論文 - 嶋田　圭太

Ki67 expression level at the time of Kasai portoenterostomy as a prognostic factor in patients with biliary atresia

Daiki Yoshii, Yukihiro Inomata, Yoshihiro Komohara, Keita Shimata, Masaki Honda, Shintaro Hayashida, Yuki Oya, Hidekazu Yamamoto, Hirotoshi Yamamoto, Yasuhiko Sugawara, Taizo Hibi

BJS Open     2020年 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Efficacy of repeated balloon venoplasty for treatment of hepatic venous outflow obstruction after pediatric living-donor liver transplantation: A single-institution experience.

Shimata K, Sugawara Y, Honda M, Ikeda O, Tamura Y, Hayashida S, Ohya Y, Yamamoto H, Yamashita Y, Inomata Y, Hibi T

Pediatric transplantation ( Pediatric Transplantation )  23 ( 6 ) e13522   2019年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019 Wiley Periodicals, Inc. HVOO is a rare complication after LT and an important cause of graft failure. Balloon venoplasty is the first-line treatment for HVOO, but the effect of repeated balloon venoplasty and stent placement for HVOO recurrence after pediatric LDLT remains unclear. Between 1998 and 2016, 147 pediatric patients underwent LDLT in our institution. Among them, the incidence of HVOO and the therapeutic strategy were retrospectively reviewed. Ten patients were diagnosed with HVOO. All the patients underwent LLS grafts. Median age at the initial endovascular intervention was 2.7 years (range, 5 months-8 years). The median interval between the LDLT and the initial interventional radiology was 2.7 months (range, 29 days-35.7 months). Four patients experienced no recurrence after a single balloon venoplasty; 6 underwent balloon venoplasty more than 3 times because of HVOO recurrence; and 2 underwent stent placement due to the failure of repeated balloon venoplasty. All patients are alive with no symptoms of HVOO. The HVOO recurrence-free period after the last intervention ranged from 20 days to 15.5 years (median, 8.9 years). Repeated balloon venoplasty may prevent unnecessary stent placement to treat recurrent HVOO after pediatric LDLT.

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Single-center Experience of Living-donor Liver Transplantation in Patients Receiving Maintenance Renal Replacement Therapy

T. Irie, Y. Sugawara, Y. Narita, S. Ibuki, K. Shimata, H. Yamamoto, T. Hibi

Transplantation Proceedings   51 ( 5 ) 1520 - 1521   2019年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019 Elsevier Inc. Background: For most patients with liver failure receiving maintenance renal replacement therapy (RRT), treatment with living-donor liver transplantation (LDLT)alone is indicated in Japan. Material and Methods: We retrospectively reviewed patients who underwent LDLT while receiving RRT in our hospital. Results: Three of the 5 patients who underwent LDLT while on RRT died during the first year after transplantation. Conclusions: The indications for liver transplantation in patients on RRT require careful examination.

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Portal Vein Stent Placement in Living-donor Liver Transplantation: A Single-center Experience

Y. Narita, Y. Sugawara, S. Ibuki, T. Irie, K. Shimata, H. Yamamoto, T. Hibi

Transplantation Proceedings   51 ( 5 ) 1522 - 1524   2019年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019 Elsevier Inc. Introduction: Portal vein thrombosis (PVT)and portal vein stenosis (PVS)are rare complications after liver transplantation that can lead to graft failure and patient death. Material and methods: The aim of this study was to evaluate the effect of interventional treatment for PVT and PVS occlusion after liver transplantation. Follow-up data of 7 patients who underwent stent replacement for PVT and/or PVS were analyzed. The clinical success, complications, and portal vein patency were analyzed. Results: Clinical success was obtained in 6 of the 7 patients. No portal hypertension-related symptoms reoccurred in the 6 patients during the follow-up. Conclusions: Interventional radiologic treatment produced a high success rate and a favorable long-term outcome.

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Hydrogen-rich solution attenuates cold ischemia-reperfusion injury in rat liver transplantation

Uto K.

BMC Gastroenterology ( BMC Gastroenterology )  19 ( 1 )   2019年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019 The Author(s). Background: Liver transplantation (LT) is considered the standard treatment for end-stage liver disease, but ideal donors remain in limited supply, resulting in an unavoidable increase in the need to use grafts from marginal donors. The attenuation of ischemia-reperfusion injury (IRI) in such marginal donors is therefore crucial for reducing the possibility of the primary non-function of grafts and graft loss. Some reports have found that molecular-hydrogen showed antioxidant and anti-inflammatory effects in preventing IRI in some non-hepatic transplant models. Therefore, we investigated whether or not molecular-hydrogen could attenuate IRI in LT model rats. Methods: We used a hydrogen-rich water bath to dissolve hydrogen into solution and graft tissues and performed isogenic and orthotopic LT in Lewis rats with University of Wisconsin (UW) solution. Blood and tissue samples were collected 6 h after the reperfusion. Hepatic enzymes in serum were measured. Pathological findings including the expressions of cytokines and heme oxygenase (HO)-1 in liver tissues were evaluated. Results: The concentration of hydrogen inside the graft tissues increased depending on the storage time, plateauing after 1 h. Serum liver enzyme levels were significantly lower and the histology score of liver damage markedly attenuated in the group given grafts preserved in hydrogen-rich UW solution than in the control group. The hydrogen-rich UW solution group also showed less oxidative damage and hepatocyte apoptosis than the control group, and the expression of proinflammatory cytokines tended to be lower while the protein levels of HO-1 were significantly increased (n = 3-12 per group, P < 0.05). Conclusions: Storage of liver grafts in hydrogen-rich UW solution resulted in superior functional and morphologic protection against IRI via the up-regulation of HO-1 expression.

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Two-staged biliary reconstruction with temporary complete external biliary drainage as a bailout procedure in a pediatric patient after difficult living donor liver retransplantation

Yamamoto H.

Intractable and Rare Diseases Research ( Intractable and Rare Diseases Research )  8 ( 3 ) 214 - 216   2019年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019 International Advancement Center for Medicine and Health Research. All rights reserved. Biliary leakage at the site of the hepaticojejunostomy after liver transplantation is a life-threatening complication. We herein present the case of a 7-year-old girl who underwent complete external biliary drainage during difficult living donor liver retransplantation as a bailout procedure. The patient had undergone duct-to-duct biliary reconstruction in the initial living donor liver transplantation. In the retransplantation, Roux-en-Y (RY) reconstruction was planned but abandoned due to the critical condition in the operation. As an alternative procedure, the patient underwent complete external drainage using a 6Fr drainage tube with cuff. Five months after retransplantation when the nutrition status and physical strength of a patient recovered fully, RY hepaticojejunostomy was successfully performed. This is a case report of two-staged biliary reconstruction with temporary complete external biliary drainage used in pediatric liver retransplantation, which was performed after some months not a few days. It is a safe and feasible alternative when primary anastomosis is deemed to carry a high risk of bile leakage in cases of difficult liver transplantation in critically ill patients.

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Living donor liver transplantation for a patient with a history of total gastrectomy

Keita Shimata, Tomoaki Irie, Masashi Kadohisa, Seiichi Kawabata, Sho Ibuki, Yasuko Narita, Hidekazu Yamamoto, Yasuhiko Sugawara, Taizo Hibi

BioScience Trends   13 ( 2 ) 212 - 215   2019年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2019, International Advancement Center for Medicine and Health Research Co., Ltd. Adhesions due to previous upper abdominal surgery may complicate later liver transplantation. Here we report successful living donor liver transplantation (LDLT) in a patient with a history of total gastrectomy. A 32-year-old Japanese woman developed end-stage liver failure due to alcoholic cirrhosis. She had undergone total gastrectomy, pancreato-splenectomy, and partial colectomy due to rupture of a pancreatic cyst. LDLT was performed using a right lobe graft from her sister. To minimize blood loss and injury to the jejunum, adhesions between the left lobe and nearby organs were dissected without blood flow in or out of the liver. The right liver graft was implanted uneventfully. She was extubated on postoperative day (POD) 1, but then developed septic shock due to aspiration pneumonia on POD 2. She was reintubated and antibiotics and antifungal agents were administered. Administration of tacrolimus was changed to an intravenous route on POD 3. Her condition improved and she was re-extubated on POD 9. On POD 14, tacrolimus was administered orally. She was discharged from our hospital on POD 30 without any other events and is doing well 6 months after LDLT. We believe that careful planning, such as mobilizing the left lobe with the blood flow blocked just before liver explantation, elevating the head of the bed during tube-feeding, and calculating the area under the curve after drug administration will enable liver transplantation for patients with a history of total gastrectomy.

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Long-term Outcomes of ABO-incompatible Pediatric Living Donor Liver Transplantation

Masaki Honda, Yasuhiko Sugawara, Masashi Kadohisa, Keita Shimata, Masataka Sakisaka, Daiki Yoshii, Keiichi Uto, Shintaro Hayashida, Yuki Ohya, Hidekazu Yamamoto, Hirotoshi Yamamoto, Yukihiro Inomata, Taizo Hibi

Transplantation   102 ( 10 ) 1702 - 1709   2018年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2018 Wolters Kluwer Health, Inc. All rights reserved. Background ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been performed to compensate for donor shortage. To date, few studies have reported detailed B-cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT. Methods Twenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age < 18; n = 10). Results There were no significant differences in the incidence of infection, vascular complications, biliary complications, and acute cellular rejection between ABOi and non-ABOi groups. The cumulative graft survival rate at 1, 3, and 5 years for non-ABOi group were 92.1%, 87.0%, and 86.1%, and those for ABOi group were 82.8%, 82.8%, and 78.2%, respectively. Rituximab-based desensitization protocol could be performed safely, and reduced CD19+ lymphocyte counts effectively. Although rituximab-treated ABOi group showed comparable clinical outcomes and graft survival rate, 2 patients developed antibody-mediated rejection. Conclusions ABOi LDLT is a feasible option for pediatric end-stage liver disease patients. However, it should be noted that current desensitization protocol does not completely prevent the onset of antibody-mediated rejection in several cases.

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Duodenal Ulcer as a Postoperative Complication in the Donor in Living-Donor Liver Transplantation

Kadohisa M.

Transplantation Proceedings ( Transplantation Proceedings )  50 ( 4 ) 1129 - 1131   2018年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2018 Elsevier Inc. Introduction: Donor safety is one of the most important factors in living-donor liver transplantation. Duodenal ulcer (DU) is a common postoperative complication. Here we aimed to reveal the risk factors associated with postoperative DU in the donors. Methods: Between April 2007 and March 2017, 318 cases underwent donor hepatectomy for liver transplantation at Kumamoto University Hospital. We classified the donors into two groups: a DU group and a non-DU group. DU was defined as mucosal break with unequivocal depth requiring an endoscopic procedure. The characteristics and clinical factors of the donors were retrospectively analyzed. Results: Postoperative DU occurred in 17 donors during the study period. The mean interval after donor hepatectomy to occurrence of DU was 124.8 ± 185.4 days. The two groups were comparable in terms of age at time of the donor hepatectomy (P =.45). The male-to-female ratio (P =.03) was significantly different between the two groups and left-side hepatectomy was performed more often in the DU group (P =.003). Multivariable logistic regression revealed that left-side hepatectomy was independently associated with postoperative DU in the donors. Conclusions: These findings indicated that left-side hepatectomy is a risk factor for postoperative DU in the donors.

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A Case Report of Living Donor Liver Transplantation for Fulminant Hepatitis Related to Hepatitis E Virus Infection

Keita Shimata, Yasuhiko Sugawara, Hidekazu Yamamoto, Hiroaki Okamoto, Koushi Uchida, Seiichi Kawabata, Kaori Isono, Shintaro Hayashida, Yukihiro Inomata

Progress in transplantation (Aliso Viejo, Calif.)   28 ( 1 ) 91 - 92   2018年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Hepatitis E virus (HEV) infection which may become fulminant, especially in elderly people is more common than previously recognized in develop countries. Here we report successful living-donor liver transplantation (LDLT) in a case of acute liver failure due to HEV. A 63-year-old Japanese man with no previous history of liver disease was admitted for severe acute hepatitis. Detection of anti-HEV immunoglobulin A established a diagnosis of this virus-related liver failure. The patient suffered from hepatic encephalopathy 10 days after symptom onset and underwent LDLT. The patient had an uneventful course. The HEV RNA showed spontaneous negative conversion 10 weeks after LDLT. LDLT led to a successful outcome in a patient with acute liver failure due to HEV infection and regular testing for HEV RNA should be performed until HEV RNA is undetectable.

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The outcomes of pediatric liver retransplantation from a living donor: a 17-year single-center experience

Kohei Miura, Seisuke Sakamoto, Keita Shimata, Masaki Honda, Takashi Kobayashi, Toshifumi Wakai, Yasuhiko Sugawara, Yukihiro Inomata

Surgery Today   47 ( 11 ) 1405 - 1414   2017年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2017, Springer Japan. Purpose: Liver retransplantation is the only therapeutic option for patients with graft failure after liver transplantation. The aim of this study is to evaluate the outcomes of pediatric retransplantation from living donor at a single center. Methods: Between December 1998 to August 2015, retransplantation from a living donor was performed for 14 children (<18 years of age) at Kumamoto University Hospital. The characteristics of the retransplantation recipient and the clinicopathological factors between primary transplantation and retransplantation were analyzed to detect the prognostic factors. Results: In retransplantation, the operative time was longer and the amount of blood loss was greater in comparison to primary transplantation. The 1-, 3-, and 5-year survival rates from the date of retransplantation were 85.7, 85.7, and 78.6%, respectively. The rates of re-laparotomy after primary transplantation, bile leakage and postoperative bleeding after retransplantation were higher than after primary transplantation. Among the three patients who died after retransplantation, the operative time, the rate of re-laparotomy after primary transplantation and the incidence of gastrointestinal complications were higher in comparison to the surviving patients. Conclusion: Pediatric retransplantation from a living donor is an acceptable procedure that could save the lives of recipients with failing allografts when organs from deceased donors are scarce. To ensure good results, it is essential to make an appropriate assessment of the cardiopulmonary function and the infectious state of the patients before Re-LDLT.

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Fatal graft-versus-host disease after living-donor liver transplantation from an HLA-DR-mismatched donor

Shimata, K; Sakamoto, R; Anan, T; Uchida, K; Honda, M; Kouroki, M; Urabe, T; Hayashida, S; Yamamoto, H; Sugawara, Y; Inomata, Y

PEDIATRIC TRANSPLANTATION ( Pediatric Transplantation )  21 ( 7 )   2017年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Acute GVHD is a rare complication after liver transplantation that has a high mortality rate. We experienced an infant case complicated with acute GVHD. An 8-month-old infant with biliary atresia underwent LDLT with a graft obtained from his mother. Their HLAs showed a donor-dominant one-way match, not at HLA-DR but at HLA-A, HLA-B, and HLA-C (recipient; A 31/33, B 51/54, C 1/14, DR 9/11, donor; A 31/-, B 51/-, C 14/-, DR 8/11). The patient exhibited a high fever, skin rash, and diarrhea, and was diagnosed with acute GVHD based on the blood chimerism test. Despite immunosuppression treatment with prednisolone and tacrolimus, plasma exchange, blood transfusion including cord blood transplantation, and antibiotics, the child died on postoperative day 126. Donor-dominant one-way matching at HLA class 1 can be a high-risk factor for acute GVHD despite HLA class 2 mismatching.

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Antibody-mediated rejection after ABO-incompatible pediatric living donor liver transplantation for propionic acidemia: A case report

Honda, M; Sakamoto, S; Sakamoto, R; Matsumoto, S; Irie, T; Uchida, K; Shimata, K; Kawabata, S; Isono, K; Hayashida, S; Yamamoto, H; Endo, F; Inomata, Y

PEDIATRIC TRANSPLANTATION ( Pediatric Transplantation )  20 ( 6 ) 840 - 845   2016年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd We herein present the case of a four-yr-old boy with PA who developed AMR after ABO-incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO-incompatible LDLT 36 days after the administration of rituximab. The CD19+ lymphocyte count just prior to LDLT was 1.2%. He developed AMR five days after LDLT, and the antidonor-type IgM and IgG antibody titers increased to 1:1024 and 1:1024, respectively. He was treated by plasma exchange, IVIG, steroid pulse therapy, and rituximab re-administration; however, his liver dysfunction continued. Despite intensive treatment, he died due to complicated abdominal hernia, acute renal failure, and ARDS. This case suggests that a streptococcal infection may induce the activation of innate immune responses; thus, additional desensitization therapy should be considered prior to ABO-incompatible LDLT if B cell reactivation is suspected.

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Living Donor Domino Liver Transplantation Using Familial Amyloid Polyneuropathy Grafts; Surgical Consequence and De novo Amyloid Neuropathy

Hidekazu Yamamoto, Yasuko Narita, Keiichi Uto, Shintaro Hashimoto, Masataka Sakisaka, Daiki Yoshii, Koshi Uchida, Keita Shimata, Seiichi Kawabata, Kaori Isono, Masaki Honda, Shintaro Hayashida, Seisuke Sakamoto, Yukihiro Inomata

TRANSPLANTATION ( LIPPINCOTT WILLIAMS & WILKINS )  100   S116 - S117   2016年05月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）