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Hayashi K, Tanaka Y, Tsuda T, Nomura A, Fujino N, Furusho H, Sakai N, Iwata Y, Usui S, Sakata K, Kato T, Tada H, Kusayama T, Usuda K, Kawashiri MA, Passman RS, Wada T, Yamagishi M, Takamura M, Fujino N, Nohara A, Kawashiri MA, Hayashi K, Sakata K, Yoshimuta T, Konno T, Funada A, Tada H, Nakanishi C, Hodatsu A, Mori M, Tsuda T, Teramoto R, Nagata Y, Nomura A, Shimojima M, Yoshida S, Yoshida T, Hachiya S, Tamura Y, Kashihara Y, Kobayashi T, Shibayama J, Inaba S, Matsubara T, Yasuda T, Miwa K, Inoue M, Fujita T, Yakuta Y, Aburao T, Matsui T, Higashi K, Koga T, Hikishima K, Namura M, Horita Y, Ikeda M, Terai H, Gamou T, Tama N, Kimura R, Tsujimoto D, Nakahashi T, Ueda K, Ino H, Higashikata T, Kaneda T, Takata M, Yamamoto R, Yoshikawa T, Ohira M, Suematsu T, Tagawa S, Inoue T, Okada H, Kita Y, Fujita C, Ukawa N, Inoguchi Y, Ito Y, Araki T, Oe K, Minamoto M, Yokawa J, Tanaka Y, Mori K, Taguchi T, Kaku B, Katsuda S, Hirase H, Haraki T, Fujioka K, Terada K, Ichise T, Maekawa N, Higashi M, Okeie K, Kiyama M, Ota M, Todo Y, Aoyama T, Yamaguchi M, Noji Y, Mabuchi T, Yagi M, Niwa S, Takashima Y, Murai K, Nishikawa T, Mizuno S, Ohsato K, Misawa K, Kokado H, Michishita I, Iwaki T, Nozue T, Katoh H, Nakashima K, Ito S, Yamagishi M. Correction: Characterization of baseline clinical factors associated with incident worsening kidney function in patients with non-valvular atrial fibrillation: the Hokuriku-Plus AF Registry. Heart Vessels 2023; 38:412. [PMID: 36508013 DOI: 10.1007/s00380-022-02218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshihiro Tanaka
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Toyonobu Tsuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroshi Furusho
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Cardiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki-higashi, Kanazawa, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Keisuke Usuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Rod S Passman
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Osaka University of Human Sciences, Settsu, Osaka, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Nakagawa A, Endo T, Kawaguchi T, Yamada M, Sato C, Kumabe T, Iwasaki M, Niizuma K, Kanamori M, Nakanishi C, Yamashita S, Nakano T, Tominaga T. Piezo Actuator-Driven Pulsed Water Jet for Neurosurgery: Laboratory Evaluation with the Swine Model and Implications of Mechanical Properties. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 36252769 DOI: 10.1055/a-1962-1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Object Pulsed water jet is an emerging surgical instrumentation intended to achieve both maximal lesion resection and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The piezo actuator-driven pulsed water jet (ADPJ) is a new technology that can deliver a precisely controlled uniform and efficient pulsed water jet with minimum water flow. The present study evaluated the ADPJ system in preclinical animal studies in the swine brain, and investigated breaking strength, one of the parameters for mechanical properties, to elucidate the mechanism of tissue selectivity for tissue dissection by the water jet. Methods This system consisted of a pump chamber driven by a piezo actuator, a stainless steel tube, and a nozzle (internal diameter: 0.15 mm). The water was supplied at 6 ml/min. The relationship between input voltage (3-25 V at 400 Hz) and peak pressure was measured using a pressure sensor through a sensing hole. Temporal profile of dissection depth during moving application was evaluated using gelatin brain phantom and swine brain. The dissected specimens were evaluated histologically. The mechanical property (breaking strength) of swine brain was measured by a compact table-top universal tester. Results Peak pressure increased linearly with increase in the input voltage, which reflected dissection depth in both the gelatin brain phantom and swine brain. Small arteries were preserved, and minimum damage to surrounding tissues occurred. The breaking strength of arachnoid membrane (0.12 ± 0.014 MPa) was significantly higher compared to gray matter (0.030 ± 0.010 MPa) and white matter (0.056 ± 0.009 MPa) (p < 0.05). The breaking strength of gray matter corresponded to that of 3 wt% gelatin, and that of white matter corresponded to a value between those of 3.5 and 4 wt% gelatin, and the dissection depth seemed to be estimated by 3-4 wt% gelatin. Conclusion The present study suggests that the ADPJ system has the potential to achieve accurate tissue dissection with preservation of blood vessels in neurosurgery. The difference in breaking strength may explain the tissue selectivity between brain parenchyma and tissue protected by the arachnoid membrane.
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Affiliation(s)
- Atsuhiro Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Biodesign, Clinical Research, Innovation, Education Center, Tohoku University Hospital, Sendai, Japan
| | | | - Tomohiro Kawaguchi
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Masato Yamada
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kuniyasu Niizuma
- Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakano
- Division of Gastroenterology and Hepatobiliary Pancreatic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Ujiie N, Nakano T, Yamada M, Sato C, Nakanishi C, Fujishima F, Ito K, Shindo T, Shimokawa H, Kamei T. Low-energy extracorporeal shock wave therapy for a model of liver cirrhosis ameliorates liver fibrosis and liver function. Sci Rep 2020; 10:2405. [PMID: 32051434 PMCID: PMC7016168 DOI: 10.1038/s41598-020-58369-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/06/2020] [Indexed: 12/02/2022] Open
Abstract
Low-energy extracorporeal shock waves (LESW) have been studied as a new treatment for angina pectoris and several ischemic diseases because of its effect on angiogenesis and inhibition of fibrosis of the heart. The effect of LESW on fibrosis in liver cirrhosis has not been studied. The aim of this study was to verify the amelioration of liver fibrosis by LESW and elucidate its mechanisms in a rat model of drug-induced liver cirrhosis. Male Wistar rats aged 7 weeks were injected with carbon tetrachloride intraperitoneally twice a week for 12 weeks. Eight rats underwent LESW therapy (0.25 mJ/mm2, 4 Hz, 1000 shots) under general anesthesia (shock wave group). Seven rats only underwent general anesthesia (control group). Quantitative analysis showed that the area of fibrosis in the shock wave group was significantly reduced compared with the control group (11,899.9 vs. 23,525.3 pixels per field, p < 0.001). In the shock wave group, the mRNA expression of transforming growth factor (TGF)-β1 was significantly suppressed (0.40-fold, p = 0.018) and vascular endothelial growth factor-B was significantly increased (1.77-fold, p = 0.006) compared with the control group. Serum albumin was significantly higher in the shock wave group than in the control group (3.0 vs. 2.4 g/dl, p = 0.025). Aspartate aminotransferase/alanine aminotransferase ratio decreased by LESW compared with the control group (1.49 vs. 2.04, p = 0.013). These results suggest that LESW therapy ameliorates liver fibrosis by reducing the expression of TGF-β1 and increasing the expression of angiogenic factors, and improves hepatic function.
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Affiliation(s)
- Naoto Ujiie
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toru Nakano
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Division of Gastroenterologic and Hepatobiliarypancreatic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan.
| | - Masato Yamada
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Yoshida S, Nomura A, Tada H, Sakata K, Nakanishi C, Fujino N, Hosomichi K, Tajima A, Takamura M. 3073Leveraging transcriptome sequencing for detecting novel disease-related pathways using human cardiac sarcoidosis myocardium biopsies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Cardiac sarcoidosis (CS) is one of the main causes of poor outcomes in patients with sarcoidosis, a systemic granulomatous disorder of complex etiology including a genetically susceptible host and specific exposure to disease-triggering antigens. Recently, transcriptome analysis using sarcoidosis peripheral monocytes was reported to be useful for exploring genetic susceptibility and novel disease-causing pathways. However, transcriptome sequencing has not been used to explore disease-related genes and pathways directly using human CS myocardial biopsies.
Purpose
This study aimed to identify transcriptome profiles and novel disease-related pathways of CS by comparing human CS myocardial biopsies with control samples using ribonucleic acid (RNA) sequencing (RNA-Seq).
Methods
We assessed 30 patients with suspected myocardial disorders who underwent transcatheter endomyocardial biopsies at our University Hospital, Japan. Of those, 7 were clinically diagnosed with CS, 9 with hypertrophic cardiomyopathy (HCM), and 14 with dilated cardiomyopathy (DCM). Messenger RNAs were extracted from cardiac muscle biopsies using the Ovation SoLo RNA-Seq System (NuGEN Technologies), according to the manufacturer's instructions. Sequencing was performed with coverage of approximately 20 million reads per sample using Illumina HiSeq 2000. Sequencing reads were mapped using the STAR 2-pass method with GRCh37 as the reference. The DESeq2 R package (version 3.8) was used for further analyses. Principal component analysis (PCA) on gene expression was conducted for detecting outliers such as non-muscular samples. Differential gene expression analysis was performed between the 7 patients with CS and 23 patients with cardiomyopathy (HCM and DCM, non-CS). Gene Ontology (GO) enrichment analysis was conducted to estimate possible disease-related pathways.
Results
We successfully sequenced 60 myocardial biopsy samples (original and biological duplicates) from 30 CS patients. Of these, 2 outlier samples shown by the PCA plot were removed, and 58 were used for further analyses. We found 243 genes that were differentially expressed between CS patients and non-CS patients. Top-rated genes were RP11–366M4.8, RELN, S100A6, WASF3and UCHL1. Pathway analysis using GO demonstrated enrichment oflymphocyte activation (P=4.8x10–16), organelle fission (P=6.1x10–14), the M phase of the mitotic cell cycle (P=2.2x10–13), nuclear division (P=2.4x10–13), mitosis (P=2.4x10–13) and T-cell activation pathways (P=1.2x10–12).
Conclusions
Our differential gene expression and pathway analysis results using human CS myocardial biopsies suggested that lymphocyte activation, specifically the T-cell activation pathway, is linked to CS pathogenesis. Further studies are needed to decipher the role of specific genes related to genetic susceptibility and/or pathways associated with CS occurrence.
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Affiliation(s)
- S Yoshida
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - A Nomura
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - H Tada
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - K Sakata
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - C Nakanishi
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - N Fujino
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
| | - K Hosomichi
- Kanazawa University Graduate School of Advance Preventive Medical Sciences, Department of Bioinformatics and Genomics, Kanazawa, Japan
| | - A Tajima
- Kanazawa University Graduate School of Advance Preventive Medical Sciences, Department of Bioinformatics and Genomics, Kanazawa, Japan
| | - M Takamura
- Kanazawa University Graduate School of Medicine, Department of Cardiology, Kanazawa, Japan
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Saitoh Y, Hara Y, Miyagi S, Nakanishi C, Nakanishi W, Nishimura R, Akamatsu D, Goto H, Unno M, Kamei T. Intraoperative modulation of arterial blood flow in a hybrid operating room: A report of three cases. Clin Case Rep 2019; 7:1839-1843. [PMID: 31624594 PMCID: PMC6787820 DOI: 10.1002/ccr3.2355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/04/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022] Open
Abstract
The preoperative modulation of arterial blood flow is widely performed to prevent massive intraoperative hemorrhage and unstable circulatory dynamics; however, this may cause complications. The intraoperative modulation of arterial blood flow can be performed with operation to reduce the physical and psychological stresses on the patients and improve intraoperative safety.
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Affiliation(s)
- Yoshikatsu Saitoh
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Yasuyuki Hara
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Wataru Nakanishi
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Ryuichi Nishimura
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Daijirou Akamatsu
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Hitoshi Goto
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Michiaki Unno
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Takashi Kamei
- Department of Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
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Nakanishi C, Miyagi S, Tokodai K, Nakanishi W, Nishimura R, Goto M, Unno M, Kamei T. Pediatric Living-Donor Liver Transplant Recipients without Transition After Reaching Adulthood. Ann Transplant 2019; 24:18-24. [PMID: 30617248 PMCID: PMC6338013 DOI: 10.12659/aot.911544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Transition to adult care can trigger certain problems for pediatric liver transplant recipients. At our institution, the same transplant team performs both adult and pediatric liver transplantation and post-transplant care; thus, pediatric liver transplant recipients do not have to be transferred. However, it is unclear whether this system affects the recipient’s outcome during the transition period. Therefore, we retrospectively assessed pediatric liver transplant recipients who reached adulthood at our institution. Material/Methods This was a single-center, retrospective study involving consecutive pediatric living-donor liver transplant recipients who reached the age of 18 by October 2017. A total of 36 recipients, 20 females and 16 males, were included in the study. Results The 5- and 10-year patient survival after reaching the age of 18 was 100% and 93%, respectively. All of the 3 patients who died had been suffering from secondary biliary cirrhosis due to biliary stricture. In 5 patients (13.9%), biliary stricture became symptomatic or recurred after reaching the age of 18 years. Late-onset acute rejection and chronic rejection developed in 2 (5.6%) and 4 patients (11.1%), respectively. Only 4 (11.1%) patients were obviously noncompliant. We found no significant association between compliance and rejection or survival. Among the patients who are 18 years old and older, 5 (13.9%) had a psychiatric diagnosis. Conclusions Pediatric liver transplant recipients who underwent transplant surgery and received post-transplant care at our institution have good long-term outcomes. This suggests that having the same team perform both adult and pediatric transplantation and post-transplant care is beneficial for young adult recipients.
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Affiliation(s)
- Chikashi Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryuichi Nishimura
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masafumi Goto
- Department of Transplantation and Regenerative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Miyagi S, Nakanishi C, Hara Y, Nakanishi W, Tokodai K, Shimizu K, Uematsu S, Kumata H, Kakizaki Y, Goto M, Kamei T, Unno M, Satomi S. Correlation Between Splenectomy and Portal Vein Complications in Living Donor Liver Transplantation. Transplant Proc 2018; 50:2611-2613. [PMID: 30401361 DOI: 10.1016/j.transproceed.2018.03.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/06/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In adults undergoing living donor liver transplantation (LDLT), the transplanted livers are partial grafts, and the portal venous pressure is higher than that observed with whole liver grafts. In patients undergoing LDLT concomitant with splenomegaly, portal venous flow is often diverted to collateral vessels, leading to a high risk of portal vein thrombosis. In such cases, occlusion of the collateral veins is important; however, complete occlusion of all collaterals without blocking the blood flow through the splenic artery causes portal hypertension and liver failure. We aimed to examine the effect of performing a splenectomy concomitant with LDLT to reduce portal vein complications. METHODS Between 1991 and 2017, we performed 170 LDLT operations, including 83 in adults. For this cohort study, adult cases were divided into 2 groups. Group I was those who underwent LDLT without splenectomy (n = 60); Group II was those who underwent LDLT with splenectomy for the reduction of portal hypertension (n = 23). We investigated the incident rates of complications, including blood loss, lethal portal vein thrombosis (intrahepatic thrombosis), acute rejection, and so on. We also investigated the survival rates in both groups. RESULTS The incident rate of lethal portal vein thrombosis in Group II was significantly lower than that observed in Group I (4.4% vs 21.7%, respectively, P = .0363). There were no statistically significant differences observed between the groups with respect to blood loss, survival rates, and other such parameters. CONCLUSION LDLT concomitant with splenectomy might effectively reduce the occurrence of portal vein complications in adults.
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Affiliation(s)
- S Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - C Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Hara
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - W Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Shimizu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Uematsu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Kumata
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Kakizaki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Goto
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Satomi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Miyazawa K, Miyagi S, Nakanishi C, Hara Y, Tokodai K, Nakanishi W, Uematsu S, Shimizu K, Goto M, Kamei T, Unno M. Effect of Middle Hepatic Vein Tributaries Preserving Technique Until Just Before Graft Retrieval on Donors' Surgical Outcomes in Living Donor Liver Transplantation. Transplant Proc 2018; 50:2636-2639. [PMID: 30401365 DOI: 10.1016/j.transproceed.2018.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/02/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The technique of preserving the major tributaries of the middle hepatic vein (MHV) (V5 and V8) until just before graft retrieval is beneficial to minimize congestion time of the graft. However, it remains unclear whether this technique exerts a burden on donors in terms of operative time, blood loss, and postoperative hepatic dysfunction. In this study we investigated adverse effects of the MHV tributaries preserving technique until immediately before graft retrieval on donors' surgical outcomes. METHODS Data from 71 donors who underwent right hepatectomy without MHV for a liver transplantation at our hospital from January 2002 to August 2016 were retrospectively reviewed. Donors were divided into 3 groups as follows: group 1 (n = 12), no MHV tributary reconstruction; group 2 (n = 33), single MHV tributary reconstruction; group 3 (n = 26), 2 or 3 MHV tributaries reconstruction. Donor operation time, blood loss, proportion of the remnant liver, maximum postoperative total bilirubin, aspartate aminotransferase, alanine transaminase, minimum platelets, prothrombin time, albumin level, number of days in hospital from surgery to discharge, and surgical complications were compared. RESULTS Compared with groups 2 and 3, group 1 exhibited shorter average operational time and less average blood loss, but the difference was not significant. Comparisons of all other factors indicated no significant differences. CONCLUSION The technique of preserving the major tributaries of the MHV until just immediately before graft retrieval does not appear to impose an apparent burden on donors.
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Affiliation(s)
- K Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - S Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - C Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Y Hara
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - W Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - S Uematsu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Shimizu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Goto
- Transplantation and Regenerative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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9
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Kumata H, Nishimura R, Nakanishi C, Inoue C, Tezuka Y, Endo H, Miyagi S, Tominaga T, Unno M, Kamei T. Surgical strategy for an adult patient with a catecholamine-producing ganglioneuroblastoma and a cerebral aneurysm: a case report. Surg Case Rep 2018; 4:119. [PMID: 30225726 PMCID: PMC6141414 DOI: 10.1186/s40792-018-0529-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/12/2018] [Indexed: 11/15/2022] Open
Abstract
Background Ganglioneuroblastomas, particularly those that produce catecholamine, are extremely rare in adults. Here, we report an interesting surgical case of an adult patient with a catecholamine-producing ganglioneuroblastomas in her adrenal gland, suspected to be a pheochromocytoma, and with a cerebral aneurysm. Case presentation The patient was a 73-year-old woman under treatment for hypertension. During a health check-up, a cystic retroperitoneal tumor was incidentally found in the superior pole of her right kidney. Her blood adrenaline level was slightly elevated, and her urinary adrenaline, noradrenaline, and dopamine levels were above the upper reference limits. In addition, 24-h urinary excretion of metanephrine, normetanephrine, and vanillylmandelic acid were all increased. 123I-Meta-iodobenzylguanidine scintigraphy showed an abnormal accumulation of the marker in the cyst wall. She was, therefore, diagnosed with a pheochromocytoma and scheduled for tumor resection. However, preoperatively, 8-mm-diameter cerebral aneurysm was incidentally found in her basilar artery. This required careful preoperative discussion. The aneurysm was difficult to approach and treat, and based on its position, shape, and size, the risk of rupture was low. Because hypertension is a major risk factor for aneurysmal rupture, we decided to proceed with the tumor resection. A lumbar catheter was placed to monitor the cerebral aneurysm for intraoperative rupture, and her transcranial motor-evoked potential and somatosensory-evoked potentials were monitored to track her intraoperative neurological function. During surgery, we carefully monitored fluctuations in blood pressure and resected the tumor with minimal mobilization. Postoperatively, head computed tomography confirmed that there was no sign of rupture. Histopathologically, the tumor was diagnosed as a catecholamine-producing ganglioneuroblastoma. The postoperative course was good, and the patient’s blood pressure improved. Conclusions Careful perioperative management is needed for a patient with both a catecholamine-producing tumor and cerebral aneurysm.
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Affiliation(s)
- Hiroyuki Kumata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Ryuichi Nishimura
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Chihiro Inoue
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Yuta Tezuka
- Division of Nephrology, Endocrinology and Vascular Medicine Tohoku University Graduate School of Medicine, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
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10
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Okada H, Nakanishi C, Yoshida S, Shimojima M, Mori M, Yokawa J, Tada H, Hayashi K, Kawashiri M, Yamagishi M. P6556Impact of genetically corrected iPSCs on possible reduction LDL-cholesterol in homozygous familial hypercholesterolemia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Okada
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - C Nakanishi
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - S Yoshida
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - M Shimojima
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - M Mori
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - J Yokawa
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - H Tada
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - K Hayashi
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - M Kawashiri
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
| | - M Yamagishi
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular and Internal Medicine, Kanazawa, Japan
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11
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Yoshida S, Nakanishi C, Okada H, Shimojima M, Mori M, Yokawa J, Ohta K, Kawashiri MA, Yachie A, Yamagishi M, Hayashi K. 5328Generation of disease specific iPSC-derived cardiomyocyte and investigation of their characteristics: study with clinically divergent female monozygotic twins with Danon disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Yoshida
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - C Nakanishi
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - H Okada
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - M Shimojima
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - M Mori
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - J Yokawa
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - K Ohta
- Kanazawa University Hospital, Pediatrics department, Kanazawa, Japan
| | - M A Kawashiri
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - A Yachie
- Kanazawa University Hospital, Pediatrics department, Kanazawa, Japan
| | - M Yamagishi
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
| | - K Hayashi
- Kanazawa University Hospital, Cardiology department, Kanazawa, Japan
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12
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Kumata H, Nakanishi C, Murakami K, Miyagi S, Fukuhara N, Carreras J, Nakamura N, Ichinohasama R, Unno M, Kamei T, Sasano H. Classical Hodgkin lymphoma-type and monomorphic-type post-transplant lymphoproliferative disorder following liver transplantation: a case report. Surg Case Rep 2018; 4:72. [PMID: 29980871 PMCID: PMC6035123 DOI: 10.1186/s40792-018-0480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication that can be difficult to treat; moreover, determination of the pathophysiological type is difficult. We report a rare case of a patient who developed two types of Epstein-Barr virus (EBV)-negative PTLD following living donor liver transplantation (LDLT). CASE PRESENTATION A 64-year-old man underwent LDLT for acute fulminant hepatitis B. Sixty-five months later, he developed EBV-negative monomorphic B cell PTLD. Reduction of immunosuppressive therapy and chemotherapy with rituximab resulted in a partial response. He received radioimmunotherapy with yttrium-90-ibritumomab tiuxetan, which was effective for all lesions, except for the splenic hilar lesion, which enlarged and seemed to penetrate the stomach. Therefore, he underwent resection of the pancreatic tail with splenectomy and partial gastrectomy. The pathological diagnosis was EBV-negative classical Hodgkin lymphoma (cHL)-type PTLD. CONCLUSIONS This patient showed an unexpected course of PTLD, from both a clinical and pathological perspective. There are no prior reports of an adult case of EBV-negative cHL-type PTLD coexisting with EBV-negative monomorphic B cell PTLD. When a strange and refractory lesion persists despite effective therapy for PTLD, we must consider the possibility of another type of PTLD within the residual lesion.
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Affiliation(s)
- Hiroyuki Kumata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Ryo Ichinohasama
- Division of Hematopathology, Tohoku University Hospital, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
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13
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Tokodai K, Miyagi S, Nakanishi C, Hara Y, Nakanishi W, Miyazawa K, Shimizu K, Murakami K, Sasano H, Goto M, Unno M, Kamei T. Association of post-transplant donor-specific HLA antibody with liver graft fibrosis during long-term follow-up after pediatric liver transplantation. Pediatr Transplant 2018. [PMID: 29542229 DOI: 10.1111/petr.13169] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this study was to evaluate the significance of post-transplant DSA as a predictor of liver fibrosis during long-term follow-up after pediatric LT. We evaluated the histological findings in 18 LT recipients who underwent liver biopsy after DSA screening. Liver fibrosis was scored based on the METAVIR fibrosis staging. Patients were divided into 2 groups based on histological findings, and clinical characteristics among patients with liver fibrosis were assessed. Of 18 patients, 7 were included in the fibrosis group. No significant between-group differences were found regarding peritransplant characteristics, including age, sex, primary disease, ABO incompatibility, and immunosuppressive regimen. Episodes of acute rejection and non-adherence to immunosuppressive drugs were comparable between both groups. The MFI for anti-DR DSA and positive rate were significantly higher in the fibrosis group (1655 vs 216; P = .019, 86% vs 27%; P = .012, respectively). MFI for anti-DQ DSA was higher in the fibrosis group, but non-significantly (2052 vs 384; P = .46). Post-transplant anti-DR DSA is associated with graft fibrosis during long-term follow-up. This finding seems useful for the implementation of valid histological examinations of liver grafts for patients with higher MFI, especially for anti-DR DSA, after pediatric LT.
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Affiliation(s)
- Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikashi Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuyuki Hara
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Shimizu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keigo Murakami
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masafumi Goto
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Transplantation and Regenerative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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14
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Miyagi S, Shimizu K, Miyazawa K, Nakanishi W, Hara Y, Tokodai K, Nakanishi C, Satomi S, Goto M, Unno M, Kamei T. A Case of Successful Simultaneous Pancreas-Kidney Transplantation Using the Injured Pancreas Graft. Transplant Proc 2017; 49:2315-2317. [PMID: 29198668 DOI: 10.1016/j.transproceed.2017.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Graft injuries sometimes occur and may cause complications such as the leakage of pancreatic secretions, which is often lethal. We report our experience of a case of successful simultaneous pancreas-kidney transplantation using injured pancreas graft. PATIENTS AND METHODS The recipient was a 57-year-old woman with type 1 diabetes mellitus, and the donor was a 30-year-old man with a brain injury. In the donation, the pancreas parenchyma, splenic artery, and gastroduodenal artery were injured iatrogenically. We therefore reconstructed these arteries using vessel grafts and then performed simultaneous pancreas-kidney transplantation. RESULTS Five days after transplantation, we noted a high titer of amylase in the ascites; therefore, we performed an urgent laparotomy. The origin of the amylase was the injured pancreatic parenchyma, and continued washing and drainage were carried out. We reconstructed the duodenojejunostomy using the Roux-en-Y technique to separate the passage of food from the pancreas graft to prevent injury to other organs due to exposure to pancreatic secretions. Thereafter, we inserted a decompression tube into the anastomosis thorough the blind end of the jejunum. Finally, we inserted 3 drainage tubes for lavage. Following this procedure, the patient recovered gradually and no longer required hemodialysis and insulin therapy. She was discharged from our hospital 56 days after transplantation. CONCLUSION The restoration of the injured graft was possible by management of pancreatic secretions and use of the donor's vessel grafts. Shortage of donors is a problem throughout the world; thus, it is important to use injured grafts for transplantation if possible.
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Affiliation(s)
- S Miyagi
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan.
| | - K Shimizu
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - K Miyazawa
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - W Nakanishi
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - Y Hara
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - K Tokodai
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - C Nakanishi
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - S Satomi
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - M Goto
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - M Unno
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
| | - T Kamei
- Department of Surgery, Tohoku University, Aoba-ku, Sendai, Japan
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15
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Ogasawara H, Nakanishi C, Miyagi S, Tokodai K, Hara Y, Nakanishi W, Miyazawa K, Shimizu K, Kumata H, Goto H, Goto M, Unno M, Kamei T. Renoportal Anastomosis in Left Lateral Lobe Living Donor Liver Transplantation: A Pediatric Case. Case Rep Gastroenterol 2017; 11:584-592. [PMID: 29118687 PMCID: PMC5662992 DOI: 10.1159/000481160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022] Open
Abstract
In adult liver transplantation, renoportal anastomosis (RPA) has been introduced as a useful technique for patients with grade 4 portal vein thrombosis and a splenorenal shunt. Here, we report a pediatric case in which RPA allowed a left lateral lobe living donor liver transplantation (LDLT) despite portal vein thrombosis and a large splenorenal shunt. At 36 days old, the patient underwent a Kasai operation for biliary atresia. At 17 months old, she underwent LDLT because of repetitive cholangitis. Pretransplant examinations revealed a large splenorenal shunt and portal vein thrombosis. Simple end-to-end portal reconstruction and clamping of the collateral route after removing the thrombosis were unsuccessful. Thus, RPA was performed using a donor superficial femoral vein as an interpositional graft. The portal vein pressure was 20 mm Hg after arterial reperfusion. Ligation of the splenic artery reduced the portal vein pressure. Although she developed severe acute cellular rejection and chylous ascites, there were no signs of portal vein complications. She was discharged 73 days after transplantation without any signs of renal dysfunction. The patient's condition was good at her last follow-up, 22 months after transplantation. To our knowledge, this is the youngest case of RPA in pediatric left lateral lobe LDLT. Additionally, this is the first case of RPA with splenic artery ligation and using the donor's superficial femoral vein as the venous graft for RPA. Although long-term follow-up is necessary, RPA could be a salvage option in LDLT in infants if other methods are unsuccessful.
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Affiliation(s)
- Hiroyuki Ogasawara
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kazuaki Tokodai
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yasuyuki Hara
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Wataru Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Koji Miyazawa
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kenji Shimizu
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hiroyuki Kumata
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hitoshi Goto
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Masafumi Goto
- Division of Transplantation and Regenerative Medicine, Tohoku University, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
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16
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Kakizaki Y, Miyagi S, Hara Y, Fujio A, Miyazawa K, Maida K, Kashiwadate T, Tokodai K, Nakanishi C, Kamei T, Unno M. The extra-anatomical jump graft reconstruction of the right hepatic artery after resection of a biliary tract malignancy with a common hepatic artery aneurysm: a case report. Clin Case Rep 2017; 5:1841-1846. [PMID: 29152283 PMCID: PMC5676259 DOI: 10.1002/ccr3.1200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/23/2017] [Accepted: 08/07/2017] [Indexed: 12/27/2022] Open
Abstract
Performing resection of a biliary tract malignancy with a hepatic artery aneurysm is very challenging. Resection of the extrahepatic bile duct and extra‐anatomical reconstruction can be successfully performed using free radial artery autografts from the aorta to the right hepatic artery. Hepatic artery thrombosis can be prevented with intimal preservation.
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Affiliation(s)
- Yuta Kakizaki
- Department of Surgery Tohoku University Sendai Japan
| | | | - Yasuyuki Hara
- Department of Surgery Tohoku University Sendai Japan
| | - Atsushi Fujio
- Department of Surgery Tohoku University Sendai Japan
| | - Koji Miyazawa
- Department of Surgery Tohoku University Sendai Japan
| | - Kai Maida
- Department of Surgery Tohoku University Sendai Japan
| | | | | | | | - Takashi Kamei
- Department of Surgery Tohoku University Sendai Japan
| | - Michiaki Unno
- Department of Surgery Tohoku University Sendai Japan
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17
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Takada Y, Kaido T, Shirabe K, Nagano H, Egawa H, Sugawara Y, Taketomi A, Takahara T, Wakabayashi G, Nakanishi C, Kawagishi N, Kenjo A, Gotoh M, Toyoki Y, Hakamada K, Ohtsuka M, Akamatsu N, Kokudo N, Takeda K, Endo I, Takamura H, Okajima H, Wada H, Kubo S, Kuramitsu K, Ku Y, Ishiyama K, Ohdan H, Ito E, Maehara Y, Honda M, Inomata Y, Furukawa H, Uemoto S, Yamaue H, Miyazaki M, Takada T. Significance of preoperative fluorodeoxyglucose-positron emission tomography in prediction of tumor recurrence after liver transplantation for hepatocellular carcinoma patients: a Japanese multicenter study. J Hepatobiliary Pancreat Sci 2017; 24:49-57. [PMID: 27806426 DOI: 10.1002/jhbp.412] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). METHODS From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months). RESULTS Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019). CONCLUSIONS These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MC patients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MC patients.
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Affiliation(s)
- Yasutsugu Takada
- Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toshimi Kaido
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Gunma, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Surgical Services, Ageo Central General Hospital, Saitama, Japan
| | - Chikashi Nakanishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan
| | - Naoki Kawagishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan
| | - Akira Kenjo
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Toyoki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Kazuhisa Takeda
- National Hospital Organization Yokohama Medical Center, Kanagawa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterological Surgery, Kanazawa University, Ishikawa, Japan
| | - Hideaki Okajima
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kaoru Kuramitsu
- Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan
| | - Yonson Ku
- Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eitaro Ito
- Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterologic Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Shinji Uemoto
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tadahiro Takada
- Japanese Society of Hepato-biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Kawashiri M, Higashikata T, Nohara A, Nakanishi C, Tada H, Okada H, Yamagishi M. P6242Impact of evolocumab, a PCSK9 inhibitor, withdrawing from regular ldl-apheresis therapy in patients with heterozygous familial hypercholesterolemia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yokawa J, Mori M, Nakanishi C, Sakata K, Okada H, Shimojima M, Yoshida S, Yoshimuta T, Yamagishi M. P3320The hyperacute vessel response after biodegradable-polymer sirolimus-eluting stent implantation in swine model. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tokodai K, Miyagi S, Nakanishi C, Hara Y, Nakanishi W, Unno M, Kamei T. Effect of Recipient Age at Liver Transplantation on Prevalence of Post-Transplant Donor-Specific HLA Antibody. Ann Transplant 2017; 22:333-337. [PMID: 28572563 DOI: 10.12659/aot.903926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Post-transplant donor-specific HLA antibodies (DSA) may have a detrimental effect on long-term outcomes of organ transplantation. The aim of this study was to specifically evaluate the effect of recipient age on the prevalence of DSA over a long-term follow-up after living donor liver transplantation (LDLT). MATERIAL AND METHODS A retrospective analysis of DSA evaluations was performed in 50 pediatric patients with HLA data available. Patients were divided into 2 groups based on their age at the time of LDLT: younger (Y) group, age <3 years; older (O) group, age ≥3 years. DSA evaluation was performed using Luminex single-antigen bead assays, with a mean fluorescence intensity ≥1000 used as a cut-off for positive results. RESULTS There were no between-group differences in terms of sex, ABO incompatibility or acute rejection. Only one of our 50 patients tested positive for class I DSA. Significantly more patients tested positive for HLA-DR DSA in group Y (40.6%) than in group O (11.1%; p=0.02). Recipients <3 years of age at the time of LDLT may be at a higher risk of testing positive for class II DSA. CONCLUSIONS These findings can inform the implementation of cost-effective screening of post-transplant DSA in pediatric LDLT recipients.
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Affiliation(s)
- Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Chikashi Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuyuki Hara
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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21
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Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Nakanishi W, Kamei T, Ohuchi N. Splenectomy for Severe Intestinal Bleeding Caused by Portal Hypertensive Enteropathy After Pediatric Living-Donor Liver Transplantation: A Report of Three Cases. Transplant Proc 2017; 49:1129-1132. [DOI: 10.1016/j.transproceed.2017.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Miyagi S, Kakizaki Y, Shimizu K, Miyazawa K, Nakanishi W, Hara Y, Tokodai K, Nakanishi C, Kamei T, Ohuchi N, Satomi S. Arterial and biliary complications after living donor liver transplantation: a single-center retrospective study and literature review. Surg Today 2017; 48:131-139. [PMID: 28439714 DOI: 10.1007/s00595-017-1515-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/05/2017] [Indexed: 12/12/2022]
Abstract
AIM The mortality of patients on the waiting list for deceased donor liver transplantation (DDLT) is high, especially in countries where donation rates are low. Thus, living donor liver transplantation (LDLT) is an attractive option. However, compared with DDLT, LDLT is associated with increased rates of arterial and biliary complications. We examined the rates of complications and risk factors following LDLT. METHODS We retrospectively investigated and compared the rates of complications of DDLT and LDLT in our institute. We also performed univariate and multivariate analyses to identify the independent risk factors for these complications. The complications and specific disadvantages of LDLT were reviewed and discussed. RESULTS The incidence rate of arterial complications in LDLT was 6.0%, compared with 3.2% (13/441) in DDLT. A multivariate analysis identified low body weight (P = 0.032) as the only independent risk factor for hepatic artery thrombosis. The rate of all biliary complications in LDLT was 17.3%, compared with 18.7% in DDLT. The risk factors for biliary stricture identified by the multivariate analysis were recurrent cholangitis and the number of bile ducts. The durations of hospital stay and overall survival rates were similar between the two groups. CONCLUSION Given the shortage of deceased donor organs, we believe that LDLT is acceptable in an attempt to meet demand.
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Affiliation(s)
- Shigehito Miyagi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yuta Kakizaki
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kenji Shimizu
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji Miyazawa
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Wataru Nakanishi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuaki Tokodai
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chikashi Nakanishi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Susumu Satomi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Kumata H, Miyagi S, Murakami K, Fujio A, Hara Y, Nakanishi C, Kawagishi N, Sasano H, Kamei T, Ouchi N. Extrahepatic bile duct hepatocellular carcinoma due to recurrence of hematogenous metastasis 50 months after hepatectomy. Surg Case Rep 2017; 3:30. [PMID: 28205184 PMCID: PMC5311010 DOI: 10.1186/s40792-017-0305-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent hepatocellular carcinoma (HCC) in the extrahepatic bile duct is rare with most cases diagnosed after manifesting sudden obstructive jaundice. Here, we report an extremely rare case of recurrent HCC in the common bile duct due to hematogenous metastasis. CASE PRESENTATION A 66-year-old man underwent an extended left hepatectomy for HCC in the medial segment of the liver. Fifty months later, he presented with sudden obstructive jaundice. Endoscopic retrograde cholangiography showed a space-occupying lesion in the common bile duct, which was suspected as cholangiocarcinoma. Therefore, he underwent extrahepatic bile duct resection and choledochojejunostomy with lymph node dissection. Macroscopically, a polypoid tumor and several nodular tumors were found in the common bile duct, which was obstructed by a tumor thrombus. Histopathologically, the tumors were diagnosed as metastases from the HCC resected 50 months before. Several distinct, nodular tumors were observed in the subepithelium of the common bile duct and had invaded some blood vessels. These findings support the conclusion that the HCC metastasized hematogenously to the extrahepatic bile duct. CONCLUSIONS Recurrent HCC in the extrahepatic bile duct due to hematogenous metastasis is rare, and it is difficult to diagnose. Further similar cases should be accumulated for clarifying the pathological mechanism.
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Affiliation(s)
- Hiroyuki Kumata
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Shigehito Miyagi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Atsushi Fujio
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Noriaki Ouchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
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Miyagi S, Kawagishi N, Kashiwadate T, Fujio A, Tokodai K, Hara Y, Nakanishi C, Kamei T, Ohuchi N, Satomi S. Relationship Between Bile Duct Reconstruction and Complications in Living Donor Liver Transplantation. Transplant Proc 2017; 48:1166-9. [PMID: 27320579 DOI: 10.1016/j.transproceed.2015.10.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In living donor liver transplantation (LDLT), the recipient bile duct is thin and short. Bile duct complications often occur in LDLT, with persistent long-term adverse effects. Recently, we began to perform microsurgical reconstruction of the bile duct. The purpose of this study was to investigate the relationship between bile duct reconstruction methods and complications in LDLT. METHODS From 1991 to 2014, we performed 161 LDLTs (pediatric:adult = 90:71; left lobe:right lobe = 95:66). In this study, we retrospectively investigated the initial bile duct complications in LDLT and performed univariate and multivariate analyses to identify the independent risk factors for complications. RESULTS The most frequent complication was biliary stricture (9.9%), followed by biliary leakage (6.8%). On univariate and multiple logistic regression analysis, the independent risk factors for biliary stricture were bile leakage (P = .0103) and recurrent cholangitis (P = .0077). However, there were no risk factors for biliary leakage on univariate analysis in our study. The reconstruction methods (hepaticojejunostomy or duct-to-duct anastomosis) and reconstruction technique (with or without microsurgery) were not risk factors for biliary stricture and leakage. CONCLUSION In this study, the most frequent complication of LDLT was biliary stricture. The independent risk factors for biliary stricture were biliary leakage and recurrent cholangitis. Duct-to-duct anastomosis and microsurgical reconstruction of the bile duct were not risk factors for biliary stricture and leakage.
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Affiliation(s)
- S Miyagi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
| | - N Kawagishi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - T Kashiwadate
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - A Fujio
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - K Tokodai
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - Y Hara
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - C Nakanishi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - T Kamei
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - N Ohuchi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - S Satomi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
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25
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Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Fujio A, Kashiwadate T, Maida K, Goto H, Kamei T, Ohuchi N. The Significance of Screening for HLA Antibodies in the Long-Term Follow-up of Pediatric Liver Transplant Recipients. Transplant Proc 2017; 48:1139-41. [PMID: 27320574 DOI: 10.1016/j.transproceed.2015.12.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Post-transplant donor-specific anti-HLA antibodies (DSA) reportedly have detrimental effects on the outcomes of organ transplantation. However, the prevalence of post-transplant DSA in the long term after pediatric liver transplantation remains unclear, and the significance of post-transplant DSA is unknown. The aim of this cross-sectional study was to determine the prevalence of and characteristics of patients with post-transplant DSA. MATERIALS AND METHODS Of the 84 pediatric liver transplant recipients who were followed up in the outpatient department of our institution, 34 patients with available HLA typing data were included after they or their parent(s) provided informed consent for DSA evaluations. Luminex single-antigen bead assays were performed, and a mean fluorescence intensity of ≥1000 was used as the cut-off for a positive reaction. RESULTS No class I DSA were detected, whereas class II DSA were detected in 11 patients (32%). There were no differences in age at transplantation, immunosuppressive drugs, or follow-up period between the DSA-positive and DSA-negative patients. The rate of positive pre-transplant complement-dependent cytotoxicity crossmatch was higher with class II DSA than without, although the difference was not statistically significant. CONCLUSIONS The utility of screening for class I DSA was insignificant in the long-term follow-up of pediatric liver transplant recipients. The prevalence of class II DSA was relatively high; therefore, screening for class II DSA might be justified, although a follow-up survey of the association between post-transplant class II DSA and the long-term clinical course needs to be conducted.
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Affiliation(s)
- K Tokodai
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan.
| | - N Kawagishi
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - S Miyagi
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - C Nakanishi
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - Y Hara
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - A Fujio
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - T Kashiwadate
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - K Maida
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - H Goto
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - T Kamei
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
| | - N Ohuchi
- Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan
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Inagaki Y, Oshiro Y, Tanaka T, Yoshizumi T, Okajima H, Ishiyama K, Nakanishi C, Hidaka M, Wada H, Hibi T, Takagi K, Honda M, Kuramitsu K, Tanaka H, Tohyama T, Ikegami T, Imura S, Shimamura T, Nakayama Y, Urahashi T, Yamagishi K, Ohnishi H, Nagashima S, Takahashi M, Shirabe K, Kokudo N, Okamoto H, Ohkohchi N. A Nationwide Survey of Hepatitis E Virus Infection and Chronic Hepatitis E in Liver Transplant Recipients in Japan. EBioMedicine 2016; 2:1607-12. [PMID: 26870785 PMCID: PMC4740318 DOI: 10.1016/j.ebiom.2015.09.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 01/11/2023] Open
Abstract
Background Recently, chronic hepatitis E has been increasingly reported in organ transplant recipients in European countries. In Japan, the prevalence of hepatitis E virus (HEV) infection after transplantation remains unclear, so we conducted a nationwide cross-sectional study to clarify the prevalence of chronic HEV infection in Japanese liver transplant recipients. Methods A total of 1893 liver transplant recipients in 17 university hospitals in Japan were examined for the presence of immunoglobulin G (IgG), IgM and IgA classes of anti-HEV antibodies, and HEV RNA in serum. Findings The prevalence of anti-HEV IgG, IgM and IgA class antibodies was 2.9% (54/1893), 0.05% (1/1893) and 0% (0/1893), respectively. Of 1651 patients tested for HEV RNA, two patients (0.12%) were found to be positive and developed chronic infection after liver transplantation. In both cases, HEV RNA was also detected in one of the blood products transfused at the perioperative period. Analysis of the HEV genomes revealed that the HEV isolates obtained from the recipients and the transfused blood products were identical in both cases, indicating transfusion-transmitted HEV infection. Interpretation The prevalence of HEV antibodies in liver transplant recipients was 2.9%, which is low compared with the healthy population in Japan and with organ transplant recipients in European countries; however, the present study found, for the first time, two Japanese patients with chronic HEV infection that was acquired via blood transfusion during or after liver transplantation. We conducted the multicenter survey for HEV infection in liver transplant recipients. Though the chronic HEV infection is rare, transfusion-transmitted cases were detected. Blood products can be a risk of chronic HEV infection in transplant recipients.
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Affiliation(s)
- Yuki Inagaki
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukio Oshiro
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomohiro Tanaka
- Organ Transplantation Service, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyu-ku, Kyoto 606-8507, Japan
| | - Kohei Ishiyama
- Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Chikashi Nakanishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Hiroshi Wada
- Department of Surgery, Graduate School of Medicine, Osaka University, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Taizo Hibi
- Department of Surgery, School of Medicine, Keio University, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Kosei Takagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-machi, Kita-ku, Okayama 700-8558, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto-shi, Kumamoto 860-8556, Japan
| | - Kaori Kuramitsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Hideaki Tanaka
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Taiji Tohyama
- Department of HPB and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, To-on, Ehime 791-0295, Japan
| | - Toshihiko Ikegami
- Department of Transplant Surgery, Shinshu University, School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Satoru Imura
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tsuyoshi Shimamura
- Division of Organ Transplantation, Hokkaido University Hospital, Kita 14, Jonishi 5-chome, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Yoshimi Nakayama
- Department of Hepatobiliary Pancreatic Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Taizen Urahashi
- Department of Transplant Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroshi Ohnishi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Shigeo Nagashima
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Nobuhiro Ohkohchi
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
- Corresponding author.
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Hara Y, Tokodai K, Nakanishi C, Miyagi S, Kawagishi N. Spontaneous resolution of de novo hepatitis B after living donor liver transplantation with hepatitis B core antibody positive graft: a case report. Surg Case Rep 2016; 2:118. [PMID: 27797067 PMCID: PMC5083705 DOI: 10.1186/s40792-016-0246-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/22/2016] [Indexed: 02/08/2023] Open
Abstract
Background Hepatitis B core antibody (HBcAb)-positive graft is reported to cause de novo hepatitis B after liver transplantation with a probability of 38–100 % without prophylaxis. Hepatitis B surface antigen loss is reported to be achieved with a probability of only 3–8 % in the patients treated by antiviral agents. We present an extremely rare case of spontaneous resolution of de novo hepatitis B after living donor liver transplantation (LDLT) with HBcAb-positive graft. Case presentation An 8-year-old female patient underwent LDLT for end-stage biliary atresia using an HBcAb-positive left lobe graft. After transplantation, she did not receive any prophylactic agents for hepatitis B. Two years after LDLT, she was diagnosed with chronic hepatitis B. Six years after LDLT, liver fibrosis and hepatitis activity were advanced and lamivudine was started. Two years after lamivudine administration, emergence of a lamivudine-resistant YMDD mutant was detected and adefovir dipivoxil was combined with lamivudine. Hepatitis B virus deoxyribonucleic acid (HBV-DNA) became undetectable soon after the addition of adefovir dipivoxil. Twelve years after transplantation, acute rejection occurred and steroid pulse therapy was performed, but hepatitis B did not become severe and HBV-DNA continued to be undetectable. Fifteen years after LDLT, she voluntarily discontinued medication of all drugs, including immunosuppressive agents and antiviral drugs for 1 year because of mental instability. After an interval of 1 year, liver function was normal and her serological HBV status was as follows: HBsAg(−), HBsAb(+), HBeAb(−), HBeAb(+), HBcAb(+) and HBV-DNA(−). From these results, we diagnosed her condition as spontaneous clearance of de novo hepatitis B. The patient is free of antiviral therapies and continues to take a low dose of immunosuppressive drugs and is leading a normal life. Conclusions In this case, HBsAg loss is finally achieved but we need to follow carefully for HBV reactivation with the fibrosis of the graft in mind.
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Affiliation(s)
- Yasuyuki Hara
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Kazuaki Tokodai
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chikashi Nakanishi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Naoki Kawagishi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Ohta M, Nakanishi C, Kawagishi N, Hara Y, Maida K, Kashiwadate T, Miyazawa K, Yoshida S, Miyagi S, Hayatsu Y, Kawamoto S, Matsuda Y, Okada Y, Saiki Y, Ohuchi N. Surgical resection of recurrent extrahepatic hepatocellular carcinoma with tumor thrombus extending into the right atrium under cardiopulmonary bypass: a case report and review of the literature. Surg Case Rep 2016; 2:110. [PMID: 27726114 PMCID: PMC5056913 DOI: 10.1186/s40792-016-0241-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Recurrent hepatocellular carcinoma accompanied by a right atrial tumor thrombus is rare. No standard treatment modality has been established. Surgical treatment may be the only curative treatment; however, surgery has been considered high risk. We herein describe a patient who underwent resection of a recurrent right atrial tumor thrombus under normothermic cardiopulmonary bypass on a beating heart. Case presentation A 60-year-old man underwent a right hepatectomy for hepatocellular carcinoma with diaphragm invasion. During the preoperative cardiac screening, he was diagnosed with an old myocardial infarction with triple-vessel coronary disease. Percutaneous coronary intervention was performed for the left anterior descending artery and left circumflex coronary artery. High-grade stenosis remained in his right coronary artery. Nine months later, computed tomography showed recurrent hepatocellular carcinoma in the diaphragm and a tumor thrombus extending from the suprahepatic inferior vena cava into the right atrium. Surgical resection of the recurrent tumor was performed through a right subcostal incision with xiphoid extension and median sternotomy. The recurrent tumor was incised with the diaphragm and pericardium. Intraoperative ultrasonography revealed that the tumor thrombus was free from right atrium wall invasion and that the right atrium could be clamped just proximal to the tumor thrombus. The right atrium, infrahepatic vena cava, left and middle hepatic veins, and hepatoduodenal ligament were encircled. Cardiopulmonary bypass was performed to prevent ischemic heart disease caused by intraoperative hypotension. Total hepatic vascular exclusion was then performed under normothermic cardiopulmonary bypass on heart beating. The inferior vena cava wall was incised. The tumor thrombus with the diaphragmatic recurrent tumor was resected en bloc. The patient had a favorable clinical course without any complications. Conclusion The recurrent hepatocellular carcinoma in the diaphragm and the right atrial tumor thrombus were safely resected using normothermic cardiopulmonary bypass on heart beating.
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Affiliation(s)
- Mineto Ohta
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Kai Maida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Toshiaki Kashiwadate
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Koji Miyazawa
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Satoru Yoshida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yukihiro Hayatsu
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasushi Matsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
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Nohara A, Kawashiri M, Tada H, Yoshida M, Mori M, Nakanishi C, Yagi K, Inazu A, Yamagishi M, Mabuchi H. Clinical characteristics of common PCSK9 gain-of-function E32K variant with higher TG elevation, and double heterozygotes with common PCSK9 variants and LDLR mutations. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miyagi S, Fujio A, Tokodai K, Hara Y, Nakanishi C, Goto H, Kamei T, Kawagishi N, Ohuchi N, Satomi S. Successful Case of Somatostatin Analog Stopping Gastrointestinal Bleeding, One of the Most Frequent Complications After Simultaneous Pancreas-kidney Transplantation: A Case Report. Transplant Proc 2016; 48:985-7. [PMID: 27234785 DOI: 10.1016/j.transproceed.2015.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 10/21/2022]
Abstract
OBJECT Pancreas transplantation has the highest surgical complication rate of all routinely performed organ transplantation procedures. The complications are not only caused by the pancreas itself but also occur due to issues with the transplant recipient. We report the case of a patient who experienced massive gastrointestinal bleeding after simultaneous pancreas-kidney transplantation (SPK), which was stopped successfully using somatostatin analog. PATIENTS AND METHODS The patient was a 45-year-old woman with diabetes mellitus type 1 who underwent SPK with enteric drainage. She had melena 5 days after SPK. RESULTS At first, we suspected that the melena was caused by the transplanted duodenum because of rejection and ischemic changes. The patient experienced severe bleeding 9 days after SPK. We quickly performed open surgery and inserted an endoscope from the recipient's ileum to investigate the transplanted duodenum. However, no bleeding source was found, including in the transplanted duodenum and the recipient's ileum end. We determined that the bleeding source was the recipient's ascending colon. We attempted to perform endovascular treatment but could not detect the source of the bleeding; therefore, we used somatostatin analog to let the blood vessels shrink and reduce pancreatic output. Thereafter, the function of the transplanted pancreas and kidney gradually recovered, and the recipient was discharged 154 days after SPK. CONCLUSION Gastrointestinal bleeding is a lethal complication and has several different causes, such as mucosal rejection, ischemic changes, and exocrine output of the pancreas graft. Somatostatin analog is one of the most acceptable treatments for patients who have gastrointestinal bleeding after SPK.
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Affiliation(s)
- S Miyagi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
| | - A Fujio
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - K Tokodai
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - Y Hara
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - C Nakanishi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - H Goto
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - T Kamei
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - N Kawagishi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - N Ohuchi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
| | - S Satomi
- Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan
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Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Fujio A, Kashiwadate T, Maida K, Goto H, Kamei T, Ohuchi N. Poor Long-Term Outcomes of Adult Liver Transplantation Involving Elderly Living Donors. Transplant Proc 2016; 48:1130-3. [DOI: 10.1016/j.transproceed.2016.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/05/2016] [Accepted: 01/21/2016] [Indexed: 12/21/2022]
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Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Fujio A, Kashiwadate T, Kanno A, Goto H, Kamei T, Ohuchi N. Indications and outcomes of an endoscopic approach under laparotomy for the treatment of bilioenteric anastomotic strictures. Pediatr Transplant 2016; 20:316-20. [PMID: 26694626 DOI: 10.1111/petr.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 01/31/2023]
Abstract
BAS is a potentially life-threatening complication of LDLT. The aim of this study was to report on the indications and outcomes of an endoscopic approach under laparotomy being used in our institution to treat BAS after LDLT, using hepaticojejunostomy, for a small case series. Eighty-three patients underwent an LDLT in our institution between 1991 and 2014. Retrospective chart review indicated that 10 of these patients developed BAS and were included in our analysis. The endoscopic approach under laparotomy was used in three patients who developed BAS 10 yr or more after their LDLT and in whom a percutaneous transhepatic approach and an endoscopic approach had failed. The course of recovery post-operatively was unremarkable for two of the three patients who underwent the endoscopic approach under laparotomy. One patient required follow-up laparotomy to treat a perforation of the bowel causing acute peritonitis. At follow-up one yr post-operatively, the stent tube was removed in two patients who recovered fully. The other patient had full recovery with the stent remaining in situ. The endoscopic approach under laparotomy could be a safe and promising option in the treatment of BAS to avoid surgical re-anastomosis.
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Affiliation(s)
- Kazuaki Tokodai
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Naoki Kawagishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Shigehito Miyagi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Chikashi Nakanishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yasuyuki Hara
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Atsushi Fujio
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Toshiaki Kashiwadate
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Atsushi Kanno
- Department of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Hitoshi Goto
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Takashi Kamei
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Noriaki Ohuchi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
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Nakanishi C, Nakano T, Nakagawa A, Sato C, Yamada M, Kawagishi N, Tominaga T, Ohuchi N. Evaluation of a newly developed piezo actuator-driven pulsed water jet system for liver resection in a surviving swine animal model. Biomed Eng Online 2016; 15:9. [PMID: 26809992 PMCID: PMC4727307 DOI: 10.1186/s12938-016-0126-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/12/2016] [Indexed: 11/26/2022] Open
Abstract
Background
Preservation of the hepatic vessels while dividing the parenchyma is key to achieving safe liver resection in a timely manner. In this study, we assessed the feasibility of a newly developed, piezo actuator-driven pulsed water jet (ADPJ) for liver resection in a surviving swine model. Methods Ten domestic pigs underwent liver resection. Parenchymal transection and vessel skeletonization were performed using the ADPJ (group A, n = 5) or an ultrasonic aspirator (group U, n = 5). The water jet was applied at a frequency of 400 Hz and a driving voltage of 80 V. Physiological saline was supplied at a flow rate of 7 ml/min. After 7 days, the animals were killed and their short-term complications were examined and compared between the two groups. Results No significant complications, such as massive bleeding, occurred in either group during the surgical procedures. The transection time per transection area was significantly shorter in group A than in group U (1.5 ± 0.3 vs. 2.3 ± 0.5 min/cm2, respectively, P = 0.03). Blood loss per transection area was not significantly different between groups A and U (9.3 ± 4.2 vs. 11.7 ± 2.3 ml/cm2, P = 0.6). All pigs in group A survived for 7 days. No postoperative bleeding or bile leakage was observed in any animal at necropsy. Conclusion The present results suggested that the ADPJ reduces transection time without increasing blood loss. ADPJ is a safe and feasible device for liver parenchymal transection.
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Affiliation(s)
- Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Toru Nakano
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Atsuhiro Nakagawa
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Masato Yamada
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
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Fujio A, Kawagishi N, Echizenya T, Tokodai K, Nakanishi C, Miyagi S, Sato K, Fujimori K, Ohuchi N. Long-term survival with growth hormone replacement after liver transplantation of pediatric nonalcoholic steatohepatitis complicating acquired hypopituitarism. TOHOKU J EXP MED 2015; 235:61-7. [PMID: 25744617 DOI: 10.1620/tjem.235.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) is the most severe form of nonalcoholic fatty liver disease (NAFLD). In adult patients, liver transplantation (LT) is the treatment of choice for end-stage liver disease secondary to NASH. However, little information is available regarding outcomes of LT in pediatric patients with NASH. We describe here a pediatric patient with NASH associated with hypopituitarism who underwent living donor liver transplantation (LDLT). An 11-year-old boy was diagnosed with a pituitary tumor, which was removed by trans-interhemispheric approach following bifrontal craniotomy. Histopathological examination revealed a mature teratoma. Eighteen months later, magnetic resonance imaging showed recurrence of the pituitary tumor, which was found to be a germinoma. He underwent 3 months of chemoradiotherapy, with a complete response. He gradually became obese, with elevated transaminase levels. At age 15 years, he developed fatigue and dyspnea and was found to have liver cirrhosis secondary to NASH with severe hepatopulmonary syndrome. He underwent LDLT using a right liver graft from his mother. Twelve months later, abdominal computed tomography showed recurrence of NAFLD. Five years after the LDLT, transaminases were slightly elevated. Growth hormone replacement therapy was started, reducing transaminase levels to their normal ranges. Ten years after LDLT, fatty liver remains stable, although his body mass index has not been reduced. Growth hormone replacement therapy may be effective in graft maintenance. This is the first case report of a patient with maintained stable liver function 10 years after LDLT for pediatric NASH.
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Affiliation(s)
- Atsushi Fujio
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University Hospital
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Hara Y, Kawagishi N, Nakanishi W, Tokodai K, Nakanishi C, Miyagi S, Ohuchi N. Prevalence and risk factors of obesity, hypertension, dyslipidemia and diabetes mellitus before and after adult living donor liver transplantation. Hepatol Res 2015; 45:764-70. [PMID: 25196899 DOI: 10.1111/hepr.12418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 02/08/2023]
Abstract
AIM The development of metabolic abnormalities after liver transplantation (LTx) contributes to cardiovascular events and mortality. We analyzed the prevalence and risk factors of obesity, hypertension, dyslipidemia and diabetes mellitus (DM) after adult living donor liver transplantation. METHODS Fifty-four adult recipients with a minimum follow up of 6 months receiving living donor liver transplantation between 2001 and 2012 at the Tohoku University Hospital were retrospectively analyzed. RESULTS The prevalence of hypertension increased from 18.5% before transplantation to 35.2% post-transplantation, and new-onset hypertension after transplantation was 57.9% of post-transplant hypertension. Univariate analysis showed that risk factors of post-transplant hypertension were age (>50 years, P = 0.0023), pretransplant body mass index (BMI) of 25 or more (P = 0.0123), pretransplant hypertension (P = 0.0012) and cyclosporin A (61.5% vs tacrolimus 25.0%, P = 0.0248). The incidence of obesity, dyslipidemia and DM did not change from before to after transplantation. LTx was curative in 77.8% of cases of pretransplant dyslipidemia and 20% of cases of pretransplant DM. Primary biliary cirrhosis cases comprised 85.7% of cases of pretransplant dyslipidemia that were cured by LTx. In univariate analysis, pretransplant BMI of 25 or more was the only risk factor of post-transplant dyslipidemia (P = 0.0098). The incidence of new-onset DM after transplantation was 20%. Risk factors of post-transplant DM were male sex (P = 0.0156), pretransplant DM (P < 0.0001), alcohol abuse (P = 0.0248) and mycophenolate mofetil (P = 0.0181) by univariate analysis. CONCLUSION The prevalence of hypertension increased after LTx and pretransplant obesity was associated with several post-transplant metabolic abnormalities.
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Affiliation(s)
- Yasuyuki Hara
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Naoki Kawagishi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Wataru Nakanishi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kazuaki Tokodai
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Chikashi Nakanishi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shigehito Miyagi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Noriaki Ohuchi
- The Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Miyagi S, Nakanishi C, Kawagishi N, Kamei T, Satomi S, Ohuchi N. Pure laparoscopic hepatectomy combined with a pure laparoscopic pringle maneuver in patients with severe cirrhosis. Case Rep Gastroenterol 2015; 9:101-5. [PMID: 26034471 PMCID: PMC4448045 DOI: 10.1159/000381394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Laparoscopic hepatectomy is a standard surgical procedure. However, it is difficult to perform in patients with severe cirrhosis because of fibrosis and a high risk of hemorrhage. We report our recent experience in five cases of pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver in patients with severe cirrhosis. From 2012 to 2014, we performed pure laparoscopic partial hepatectomy in five patients with severe liver cirrhosis (indocyanine green retention rate at 15 min [ICG R15] >30% and fibrosis stage f4). A pure laparoscopic Pringle maneuver was employed in all patients. We investigated operative time, blood loss, duration of hospitalization and the days when discharge was possible, and compared these findings with those of patients with a normal liver (ICG R15 <10%, f0) who underwent pure laparoscopic partial hepatectomy during the same period (n = 7). As a result, operative time, blood loss, duration of hospitalization and the days when discharge was possible were similar in patients with cirrhosis undergoing pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver to those in patients with a normal liver undergoing pure laparoscopic partial hepatectomy. In conclusion, pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver appears to be safe in patients with severe cirrhosis.
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Affiliation(s)
- Shigehito Miyagi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikashi Nakanishi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kawagishi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kamei
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Susumu Satomi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriaki Ohuchi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Yamada M, Nakano T, Sato C, Nakagawa A, Fujishima F, Kawagishi N, Nakanishi C, Sakurai T, Miyata G, Tominaga T, Ohuchi N. The dissection profile and mechanism of tissue-selective dissection of the piezo actuator-driven pulsed water jet as a surgical instrument: laboratory investigation using Swine liver. Eur Surg Res 2014; 53:61-72. [PMID: 25139450 DOI: 10.1159/000365288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 06/16/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE The water jet technique dissects tissue while sparing cord-like structures such as blood vessels. The mechanism of such tissue-selective dissection has been unknown. The novel piezo actuator-driven pulsed water jet (ADPJ) system can achieve dissection with remarkably reduced water consumption compared to the conventional water jet; however, the system's characteristics and dissection capabilities on any organ have not been clarified. The purposes of this study were to characterize the physical properties of the novel ADPJ system, evaluate the dissection ability in swine organs, and reveal the mechanism of tissue-selective dissection. METHODS The pulsed water jet system comprised a pump chamber driven by a piezo actuator, a stainless steel tube, and a nozzle. The peak pressure of the pulsed water jet was measured through a sensing hole using a pressure sensor. The pulsed water jet technique was applied on swine liver in order to dissect tissue on a moving table using one-way linear ejection at a constant speed. The dissection depth was measured with light microscopy and evaluated histologically. The physical properties of swine liver were evaluated by breaking strength tests using tabletop universal testing instruments. The liver parenchyma was also cut with three currently available surgical devices to compare the histological findings. RESULTS The peak pressure of the pulsed water jet positively correlated with the input voltage (R(2) = 0.9982, p < 0.0001), and this was reflected in the dissection depth. The dissection depth negatively correlated with the breaking strength of the liver parenchyma (R(2) = 0.6694, p < 0.0001). The average breaking strengths of the liver parenchyma, hepatic veins, and Glisson's sheaths were 1.41 ± 0.45, 8.66 ± 1.70, and 29.6 ± 11.0 MPa, respectively. The breaking strength of the liver parenchyma was significantly lower than that of the hepatic veins and Glisson's sheaths. Histological staining confirmed that the liver parenchyma was selectively dissected, preserving the hepatic veins and Glisson's sheaths in contrast to what is commonly observed with electrocautery or ultrasonic instruments. CONCLUSIONS The dissection depth of liver tissue is well controlled by input voltage and is influenced by the moving velocity and the physical properties of the organ. We showed that the device can be used to assure liver resection with tissue selectivity due to tissue-specific physical properties. Although this study uses an excised organ, further in vivo studies are necessary. The present work demonstrates that this device may function as an alternative tool for surgery due to its good controllability of the dissection depth and ability of tissue selectivity.
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Affiliation(s)
- Masato Yamada
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Nohara A, Yagi K, Liu J, Okazaki S, Yoshida M, Mori M, Nakanishi C, Kawashiri M, Inazu A, Yamagishi M, Mabuchi H. Impact of loss of function variant of betatrophin on advanced coronary artery disease among diabetic patients in japan. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Miyagi S, Kawagishi N, Maida K, Nakanishi W, Hara Y, Nakanishi C, Takeda I, Satoh K, Ohuchi N, Satomi S. Risk Factors for Portal Vein Stenosis in Living-Donor Liver Transplantation. Transplant Proc 2014; 46:689-91. [DOI: 10.1016/j.transproceed.2013.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 11/27/2022]
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40
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Nakanishi C, Sato K, Ito Y, Abe T, Akada T, Muto R, Sakashita K, Konno T, Kato H, Satomi S. Combined hepatocellular carcinoma and neuroendocrine carcinoma with sarcomatous change of the liver after transarterial chemoembolization. Hepatol Res 2012; 42:1141-5. [PMID: 23094854 DOI: 10.1111/j.1872-034x.2012.01017.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary hepatic neuroendocrine carcinoma is rare and its origin is not clearly understood. An admixture of hepatocellular carcinoma (HCC) and neuroendocrine carcinoma is particularly rare. Here, we report a patient with an extremely rare combination of HCC and neuroendocrine carcinoma of the liver. To our knowledge, this is the first reported case in which the carcinoma showed sarcomatous change. The patient was a 76-year-old man who had received outpatient treatment for chronic hepatitis C. On abdominal computed tomography (CT), the hepatic tumor was enhanced in the arterial phase but its density was lower than that of normal liver in the portal phases. His serum α-fetoprotein (AFP) level was very high. Therefore, transarterial chemoembolization (TACE) was performed based on the diagnosis of HCC. Ten months after TACE, his serum AFP level had increased to the level measured before TACE. Partial hepatectomy was performed because CT revealed poor enhancement of the recurrent tumor. Histopathologically, the tumor consisted of two distinct components: moderately differentiated HCC was intermingled with a neuroendocrine carcinoma, which was accompanied by sarcomatous changes. Immunohistochemically, the neuroendocrine carcinoma cells were positive for CD56, chromogranin A and neuron-specific enolase, and negative for AFP. The sarcomatous area was positive for AE1/3 and CD56, consistent with sarcomatous change of neuroendocrine carcinoma. The neuroendocrine carcinoma and/or sarcomatous change may have been due to phenotypic changes and/or dedifferentiation of HCC induced by TACE. Six months after surgery, the patient was diagnosed with metastasis of the neuroendocrine carcinoma to sacral bone. He died 7 months after surgery.
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Affiliation(s)
- Chikashi Nakanishi
- Department of Surgery, Iwate Prefectural Iwai Hospital, Ichinoseki Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Sato K, Ito Y, Abe T, Akada T, Muto R, Nakanishi C, Dendo M, Ozawa Y, Sakashita K, Kato H. [The evaluation of chemotherapy for patients over eighty-years-old]. Gan To Kagaku Ryoho 2012; 39:567-570. [PMID: 22504679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE We investigated the effect and safety of chemotherapy for patients over eighty-year-old. OBJECT Ten patients with advanced or recurrent pancreas or biliary tract cancer who were over 80 years old and administered gemcitabine hydrochloride (GEM), were named as "the oldest group", and compared with the control group. RESULT The overall response rate was 22. 2% without a significant difference between those 2 groups. The mean duration of treatment and the mean period from the initial chemotherapy to death were 8. 0 and 12 months, respectively, without a significant difference. There was a higher incidence of initial reduction of GEM in the oldest group. There was no significant difference at the DI ratio (actual drug intensity/ideal drug intensity) between 2 groups. Side effects found were 5 cases of neutropenia, 4 cases of anemia and appetite loss greater than grade 3. The dropout ratio (50%) in the oldest group was significantly higher. There was no death related with chemotherapy. CONCLUSION Chemotherapy can be used safely and usefully, if appropriately reduced from first administration, for a patient over eighty years old.
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Affiliation(s)
- Koichiro Sato
- Division of Surgery, Iwate Prefectural Iwai Hospital
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42
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Nohara A, Kobayashi J, Noguchi T, Tada H, Nakanishi C, Kawashiri MA, Inazu A, Yamagishi M, Mabuchi H. P238 ONSET OF CORONARY ARTERY DISEASE IN PATIENTS WITH AND WITHOUT FAMILIAL HYPERCHOLESTEROLEMIA IN JAPAN. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nakanishi C, Doi H, Katsura K, Satomi S. Treatment with L-Valine Ameliorates Liver Fibrosis and Restores Thrombopoiesis in Rats Exposed to Carbon Tetrachloride. TOHOKU J EXP MED 2010; 221:151-9. [DOI: 10.1620/tjem.221.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Hideyuki Doi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Kazunori Katsura
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Susumu Satomi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
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Noguchi T, Katsuda S, Kawashiri MA, Nohara A, Kobayashi J, Inazu A, Takata M, Tsuchida M, Tada H, Nakanishi C, Yamagishi M, Mabuchi H. Abstract: P851 PROFILES OF GAIN-OF-FUNCTION PCSK9 E32K MUTATION: INCLUDING PURE HOMOZYGOTE AND COMPOUND HETEROZYGOTE WITH LDLR GENE MUTATION. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nakanishi C, Kawagishi N, Sekiguchi S, Akamatsu Y, Sato K, Miyagi S, Takeda I, Hukushima K, Aiso T, Sato A, Fujimori K, Satomi S. Steroid-Resistant Late Acute Rejection after a Living Donor Liver Transplantation: Case Report and Review of the Literature. TOHOKU J EXP MED 2007; 211:195-200. [PMID: 17287604 DOI: 10.1620/tjem.211.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The majority of acute cellular rejection occurs in the first few months after liver transplantation. It has been, however, reported that some recipients experience late acute rejection, which occurs more than 3 months after transplantation. We herein report a case of late acute rejection that occurred nearly 10 years after liver transplantation. The patient is a 27-year-old male who underwent a living donor liver transplantation when he was 17 years old. At 9 years 6 months after transplantation, the patient presented with the elevated serum levels of liver enzymes and total bilirubin. A liver biopsy showed acute cellular rejection. Steroid bolus therapy was not effective, but we successfully used deoxyspergualin as a rescue therapy. Late acute cellular rejection that occurs nearly 10 years after transplantation has so far been rarely reported. It is generally believed that late acute rejection may be more resistant to treatment and be associated with a higher rate of graft loss, as well being associated with the development of chronic ductopenic rejection. In this report, we have shown that deoxyspergualin is safe and effective for treatment of steroid-resistant late acute rejection, preventing from graft loss of chronic rejection.
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Affiliation(s)
- Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Baba H, Suzuki Y, Ema T, Kawakami M, Nakanishi C, Hashimoto T, Arai T, Matsumoto G, Tsuruta K, Okamoto A, Karasawa K. [Gemcitabine concurrent with radiation for locally advanced pancreatic cancer]. Gan To Kagaku Ryoho 2005; 32:1730-2. [PMID: 16315923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Gemcitabine (GEM) concurrent with radiation is clinically not well defined. We herein report four cases of chemo-radiotherapy against locally advanced pancreatic cancer using low-dose GEM concurrent with extra-beam radiation. A total of eight cases entered the study. Three were resected and five were non-resected cases. Intraoperative radiation was carried out in every case using an 8 or 10 centimeter cone with a radiation dose of 25 Gy. Postoperative radiation was 2 Gy per day on weekdays for 5 weeks. Four cases were concurrent with low-dose GEM (40 mg/m2) twice a week, whereas the other four were radiation only. With the use of GEM concurrent with radiation, tumor markers decreased more than 80 percent regardless of the tumor resection. CT scan confirmed a necrotic change and the decrease of the tumor size. In conclusion, low dose GEM concurrent with radiation therapy may be a promising therapeutic choice for the local control of advanced pancreatic cancers.
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Affiliation(s)
- Hiroyuki Baba
- Dept. of Surgery, Tokyo Metropolitan Komagome Hospital
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Abstract
The cytotoxicity of chemotherapeutic agents is attributed to apoptosis. Acquired resistance to the effects of chemotherapy has emerged as a significant impediment to effective cancer therapy. One feature that cytotoxic treatments of cancer have in common is their activation of the transcription factor nuclear factor-kappaB (NF-kappaB), which regulates cell survival. NF-kappaB activation suppresses the apoptotic potential of chemotherapeutic agents and contributes to resistance. What evidence is there that inhibitors of NF-kappaB might promote apoptosis in cancer cells and can NF-kappaB inhibitors be used to overcome resistance to chemotherapeutic agents?
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Affiliation(s)
- Chikashi Nakanishi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22, Honkomagome, Bunkyoku, Tokyo 113-8677, Japan.
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Nakanishi C, Yamaguchi T, Iijima T, Saji S, Toi M, Mori T, Miyaki M. Germline mutation of the LKB1/STK11 gene with loss of the normal allele in an aggressive breast cancer of Peutz-Jeghers syndrome. Oncology 2005; 67:476-9. [PMID: 15714005 DOI: 10.1159/000082933] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 05/15/2004] [Indexed: 01/01/2023]
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal-dominant polyposis disorder with an increased risk of multiple cancer. The LKB1/STK11 gene, which acts as a tumor suppressor, is responsible for PJS and plays a role in suppressing breast cancer. The low expression of LKB1/STK11 in sporadic breast cancer is significantly associated with shorter survival. Here we describe a PJS patient with aggressive breast cancer that carried not only a germline mutation of LKB1/STK11 but also loss of the normal allele. The combination of these mutations may be associated with the poor prognosis of this patient. To our knowledge, we are the first to show that a germline mutation causing PJS is combined with the loss of the homologous normal allele of LKB1/STK11 in breast cancer.
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Affiliation(s)
- Chikashi Nakanishi
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
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Nakanishi C, Toi M, Saji S, Bando H. [Current indications for mastectomy in patients with breast cancer]. Nihon Geka Gakkai Zasshi 2002; 103:821-4. [PMID: 12478859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Recent aggressive changes in the strategy for breast cancer treatment have reduced the frequency of mastectomy as the primary surgery. In addition to the current expanded indications for breast-conserving therapy (BCT), the introduction of preoperative chemotherapy for patients with operable tumors allows BCT to be performed in a larger population of patients. The results of a questionnaire on breast cancer surgery conducted in Japan in 2000 revealed that the frequency of radical modified mastectomy had decreased by 52.2%. However, mastectomy cannot be completely eliminated, since some patients still present with locally advanced tumors and preoperative chemotherapy cannot remove the requirement for mastectomy in all patients. The current standard procedure for mastectomy appears to be the Auchincloss operation. The Halsted radical mastectomy is performed only for patients with cancer involving the pectoralis major muscle or the chest wall, and/or with marked axillary lymph node metastasis and Rotter's node metastasis. Simple mastectomy is selected for wide-spread noninvasive cancer and recently in our department for patients confirmed to be node negative by preoperative sentinely lymph node biopsy. In dealing with the changes in the treatment algorithm, we need to select the appropriate surgical options flexibly.
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Affiliation(s)
- Chikashi Nakanishi
- Department of Surgery, Breast Oncology Unit, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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Nakanishi C, Wasa M, Sando K, Nose K, Iiboshi Y, Takagi Y, Okada A. [Home parenteral nutrition in the elderly]. Gan To Kagaku Ryoho 1997; 24 Suppl 4:529-31. [PMID: 9429560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The number of elderly patients receiving home parenteral nutrition (HPN) has been increasing. This could result from several factors such as advances in HPN therapy and the natural aging of long-term older patients on HPN. Our experience shows that elderly patients receiving HPN are likely to be highly dependent on family members to supervise their HPN therapy. Therefore, indepth education of family members is essential before HPN is initiated. The important points to manage the elderly HPN patients are as follows: 1) It takes a long time for the elderly to learn the technique. 2) They often make technical mistakes. 3) In many cases, patients are not living with their children. Therefore, it is often difficult for them to support the patient's HPN therapy. 4) Nurses play an important role in giving instructions on catheter care and HPN techniques to the patient or family members.
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Affiliation(s)
- C Nakanishi
- Dept. of Pediatric Surgery, Osaka University Medical School
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