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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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）

© 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）

© 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）

© 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）

© 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）

© 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）

© 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）

© 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）

© 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）

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）

© 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）

© 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）

© 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）

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