Shimata, Yuzuru Sambommatsu, Sho Ibuki, Kaori Isono, Hidekazu Yamamoto, Yasuhiko Sugawara, Seisuke Sakamoto, Yukihiro Inomata, Taizo Hibi

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 19 ( 4 ) 386 - 389 2021年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Hungry bone syndrome is a rare but potentially lethal complication that is characterized by rapid, severe, long-lasting hypocalcemia and hypophosphatemia secondary to increased bone metabolism. We present a case of hungry bone syndrome after living donor liver transplant for biliary atresia. Following a failed Kasai procedure for biliary atresia, a 5-month-old boy underwent living donor liver transplant with reduced left lateral lobe from his father. Despite the oral administration of alfacalcidol, the patient exhibited severe craniotabes before the surgery. He developed severe hypocalcemia and hypophosphatemia im-mediately after liver transplant and required supplementation of calcium and phosphorus for 1 month thereafter. After serum levels of calcium and phosphate had normalized, there was a rapid increase in the serum bone-type alkaline phosphatase level, and the craniotabes subsided remarkably. To our knowledge, this is the world's first reported case of hungry bone syndrome after liver transplant for cholestatic cirrhosis. It underscores the importance of strict nutritional and electrolyte management in the perioperative period. A prompt diagnosis and correction of hungry bone syndrome are imperative to prevent the associated significant morbidity and mortality.

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Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports.

Keita Shimata, Yasuhiko Sugawara, Tomoaki Irie, Yuzuru Sambommatsu, Masashi Kadohisa, Sho Ibuki, Seiichi Kawabata, Kaori Isono, Masaki Honda, Hidekazu Yamamoto, Taizo Hibi

BMC gastroenterology 20 ( 1 ) 378 - 378 2020年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

BACKGROUND: Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. CASE PRESENTATION: CASE 1: A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient's right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. CASE 2: A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. CONCLUSIONS: Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis.

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Living donor domino liver transplantation in a hepatitis C virus/human immunodeficiency virus-coinfected hemophilia patient: a case report.

Hidekazu Yamamoto, Yasuhiko Sugawara, Yuzuru Sambommatsu, Keita Shimata, Daiki Yoshii, Kaori Isono, Masaki Honda, Taro Yamashita, Shuzo Matsushita, Yukihiro Inomata, Taizo Hibi

Surgical case reports 6 ( 1 ) 184 - 184 2020年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

BACKGROUND: Outcome of the liver transplantation (LT) is worse in hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfected patients compared to patients infected with HCV alone. We report the world's first case of living donor domino liver transplantation (LDDLT) using a familial amyloid polyneuropathy (FAP) liver in a coinfected recipient with HCV-related liver cirrhosis. CASE PRESENTATION: The recipient was a 43-year-old male with a CD4 cell count of 52/μL and undetectable HIV-RNA at the time of LT. He received a domino liver graft from a 41-year-old female with FAP. No acute cellular rejection or infection occurred after LT. HCV recurrence was confirmed histologically on the posttransplant day 34. Peginterferon/ribavirin therapy resulted in non-response; however, the patient achieved a sustained viral response with sofosbuvir (SOF)/ledipasvir (LDV). Currently, HCV and HIV testing are negative, and symptomatic de novo amyloidosis has not occurred. CONCLUSIONS: LDDLT allows successful LT in HCV/HIV-coinfected patients; posttransplant HCV recurrence can be successfully treated with anti-viral therapy.

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Portal Vein Complications After Adult Living Donor Liver Transplantation: Time of Onset and Deformity Patterns Affect Long-Term Outcomes

Yuzuru Sambommatsu, Keita Shimata, Sho Ibuki, Yasuko Narita, Kaori Isono, Masaki Honda, Tomoaki Irie, Masashi Kadohisa, Seiichi Kawabata, Hidekazu Yamamoto, Yasuhiko Sugawara, Osamu Ikeda, Yukihiro Inomata, Taizo Hibi

Liver Transplantation 2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Portal vein complications (PVCs) after adult living donor liver transplantation (LDLT) are potentially lethal. We categorized PVCs by the time of onset (early versus late, <1 month versus ≥1 month, respectively) and deformity patterns (portal vein stenosis [PVS], portal vein thrombosis [PVT], and portal vein occlusion [PVO]) to establish optimal treatment strategies. Overall, 35/322 (10.9%) recipients developed PVCs between 2000 and 2019. Pretransplant PVT (odds ratio [OR], 15.20; 95% confidence interval [CI], 3.70-62.40; P < 0.001) was the only independent risk factor for PVS. In contrast, male sex (OR, 5.57; 95% CI, 1.71-18.20; P = 0.004), pretransplant PVT (OR, 4.79; 95% CI, 1.64-14.00; P = 0.004), and splenectomy (OR, 3.24; 95% CI, 1.23-8.57; P = 0.018) were independent risk factors for PVT. PVS was successfully treated with interventional radiology regardless of its time of onset. On the other hand, late PVT and PVO had significantly lower treatment success rates (2/15, 13%) compared with those that occurred in the early period (10/11, 91%) despite aggressive intervention (P < 0.001). Deformity patterns had a significant impact on the 5-year cumulative incidence of graft loss as a result of PVC (PVO + Yerdel grades 2-4 PVT group [n = 16], 41% versus PVS + Yerdel grade 1 PVT group [n = 19], 0%; P = 0.02). In conclusion, late grades 2 to 4 PVT and PVO are refractory to treatment and associated with poor prognoses, whereas PVS has a good prognosis regardless of time of onset. A tailored approach according to the time of onset and deformity patterns of PVC is essential.

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Long-term outcomes of living donor liver transplantation in patients with a prior history of nonhepatic malignancy

Hidekazu Yamamoto, Yuzuru Sambommatsu, Sho Ibuki, Keita Shimata, Yasuhiko Sugawara, Taizo Hibi

BioScience Trends 14 ( 1 ) 42 - 47 2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

© 2020 International Advancement Center for Medicine and Health Research Co., Ltd. Posttransplant malignancy has become a significant cause of mortality. Data on the long-term outcomes of patients with pretransplant nonhepatic malignancy (PTM) after living donor liver transplantation (LDLT) are scarce, although the recipients of other organs with PTM have been reported to have a poor survival. Fifteen patients with PTM (4.4%) among the 342 adult recipients were identified in our LDLT programs. The outcomes of the patients with PTM after LDLT were compared to those of patients without PTM in terms of the all-cause mortality and cancer-specific mortality (defined as mortality related to malignancy expect for hepatocellular carcinoma, cholangiocarcinoma, or neuroendocrine tumor). The sites of PTM included the breast in six, stomach in two, and colon, lung, kidney, uterine, thyroid, larynx, and acute myelogenous leukemia in one each. The median interval from the PTM treatment to LDLT was 57 months (range, 2-298). The patients who received the curative treatment for PTM were selected as the recipients. No patients with PTM had recurrence during the follow-up period. The 1-, 5-, and 10-year patient survival rates were 100%, 92.9%, and 92.9% in the PTM group and 86.2%, 76.7%, and 68.5% in the non-PTM group, respectively (p = 0.142). Likewise, there was no significant difference between the two groups in the cancer-specific mortality. In conclusion, the patients with PTM had comparable outcomes with regard to mortality and cancer-specific mortality compared with those without PTM. This study showed that the patients with PTM can obtain an acceptable outcome after LDLT when carefully selected.

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