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31.
Naoya Yamada Yukihiro Sanada Yuta Hirata Noriki Okada Yoshiyuki Ihara Hideki Sasanuma Taizen Urahashi Yasunaru Sakuma Yoshikazu Yasuda Koichi Mizuta 《Pediatric surgery international》2016,32(4):363-368
Purpose
We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy.Methods
The data was collected retrospectively. SFSG was used in 14LDLTs (5.7 %) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient.Results
The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1 %, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14–88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively).Conclusions
Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.32.
Y. Kawano Y. Sanada T. Urahashi Y. Ihara N. Okada N. Yamada Y. Hirata T. Katano N. Taniai A. Matsuda M. Miyashita H. Yoshida K. Mizuta 《Transplantation proceedings》2018,50(9):2718-2722
Purpose
After undergoing the Kasai procedure for biliary atresia (BA), most patients develop severe splenomegaly that tends to be improved by liver transplantation. However, fluctuations in splenic volume long after transplantation remain to be elucidated.Patients and Methods
Seventy-one consecutive patients who had undergone pediatric living donor liver transplantation (LDLT) for BA were followed up in our outpatient clinic for 5 years. They were classified into 3 groups according to their clinical outcomes: a good course group (GC, n = 41) who were maintained on only 1 or without an immunosuppressant, a liver dysfunction group (LD, n = 18) who were maintained on 2 or 3 types of immunosuppressants, and a vascular complication group (VC, n = 11). Splenic and hepatic volumes were calculated by computed tomography in 464 examinations and the values compared before and after the treatment, especially in the VC group.Results
Splenic volume decreased exponentially in the GC group, with splenic volume to standard spleen volume ratio (SD) being 1.59 (0.33) 5 years after liver transplantation. Splenic volume to standard spleen volume ratios were greater in the VC and LD groups than in the GC group. Patients in the VC group with portal vein stenosis developed liver atrophy and splenomegaly, whereas those with hepatic vein stenosis developed hepatomegaly and splenomegaly. Interventional radiation therapy tended to improve the associated symptoms.Conclusions
Fluctuations in splenic volume long after pediatric LDLT for BA may reflect various clinical conditions. Evaluation of both splenic and hepatic volumes can facilitate understanding clinical conditions following pediatric LDLT. 相似文献33.
Yukihiro Sanada Youichi Kawano Atsushi Miki Junko Aida Ken‐ichi Nakamura Naotaka Shimomura Naoshi Ishikawa Tomio Arai Yuta Hirata Naoya Yamada Noriki Okada Taiichi Wakiya Yoshiyuki Ihara Taizen Urahashi Yoshikazu Yasuda Kaiyo Takubo Koichi Mizuta 《Transplant international》2014,27(4):383-390
Some studies have found that gender mismatch between donors and recipients are related to poor graft prognosis after liver transplantation. However, few studies have investigated the impact of gender mismatch on acute cellular rejection (ACR) in pediatric living donor liver transplantation (LDLT). This retrospective study investigated the clinical significance of these factors in ACR after pediatric LDLT. Between November 2001 and February 2012, 114 LDLTs were performed for recipients with biliary atresia (BA) using parental grafts. We performed univariate and multivariate analyses to identify the factors associated with ACR. The donor–recipient classifications included mother donor to daughter recipient (MD; n = 43), mother to son (n = 18), father to daughter (FD; n = 33), and father to son (n = 20) groups. The overall incidence rate of ACR in the recipients was 36.8%. Multivariate analysis showed that gender mismatch alone was an independent risk factor for ACR (P = 0.012). The FD group had a higher incidence of ACR than the MD group (P = 0.002). In LDLT, paternal grafts with gender mismatch were associated with a higher increased incidence of ACR than maternal grafts with gender match. Our findings support the possibility that maternal antigens may have an important clinical impact on graft tolerance in LDLT for patients with BA. 相似文献
34.
35.
Aiko HATA Masaya ODA Takahiro ONO Akira SUZUKI Noriaki HANYU Masataka TAKAHASHI Toshio SASAJIMA Manabu HASHIMOTO Taizen NAKASE Hiroaki SHIMIZU 《Neurologia medico-chirurgica》2021,61(7):404
The efficacy of stereotactic radiotherapy (SRT) has been well established for postoperative residual and recurrent nonfunctioning pituitary adenomas (NFPAs). However, the risk of visual impairment due to SRT for lesions adjacent to the optic pathways remains a topic of debate. Herein, we evaluated the long-term clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) for perioptic NFPAs. From December 2002 to November 2015, 32 patients (18 males and 14 females; median age 63 years; range, 36–83 years) with residual or recurrent NFPAs abutting or displacing the optic nerve and/or chiasm (ONC) were treated with HFSRT. The median marginal dose was 31.3 Gy (range, 17.2–39.6) in 8 fractions (range, 6–15). Magnetic resonance imaging (MRI) and visual and hormonal examinations were performed before and after HFSRT. The median follow-up period was 99.5 months (range, 9–191). According to MRI findings at the last follow-up, the tumor size had decreased in 28 (88%) of 32 patients, was unchanged in 3 (9%), and had increased in 1 (3%). The successful tumor size control rate was 97%. Visual functions remained unchanged in 19 (60%) out of 32 patients, improved in 11 (34%), and deteriorated in 2 (6%). Two patients had deteriorated visual functions; no complications occurred because of the HFSRT. One patient developed hypopituitarism that required hormone replacement therapy. The result of this long-term follow-up study suggests that HFSRT is safe and effective for the treatment of NFPAs occurring adjacent to the ONC. 相似文献
36.
Yukihiro Sanada Koshi Matsumoto Taizen Urahashi Yoshiyuki Ihara Taiichi Wakiya Noriki Okada Naoya Yamada Yuta Hirata Koichi Mizuta 《World journal of gastroenterology : WJG》2014,20(21):6638-6650
AIM:To assessed the clinical significance of protocol liver biopsy(PLB)in pediatric liver transplantation(LT).METHODS:Between July 2008 and August 2012,89and 55 PLBs were performed in pediatric patients at two and five years after LT,respectively.We assessed the histopathological findings using the Metavir scoring system,including activity(A)and fibrosis(F),and we identified factors associated with scores of≥A1 and≥F1.Our results clarified the timing and effectiveness of PLB.RESULTS:The incidences of scores of≥A1 and≥F1 were 24.7%and 24.7%,respectively,at two years after LT and 42.3%and 34.5%,respectively,at five years.Independent risk factors in a multivariate analysis of a score of≥A1 at two years included≥2 h ofcold ischemic time,no acute cellular rejection and an alanine amino transaminase(ALT)level of≥20 IU/L(P=0.028,P=0.033 and P=0.012,respectively);however,no risk factors were identified for a score of≥F1.Furthermore,no independent risk factors associated with scores of≥A1 and≥F1 at five years were identified using multivariate analysis.A ROC curve analysis of ALT at two years for a score of≥A1 demonstrated the recommended cutoff value for diagnosing≥A1 histology to be 20 IU/L.The incidence of scores of≥A2 or≥F2 at two years after LT was 3.4%(three cases),and all patients had an absolute score of≥A2.In contrast to that observed for PLBs at five years after LT,the incidence of scores of≥A2 or≥F2 was 20.0%(11 cases),and all patients had an absolute score of≥F2.In all cases,the dose of immunosuppressants was increased after the PLB,and all ten patients who underwent a follow-up liver biopsy improved to scores of≤A1 or F1.CONCLUSION:PLB at two years after LT is an unnecessary examination,because the serum ALT level reflects portal inflammation.In addition,immunosuppressive therapy should be modulated to maintain the ALT concentration at a level less than 20 IU/L.PLB at five years is an excellent examination for the detection of early reversible graft fibrosis because no serum markers reflect this finding. 相似文献
37.
Taizen Urahashi Hideo Katsuragawa Masakazu Yamamoto Koichi Mizuta Yukihiro Sanada Taiichi Wakiya Minoru Umehara Hideo Kawarasaki 《Clinical transplantation》2012,26(6):816-819
To improve the processes used for perfusion of the explanted graft and measuring the portal venous pressure (PVP) in adult living donor transplantation (LDLT), we performed transumbilical portal venous catheterization (TPVC) to reopen the umbilical vein and insert the catheter for seven adult patients undergoing left lobe LDLT. There were no major complications as a result of this procedure. This procedure prior to implanting the graft was derived from our experience and is a classic diagnostic technique used during liver surgery. It is a simple and effective procedure for perfusion and washout of the graft and for the safe monitoring of the intraoperative PVP. We hope that this technique for left lobe LDLT will be helpful to others using postoperative PVP monitoring, administration of therapeutic drugs through the portal vein, and temporal portal decompression by preparation of extracorporeal shunting in patients with a small‐for‐size graft. 相似文献
38.
Noriki Okada Yuta Kawahara Yukihiro Sanada Yuta Hirata Shinya Otomo Hitomi Niijima Akira Tanaka Akira Morimoto Alan K. Lefor Taizen Urahashi Yoshikazu Yasuda Koichi Mizuta Yasunaru Sakuma Naohiro Sata 《American journal of transplantation》2021,21(9):3184-3189
Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X-linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X-linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux-en-Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X-linked SCID and liver failure. 相似文献
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