94 results on '"Takayama, T."'
Search Results
2. Late-onset arterial hemorrhage mimicking pseudoaneurysm after living donor liver transplantation.
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Miyazaki T, Yamazaki S, Takayama T, Moriguchi M, Higaki T, Kashimura T, Nakazawa H, Matsuoka S, Moriyama M, and Makuuchi M
- Subjects
- Adult, Balloon Occlusion adverse effects, Diagnosis, Differential, Humans, Living Donors, Male, Postoperative Hemorrhage pathology, Thrombosis etiology, Aneurysm, False diagnosis, Hepatic Artery pathology, Hepatitis surgery, Liver Diseases surgery, Liver Transplantation adverse effects, Postoperative Hemorrhage diagnosis
- Published
- 2016
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3. The risk factors of fungal infection in living-donor liver transplantations.
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Ohkubo T, Sugawara Y, Takayama T, Kokudo N, and Makuuchi M
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- Adolescent, Adult, Aspergillosis epidemiology, Biliary Atresia surgery, Candidiasis epidemiology, Child, Child, Preschool, Cholangitis, Sclerosing surgery, Female, Humans, Infant, Kaplan-Meier Estimate, Liver Cirrhosis surgery, Living Donors, Male, Middle Aged, Multivariate Analysis, Mycoses mortality, Pneumocystis Infections epidemiology, Pneumocystis carinii, Retrospective Studies, Risk Factors, Young Adult, Liver Transplantation adverse effects, Liver Transplantation mortality, Mycoses epidemiology
- Abstract
Purpose: The aim of the study was to retrospectively assess in a Japanese university hospital the risk factors for fungal infections and mortality in living-donor liver transplantations (LDLTs). Although fungal infections are an important complication associated with high mortality in liver transplantation, the risk factors for fungal infections developing after LDLT remain poorly understood., Methods: Patient records for a total of 156 patients undergoing LDLT over a 6-year period in our institution were retrospectively evaluated. All transplant recipients were routinely observed for fungal infections with close monitoring for febrile episodes and collection and culture of saliva, pharynx, sputum, urine, feces, and drain discharge specimens undertaken. Fungal infection was defined as proposed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group. Patients with definite or probable infection were diagnosed as having specific invasive fungal infection in this study. Data were reviewed and collated from these patients' records, and multivariate analyses were performed to identify possible risk factors for mortality and the development of fungal infections., Results: Nineteen of 156 patients (12.2%) developed invasive fungal infections, involving Candida spp. (n = 13), Pneumocystis jiroveci (n = 4), and Aspergillus spp. (n = 2). Eight of these 19 patients died, 4 from pneumonia, and 1 each from cerebral hemorrhage, chronic rejection, virus-associated hemophagocytic syndrome, and cancer recurrence. The 5-year survival rate was significantly lower in patients with fungal infections than in those without (53 vs. 90%; p < 0.001). Fungal infection was independently associated with reoperation (odds ratio 6.92, 1.82-26.27, p = 0.004), posttransplant dialysis (5.62, 1.51-20.88, p = 0.009), and bacterial infection (3.94, 1.02-15.26, p = 0.04)., Conclusion: Independent risk factors of fungal infection after LDLT are reoperation, posttransplant dialysis, and bacterial infection.
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- 2012
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4. Surgical treatment for hepatocellular carcinoma.
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Takayama T
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- Algorithms, Catheter Ablation, Humans, Incidence, Internet, Japan epidemiology, Living Donors, Neoplasm Recurrence, Local epidemiology, Neoplasm Staging, Patient Selection, Practice Guidelines as Topic, Risk Factors, Survival Rate, Ultrasonography, Interventional, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Hepatectomy mortality, Liver Neoplasms mortality, Liver Neoplasms surgery, Liver Transplantation
- Abstract
Surgery is the most important therapeutic approach for patients with hepatocellular carcinoma. We have reviewed patients' survival after resection for hepatocellular carcinoma in 17 series since 2000, each including more than 100 patients. Median survival rates were 80% (range 63-97%) at 1 year, 70% (34-78%) at 3 years and 50% (17-69%) at 5 years. Such wide ranges of survival rates are attributed mainly to differences in the hepatocellular carcinoma stage among studies, but the survival rate is obviously much better for early hepatocellular carcinomas. Today, liver resection is an established treatment for hepatocellular carcinoma owing to minimal surgical mortality and improved survival. Liver transplantation is one of the best treatments for hepatocellular carcinoma in patients who meet the selection criteria. Further studies are needed to establish suitable criteria for transplantation in patients with hepatocellular carcinoma. For patients who are not candidates for liver resection or transplantation, percutaneous ablation is the best treatment option. However, no randomized controlled clinical trial has compared the results of ablation with those of surgical therapy for hepatocellular carcinoma, and none of the ablation techniques have been shown to offer a definitive survival advantage. A treatment algorithm based on published evidence is now available, which helps us to select the most suitable therapeutic option for individual patients, depending on tumor characteristics and liver functional reserve. This review paper summarizes the current status of the surgical management of hepatocellular carcinoma.
- Published
- 2011
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5. A case of Fournier's gangrene after liver transplantation: treated by hyperbaric oxygen therapy.
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Yoshida N, Yamazaki S, and Takayama T
- Subjects
- Humans, Male, Middle Aged, Patient Admission, Pelvis diagnostic imaging, Tomography, X-Ray Computed, Fournier Gangrene etiology, Fournier Gangrene therapy, Hyperbaric Oxygenation, Liver Transplantation adverse effects
- Abstract
Fournier's gangrene (FG) is known as a rapidly progressing necrotizing fasciitis arising from genitourinary and colorectal infections. Misdiagnoses have occurred often because the initial presentation varies and is unclear. We report a case of FG in a 59-year-old man who had undergone a living donor liver transplant. He was in the maintenance phase of immunosuppressant treatment. FG occurred rapidly without symptoms and required prompt and aggressive debridement. Computed tomography demonstrated a small air density in his left testis. Treatment with hyperbaric oxygen therapy followed by intra- operative Gram's staining navigated debridement was additionally performed with general systematic anti-biological therapy and successfully cured the patient. Extra caution should be paid to patients who are maintained on immunosuppressants. Earlier detection and intervention will reduce the rate of mortality to a minimum.
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- 2011
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6. The technical advance and impact of caudate lobe venous reconstruction in left liver: additional safety for living-related donor liver transplantation.
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Yamazaki S, Takayama T, and Makuuchi M
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- Anastomosis, Surgical, Hepatectomy methods, Hepatic Veins pathology, Hepatic Veins surgery, Humans, Liver anatomy & histology, Liver blood supply, Liver pathology, Living Donors, Models, Anatomic, Safety, Surgical Procedures, Operative, Treatment Outcome, Liver physiopathology, Liver Transplantation methods
- Abstract
The key to obtaining good overall outcomes in small-for-size liver-graft transplantation is ensuring sufficient blood flow to the graft during the initial period after surgery. In left lobe liver grafting, various reconstruction techniques have been devised to maximize the limited graft volume. The reconstructions of the caudate lobe (CL) vessels were one of the main streams. In this article, we focus on the clinical significance of CL vessel reconstructions after small-for-size liver-graft transplantation and discuss the roles of various techniques. These techniques contribute to the enlargement of the margin of safety with respect to small-for-size liver-graft transplantation.
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- 2010
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7. Current approaches to the treatment of early hepatocellular carcinoma.
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Ye SL, Takayama T, Geschwind J, Marrero JA, and Bronowicki JP
- Subjects
- Ablation Techniques, Carcinoma, Hepatocellular surgery, Humans, Japan, Liver surgery, Liver Neoplasms surgery, Neoadjuvant Therapy, Neoplasm Staging, Randomized Controlled Trials as Topic, Recurrence, Treatment Outcome, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular therapy, Liver Neoplasms pathology, Liver Neoplasms therapy, Liver Transplantation, Living Donors
- Abstract
For patients with early-stage hepatocellular carcinoma (HCC), potentially curative treatment options exist, including liver transplantation, surgical resection, and ablation therapy. These treatments are associated with survival benefits, and outcomes are optimized by identification of appropriate patients. However, further studies are needed to definitively confirm optimal treatment approaches for all patients. Treatment patterns vary in different parts of the world as a result of geographic differences in the incidence and presentation of the disease. In particular, because of successful screening programs, a high proportion of tumors that are identified in Japan are amenable to curative treatments, which are appropriate in a smaller proportion of patients in the west, although screening is now widely carried out in industrialized countries. Differences in the applicability of transplantation are also evident between the west and Asia. Although existing treatments for early-stage HCC are supported by considerable evidence, there remain significant data gaps. For example, further data, ideally from randomized controlled trials, are needed regarding: the use of neoadjuvant and adjuvant therapy to decrease the rate of recurrence after resection or ablation, further investigation of the role of chemoprevention following resection, and prospective analysis of outcomes of living donor compared with deceased donor liver transplantation.
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- 2010
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8. Use of a bridging autologous hepatic vein graft for extended right-liver transplantation.
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Watanabe Y, Takayama T, Yamazaki S, Aramaki O, Moriguchi M, Higaki T, Inoue K, and Makuuchi M
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- Anastomosis, Surgical, Cryopreservation, Graft Survival, Humans, Liver blood supply, Living Donors, Male, Middle Aged, Tomography, X-Ray Computed, Treatment Outcome, Vascular Patency, Hepatic Veins pathology, Hepatic Veins surgery, Liver surgery, Liver Transplantation methods
- Published
- 2009
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9. Simplified technique for one-orifice vein reconstruction in left-lobe liver transplantation.
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Yamazaki S, Takayama T, Inoue K, Higaki T, and Makuuchi M
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- Anastomosis, Surgical, Cardiovascular Surgical Procedures, Constriction, Pathologic, Cryopreservation, Hepatic Veins pathology, Humans, Regeneration, Vena Cava, Inferior pathology, Liver blood supply, Liver surgery, Liver Transplantation methods, Vascular Surgical Procedures methods
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- 2009
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10. Transplantation-related thrombotic microangiopathy triggered by preemptive therapy for hepatitis C virus infection.
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Yamazaki S, Takayama T, Inoue K, Higaki T, and Makuuchi M
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- Adult, Brain drug effects, Brain pathology, Cerebrovascular Circulation drug effects, Cerebrovascular Disorders pathology, Female, Humans, Immunosuppressive Agents toxicity, Magnetic Resonance Imaging, Tacrolimus toxicity, Antiviral Agents adverse effects, Cerebrovascular Disorders chemically induced, Hepatitis C drug therapy, Hepatitis C surgery, Liver Transplantation adverse effects, Purpura, Thrombotic Thrombocytopenic chemically induced
- Published
- 2008
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11. Branch patch reconstruction in living donor liver transplantation: arterialization of grafts with replaced type arteries.
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Aramaki O, Sugawara Y, Kokudo N, Takayama T, and Makuuchi M
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- Anastomosis, Surgical methods, Hepatectomy methods, Hepatic Artery abnormalities, Humans, Liver blood supply, Liver surgery, Treatment Outcome, Angioplasty methods, Hepatic Artery surgery, Liver Transplantation methods, Living Donors, Tissue and Organ Harvesting methods
- Abstract
We developed a hepatic arterialization technique in living donor liver transplantation. The technique was indicated in patients with a left graft from donors with a right hepatic artery originated from superior mesenteric artery or a right graft from donors with a left hepatic artery from left gastric artery. The donor common hepatic and gastroduodenal arteries were split. On the recipient side, left and right hepatic arteries or branches of the right hepatic artery were split, received patch plasty, and anastomosed with the graft arteries under loupe observation. Livers from 25 donors were procured (16 right livers and 9 left livers) using this technique. There were no vascular complications in the donors. Three recipients died due to infectious disease with arterial patency. The remaining 22 recipients survived without hepatic arterial thrombosis. In limited situations, this technique can be adapted for living donor liver transplantation without increasing donor complications.
- Published
- 2006
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12. Correlation between acute rejection severity and CD8-positive T cells in living related liver transplantation.
- Author
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Kubota N, Sugitani M, Takano S, Sheikh A, Takayama T, Haga H, Tanaka K, and Yamabe H
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- Adolescent, Adult, CD8-Positive T-Lymphocytes cytology, Cell Movement immunology, Child, Child, Preschool, Female, Graft Rejection pathology, Humans, Infant, Liver cytology, Liver pathology, Liver Transplantation pathology, Living Donors, Lymphocyte Count, Male, Middle Aged, CD8-Positive T-Lymphocytes immunology, Graft Rejection immunology, Liver immunology, Liver Transplantation immunology
- Abstract
The Banff schema is the most widely used standard grading system for liver allograft rejection. To investigate the relationship between the Banff rejection activity index (RAI) and the presence of lymphocyte subpopulations in allograft liver tissue, assuming these cells to probably play an important role in the mechanism of acute cellular rejection (ACR), we performed immunohistological examinations using liver tissues with various ACR severities after living related liver transplantation (LRLT). In total, 37 needle liver biopsy specimens with ACR in LRLT were examined using antibodies to CD4, CD8, and CD20. Formalin-fixed and paraffin-embedded liver tissues were used to maintain morphology. Immunohistological findings and RAI score according to the Banff schema were compared. In the results, mainly CD8-positive (CD8+), rather than CD4-positive (CD4+), cells were detected in the portal tract and were also found in bile duct epithelium and subendothelial areas of portal veins. The number of CD8+ cells increased according to ACR grade, whereas CD4+ cells tended to decrease. There were significant correlations between the presence of CD8+ cells (p = 0.0006) and CD4+ cells (p = 0.0003) and ACR severity. On the other hand, CD20-positive cells did not correlate with ACR severity (p = 0.472). The results indicate that CD8+ cells play important roles in ACR severity of LRLT, suggesting the number of CD8+ cells in liver tissue to be useful as a supplementary tool, in addition to RAI of the Banff schema, for objective evaluation of ACR severity.
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- 2006
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13. Interposition of autologous portal vein graft in left liver transplantation.
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Yamazaki S, Takayama T, Inoue K, Higaki T, and Makuuchi M
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- Follow-Up Studies, Humans, Liver Cirrhosis surgery, Middle Aged, Portal Vein diagnostic imaging, Portal Vein surgery, Reoperation, Tomography, X-Ray Computed, Transplantation, Autologous, Liver Transplantation, Portal Vein abnormalities, Vascular Surgical Procedures methods
- Published
- 2005
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14. Pringle's maneuver and selective inflow occlusion in living donor liver hepatectomy.
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Imamura H, Kokudo N, Sugawara Y, Sano K, Kaneko J, Takayama T, and Makuuchi M
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- Adult, Alanine Transaminase analysis, Aspartate Aminotransferases analysis, Constriction, Female, Hepatic Artery physiopathology, Humans, Intraoperative Period, Liver enzymology, Liver Circulation, Male, Middle Aged, Retrospective Studies, Hemostasis, Surgical methods, Hepatectomy, Liver Transplantation, Living Donors, Tissue and Organ Harvesting
- Abstract
While inflow occlusion techniques such as Pringle's maneuver are accepted methods of reducing bleeding without inducing liver injury during liver surgery, donor hepatectomy for living donor liver transplantation is currently performed without inflow occlusion for fear that injury to the graft may result. We have performed donor hepatectomy for 12 years using selective intermittent inflow occlusion, a technique in which the portion used to form the graft is perfused during hepatectomy. Starting in November 2000, we applied intermittent Pringle's maneuver to donor hepatectomy in 81 cases of living donor liver transplantation. We reviewed our experience with Pringle's maneuver and selective inflow occlusion techniques in donor hepatectomy in living donor liver transplantation. The quality of the grafts was assessed and compared by determining maximum postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values. Neither primary nonfunction nor dysfunction occurred. Maximum AST values in the recipients were the same whether the liver segments that formed the grafts were totally ischemic during dissection (total ischemia), partially ischemic (partial ischemia), perfused only with arterial blood flow (portal ischemia), or not ischemic at all (no ischemia). Maximum ALT values in the recipients of the total ischemia group was lower, albeit not significantly, than in other groups. Total inflow occlusion can be applied to living donor hepatectomy without causing graft injury. In conclusion, because the transection surface is blood-free, there is decreased risk to the donor during living donor liver transplantation surgery, and surgeons should not hesitate to apply this technique because it contributes to donor safety.
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- 2004
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15. Effect of hematocrit on pharmacokinetics of tacrolimus in adult living donor liver transplant recipients.
- Author
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Minematsu T, Sugiyama E, Kusama M, Hori S, Yamada Y, Ohtani H, Sawada Y, Sato H, Takayama T, Sugawara Y, Makuuchi M, and Iga T
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- Adult, Drug Monitoring methods, Humans, Immunosuppressive Agents blood, Immunosuppressive Agents pharmacokinetics, Kinetics, Liver Transplantation immunology, Metabolic Clearance Rate, Retrospective Studies, Tacrolimus blood, Hematocrit, Liver Transplantation physiology, Living Donors, Tacrolimus pharmacokinetics
- Abstract
Objective: Plasma drug concentrations are generally considered to reflect efficacy and pharmacokinetics more directly than those in whole blood. However, whole blood has been selected as the matrix to monitor concentrations of tacrolimus (FK506), because it is difficult to accurately measure plasma FK506 concentrations. Because FK506 highly and saturably binds in blood cells, a change in hematocrit value (Hct) may affect FK506 pharmacokinetics. Therefore, we investigated effects of Hct on FK506 pharmacokinetics., Methods: First, we analyzed data on FK506 distribution among human blood cells in vitro. Briefly, we employed an equation, which describes saturable binding of FK506 to blood cells, and simulated plasma FK506 concentrations and clearances using the above equation with respect to a variable Hct. Subsequently, we retrospectively analyzed dosages and whole blood FK506 concentrations to predict plasma FK506 concentrations in living donor transplant recipients., Results: In the simulation study, the Hct changed plasma FK506 concentrations and clearances based in whole blood. In living donor liver transplant recipients, whole blood FK506 concentrations were maintained within a therapeutic range, while the Hct varied after transplantation. The correlation of Hct with the ratio of dose/trough concentrations of FK506 (D/C) in plasma (D/Cp) (R = -0.23, n = 343) was weaker than that for D/C in whole blood (D/CWB) (R = -0.53, n = 343)., Conclusion: Hct may be an important factor affecting the pharmacokinetics of FK506 in living donor liver transplantation recipients. It may be necessary to take Hct into consideration in the FK506 dosing regimen, especially when the Hct is low., (Copyright 2004 Elsevier Inc.)
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- 2004
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16. Pringle's manoeuvre in living donors.
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Imamura H, Takayama T, Sugawara Y, Kokudo N, Aoki T, Kaneko J, Matsuyama Y, Sano K, Maema A, and Makuuchi M
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- Adult, Child, Female, Humans, Infant, Male, Middle Aged, Postoperative Period, Blood Loss, Surgical prevention & control, Liver Transplantation methods, Living Donors
- Abstract
The safety of the donor is paramount in living donor liver transplantation. The most important risk to the donor during hepatectomy is bleeding, and the inflow occlusion technique (Pringle's manoeuvre) has been reported to decrease bleeding without inducing liver injury in liver surgery. However, most transplant centres are doing donor hepatectomies without this technique for fear that it would result in ischaemic injury to the graft. We have done 46 living donor hepatectomies with Pringle's manoeuvre without any negative outcome on the quality of the graft. Surgeons should not hesitate to apply this technique in living donor hepatectomy.
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- 2002
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17. Psychiatric problems in living-related transplantation (I): incidence rate of psychiatric disorders in living-related transplantation.
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, Kita Y, Aikawa A, and Hasegawa A
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- Adult, Age Factors, Child, Depressive Disorder classification, Depressive Disorder epidemiology, Follow-Up Studies, Humans, Incidence, Postoperative Complications epidemiology, Postoperative Complications psychology, Psychotic Disorders classification, Psychotic Disorders epidemiology, Time Factors, Liver Transplantation psychology, Living Donors psychology, Mental Disorders epidemiology
- Published
- 2002
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18. Left liver plus caudate lobe graft with complete revascularization.
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Sugawara Y, Makuuchi M, and Takayama T
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- Humans, Liver Circulation, Liver Regeneration, Liver Transplantation methods
- Published
- 2002
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19. Psychiatric problems in living-related transplantation (III): pretransplant psychological assessment in living-related transplantation.
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, Kita Y, Aikawa A, and Hasegawa A
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- Adult, Conflict, Psychological, Fear, Hepatectomy psychology, Humans, Psychological Tests, Family, Liver Transplantation psychology, Living Donors psychology, Mental Disorders epidemiology, Tissue and Organ Harvesting psychology
- Published
- 2002
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20. Gastrointestinal bleeding after living-related liver transplantation.
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Hirata M, Kita Y, Harihara Y, Hisatomi S, Sano K, Mizuta K, Yoshino H, Sugawara Y, Takayama T, Kawarasaki H, Hashizume K, and Makuuchi M
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- Adolescent, Adult, Child, Child, Preschool, Esophageal and Gastric Varices etiology, Female, Humans, Liver Transplantation methods, Male, Middle Aged, Portal Vein, Venous Thrombosis complications, Gastrointestinal Hemorrhage etiology, Liver Transplantation adverse effects, Living Donors
- Abstract
We examined the prevalence of gastrointestinal bleeding in patients undergoing living-related liver transplantation (LRLT). Seventy-seven patients (37 male and 40 female) underwent LRLT at the University of Tokyo Hospital from January 1996 through December 1999. Forty-nine patients were children or adolescents and 28 patients were adults. The mean follow-up period was 21.3 +/- 12.8 months. Nine of the 77 recipients had gastrointestinal bleeding after transplantation. The incidence of posttransplant bleeding was significantly higher in adult recipients than in pediatric recipients (25% vs 4%, P < 0.05). The ratio of graft volume to standard liver volume was significantly lower in adult recipients than in pediatric recipients (41 +/- 6% vs 86 +/- 26%, P < 0.05). Portal vein thrombosis (PVT) developed after LRLT in 8 patients. Variceal bleeding subsequently occurred in all 4 adult patients with PVT but in only 1 of 4 pediatric patients. Small-for-size grafts may cause transient portal hypertension, which increases the risk of gastrointestinal bleeding.
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- 2002
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21. Psychiatric problems in living-related transplantation (II): the association between paradoxical psychiatric syndrome and guilt feelings in adult recipients after living donor liver transplantation.
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, Kita Y, Aikawa A, and Hasegawa A
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- Adult, Female, Humans, Japan, Male, Middle Aged, Parents, Siblings, Guilt, Liver Transplantation psychology, Living Donors psychology, Postoperative Complications psychology, Psychotic Disorders etiology
- Published
- 2002
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22. Advantage in using living donors with aberrant hepatic artery for partial liver graft arterialization.
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Sakamoto Y, Takayama T, Nakatsuka T, Asato H, Sugawara Y, Sano K, Imamura H, Kawarasaki H, and Makuuchi M
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- Adult, Anastomosis, Surgical, Arterial Occlusive Diseases etiology, Female, Humans, Male, Middle Aged, Tissue Donors, Hepatic Artery abnormalities, Hepatic Artery surgery, Liver Transplantation methods
- Abstract
Background: In living-related partial liver transplantation, the feasibility and safety of using left-sided liver grafts from donors with aberrant hepatic arteries remains to be evaluated., Methods: Between 1996 and 2000, we harvested left-sided liver grafts from 101 living donors. Hepatic arterial variation in the donors was classified into three types: type I (n=69), normal anatomy; type II (n=24), aberrant left hepatic artery arising from the left gastric artery; and type III (n=8), replaced right hepatic artery arising from the superior mesenteric artery. We performed arterial reconstructions using the donor's left hepatic artery in 70 cases (69 in type I, 1 in type II), an aberrant left hepatic artery in 24 cases (23 in type II, 1 in type III), and the common hepatic artery in 7 cases (all in type III)., Results: The diameter and length of the anastomosed hepatic artery were larger (2.5+/-0.7 vs. 2.0+/-0.8 mm, P=0.03) and longer (42.0+/-14.7 vs. 9.0+/-7.3 mm, P<0.0001) in cases in which the aberrant left hepatic artery or common hepatic artery was used for the anastomosis (n=31) than in those using the left hepatic artery (n=70). Hepatic arterial occlusion occurred in nine patients, with the incidence of occlusion tending to be lower in the former cases in which aberrant left or common hepatic arteries were used (3.2% vs. 11.4% for the left hepatic artery group, P=0.15)., Conclusion: Because thicker and longer arterial branches can be obtained in left-sided liver grafts with aberrant hepatic arteries than in grafts with normal left hepatic arteries, their use is advantageous for safe arterialization in partial liver grafts.
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- 2002
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23. Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction.
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Sano K, Makuuchi M, Miki K, Maema A, Sugawara Y, Imamura H, Matsunami H, and Takayama T
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- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Humans, Infant, Liver diagnostic imaging, Liver Transplantation methods, Living Donors, Male, Middle Aged, Perioperative Care, Prospective Studies, Spectroscopy, Near-Infrared, Ultrasonography, Doppler, Color, Vascular Diseases physiopathology, Vascular Surgical Procedures standards, Hepatic Veins surgery, Liver blood supply, Liver Transplantation standards, Vascular Diseases diagnosis, Vascular Diseases surgery, Vascular Surgical Procedures methods
- Abstract
Objective: To establish criteria for venous reconstruction of middle hepatic vein (MHV) tributaries of the right liver graft in adult-to-adult living donor liver transplantation (LDLT)., Summary Background Data: In adult LDLT using the right hemiliver, the MHV is usually separated from the graft, which results in potential venous congestion in the major part of the right paramedian sector (segments 5 and 8). It is controversial whether MHV tributaries should be reconstructed., Methods: Thirty-nine donors for LDLT were enrolled in the study. After liver transection, temporary arterial clamping was carried out to visualize congestion in the right paramedian sector by occlusion of MHV tributaries. Intra- and postoperative (on postoperative days 3 and 7) Doppler ultrasonography was performed to check the hepatic venous and portal flow in the veno-occlusive area., Results: In 29 of 37 donors (78%), the liver surface of the veno-occlusive area was discolored with temporary arterial clamping. The discolored area was calculated to represent approximately two thirds of the right paramedian sector on computed tomography volumetry. All of the cases with discoloration exhibited absent venous flow and regurgitated portal flow in the discolored area by intraoperative Doppler ultrasonography. These ultrasonographic findings resolved by postoperative day 7 in 6 of 14 cases (43%)., Conclusions: The state of venous congestion in the right liver graft can be correctly assessed by the temporary arterial clamping method and intraoperative Doppler ultrasonography. If the venocongestive area is demonstrated to be so large that the graft volume excluding this area is thought to be insufficient for postoperative metabolic demand, venous reconstruction is recommended.
- Published
- 2002
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24. Role of splenectomy in living-donor liver transplantation for adults.
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Cescon M, Sugawara Y, Takayama T, Seyama Y, Sano K, Imamura H, and Makuuchi M
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- Adult, Female, Humans, Liver Diseases complications, Male, Middle Aged, Thrombocytopenia complications, Liver Transplantation, Living Donors, Splenectomy, Thrombocytopenia surgery
- Abstract
Background/aims: Splenectomy is occasionally required in liver transplantation. However, its indications and drawbacks have not been clearly defined in living-donor liver transplantation., Methodology: Eleven of 59 adult living-donor liver transplantation recipients underwent splenectomy. Indications were thrombocytopenia in 6 cases, portal flow disturbances due to splenorenal shunt in four, and splenic infarction in one. The incidence of bacterial complications and changes in platelet counts and portal vein flow were evaluated., Results: Two patients died of pneumonia and cerebral bleeding, respectively. Six events of bacterial infections occurred in the remaining nine patients. After splenectomy, a normal portal flow was achieved and the platelet count significantly increased., Conclusions: Splenectomy may be an acceptable option in patients with thrombocytopenia or when it is necessary to change the portal flow.
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- 2002
25. Duct-to-duct biliary reconstruction in living-related liver transplantation.
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Sugawara Y, Makuuchi M, Sano K, Ohkubo T, Kaneko J, and Takayama T
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- Adult, Anastomosis, Surgical, Family, Humans, Middle Aged, Reoperation, Bile Ducts surgery, Hepatectomy methods, Liver Transplantation methods, Living Donors, Surgical Procedures, Operative methods
- Abstract
Background: Bile duct-to duct reconstruction is now used in living-related liver transplantation for adult patients. However, the feasibility remains controversial., Methods: Bile duct-to-duct reconstruction was performed in 25 adult patients. In the total hepatectomy of the patients, the hilar plate was dissected at the second-order branch of the bile ducts. The anastomosis was performed using an interrupted suture with an external stent tube. A C tube was inserted from the stump of the cystic duct and introduced into the duodenum., Results: All of the patients survived the operation. During the observation period ranging from 34 to 345 days, biliary complications were observed in 8% cases. Dilation of the bile ducts and an absence of bile output were recognized in one patient each, and necessitated surgical revision., Conclusions: Our preliminary experience in biliary reconstruction seems to warrant its long-term observation in the postoperative period.
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- 2002
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26. Impaired volume regeneration of split livers with partial venous disruption: a latent problem in partial liver transplantation.
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Maema A, Imamura H, Takayama T, Sano K, Hui AM, Sugawara Y, and Makuuchi M
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- Adult, Female, Hepatectomy, Humans, Liver diagnostic imaging, Liver Transplantation adverse effects, Male, Middle Aged, Postoperative Complications, Tomography, X-Ray Computed, Hepatic Veins surgery, Liver Regeneration, Liver Transplantation methods
- Abstract
Background: In living-donor and split-liver transplantations using a hemi-liver graft, it is practically impossible to maintain complete venous drainage in both the right and left livers, because the middle hepatic vein can be preserved only on the unilateral side. However, it is not clear whether partial venous disturbances affect postoperative liver volume regeneration., Methods: Living donors who underwent left-sided hepatectomy preserving the middle hepatic vein (group A, n=40) or left hepatectomy with middle hepatic vein resection (group B, n=37) were reviewed. Volume regeneration of the remnant right paramedian (segments V + VIII) and lateral (segments VI + VII) sectors and overall liver volume was assessed at 3 postoperative months by computed tomography., Results: In group A, both sectors showed a proportional increase by 21.7% (P=0.991), whereas in group B the rate of increase of the right paramedian sector was less than that of the right lateral sector (13.3% vs. 36.5%, P<0.001). Comparisons of rate of increase for each sector between the groups indicated that interruption of the middle hepatic venous drainage impaired enlargement of the right paramedian sector and induced a compensatory hypertrophy of the right lateral sector. Overall liver mass restoration rate in group B was inferior to that in group A (78.9% vs. 85.0%, P=0.001)., Conclusions: Split livers with partial outflow disturbances are associated with latent disadvantages in postoperative liver volume regeneration even if venous congestion is not evident. These results suggest a problem of regenerative capacity of right liver grafts.
- Published
- 2002
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27. Small bile duct reconstruction of the caudate lobe in living-related liver transplantation.
- Author
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Kubota K, Takayama T, Sano K, Hasegawa K, Aoki T, Sugawara Y, and Makuuchi M
- Subjects
- Adolescent, Adult, Anastomosis, Surgical, Bile Ducts pathology, Dilatation, Pathologic, Humans, Living Donors, Middle Aged, Suture Techniques, Bile Ducts surgery, Liver Transplantation methods
- Abstract
Objective: To justify the technique of biliary reconstruction without mucosa-to-mucosa alignment for reconstructing the caudate lobe bile duct., Summary Background Data: The use of a left hepatic lobe graft with the caudate lobe (LHGC) has been introduced to resolve the problem of small-for-size grafts in living-related liver transplantation. The authors have found that the LHGCs occasionally have independent openings of the bile duct of the caudate lobe., Methods: The graft bile ducts were anastomosed to Roux-en-Y jejunal loops. The main left hepatic ducts were reconstructed in a standard manner. Small bile ducts of the caudate lobe were anastomosed to the intestine without mucosa-to-mucosa alignment, with an external biliary drainage tube, positioned transanastomotically., Results: In 8 of the 19 patients who received LHGCs, nine bile ducts of the caudate lobe (median 1 mm) were reconstructed. After surgery there was no bile leakage. In five of the eight patients, the tubes were removed a median of 92 days after transplantation. Bile duct dilatation had not been observed at a median of 363 days after surgery., Conclusions: The authors consider their technique of biliary reconstruction without mucosa-to-mucosa alignment useful for the safe reconstruction of small bile ducts of the caudate lobe.
- Published
- 2002
- Full Text
- View/download PDF
28. Right lateral sector graft in adult living-related liver transplantation.
- Author
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Sugawara Y, Makuuchi M, Takayama T, Imamura H, and Kaneko J
- Subjects
- Adult, Blood Loss, Surgical, Blood Transfusion, Autologous, Female, Follow-Up Studies, Graft Rejection epidemiology, Humans, Liver anatomy & histology, Living Donors, Male, Middle Aged, Postoperative Complications classification, Postoperative Complications epidemiology, Retrospective Studies, Treatment Outcome, Hepatectomy methods, Liver Transplantation methods, Liver Transplantation physiology, Tissue and Organ Harvesting methods
- Abstract
Background: A major concern regarding adult living-related liver transplantation (LRLT) is graft-size disparity. The authors report their experience with LRLT using the right lateral sector., Patients and Methods: Between January 2000 and April 2001, 32 adult-to-adult LRLTs were performed at our institution. Of these, six patients received a right lateral sector (RLS, segments VI and VII according to Couinaud's nomenclature for liver segmentation) graft. The right liver was over 70% of the estimated volume of the whole donor liver. The estimated RLS volume was greater than that of the left liver, which was over 40% of the recipient's standard liver volume., Results: The postoperative course was uneventful in all donors. All of the patients survived the operation. Three patients were complicated with bile leakage from the dissection plane of the graft. Four patients suffered from acute rejection., Conclusions: RLS graft obtained by this procedure may be useful for overcoming borderline graft-recipient size differences and expanding the donor pool.
- Published
- 2002
- Full Text
- View/download PDF
29. Safe donor hepatectomy for living related liver transplantation.
- Author
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Sugawara Y, Makuuchi M, Takayama T, Imamura H, Kaneko J, and Ohkubo T
- Subjects
- Adolescent, Adult, Biliary Atresia surgery, Child, Child, Preschool, Graft Survival, Humans, Infant, Liver Cirrhosis surgery, Liver Cirrhosis, Biliary surgery, Middle Aged, Hepatectomy methods, Liver Transplantation methods, Living Donors
- Abstract
Minimizing the risk of donor hepatectomy while preserving graft viability is an important concern in living related liver transplantation. This report describes clinical outcomes for living donor hepatectomy with reference to the type of hepatectomy. Donor hepatectomy was performed in 130 consecutive living donors. They were divided into three groups: left lateral or extended left lateral segmentectomy (group S; n = 50), left hepatectomy with or without caudate lobe or right lateral resection (group L; n = 64), and right hepatectomy (group R; n = 16). Intraoperative and postoperative data were examined and compared among the groups. No critical complications were observed in any group. However, there were differences in donor age, surgical and ischemia times, volume of blood loss, graft weight, and aspartate aminotransferase level elevation among the groups. Livers showed a substantial increase in volume, tending to the standard liver volume 1 month after surgery. Regardless of the extent of donor hepatectomy, serious complications did not occur after surgery. Surgical risk for a living donor is minimal if the operation is performed by experienced surgeons using present procedures.
- Published
- 2002
- Full Text
- View/download PDF
30. Association between pretransplant psychological assessments and posttransplant psychiatric disorders in living-related transplantation.
- Author
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, and Surman OS
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Kidney Transplantation psychology, Liver Transplantation psychology, Living Donors psychology, Mental Disorders diagnosis, Postoperative Complications
- Abstract
The authors examined pretransplant assessment in order to predict posttransplant occurrence of psychiatric disorders in living-related transplantation (LRT). Before LRT, the authors administered the Integrated House-Tree-Person Drawing Test (I-HTP) and 20-item Toronto Alexithymia Scale (TAS-20) to 31 donor-recipient pairs undergoing living-related liver transplantation (LRLT) and 65 pairs undergoing living-related kidney transplantation (LRKT). After LRT, the authors examined the occurrence of psychiatric disorders for the recipients and donors. Pretransplant, two psychological indicators,-alexithymia, a lack of verbalized emotion and abnormal projective drawings such as truncated tree representation-were significantly related to the manifestation of paradoxical psychiatric syndrome (PPS) in LRLT and LRKT. The occurrence of PPS was significantly related to recipients' guilt feelings toward living donors, but these were strongly superseded by recipients' desires to escape from approaching death just before LRT. These results suggest that pretransplant psychological assessment is useful for predicting posttransplant occurrence of psychiatric disorders.
- Published
- 2002
- Full Text
- View/download PDF
31. Living-related liver transplantation for primary biliary cirrhosis.
- Author
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Sugawara Y, Makuuchi M, Takayama T, and Imamura H
- Subjects
- Adult, Feasibility Studies, Female, Humans, Liver anatomy & histology, Male, Middle Aged, Models, Theoretical, Organ Size, Retrospective Studies, Survival Analysis, Liver Cirrhosis, Biliary surgery, Liver Transplantation mortality, Living Donors
- Abstract
Background: The prognosis of patients with primary biliary cirrhosis has improved since the introduction of transplantation. However, there has been limited experience with living-related liver transplantation for primary biliary cirrhosis., Patients and Methods: Between January 1996 and October 2000, 105 patients underwent living-related liver transplantation at the University of Tokyo Hospital. Eighteen of these patients with primary biliary cirrhosis were the subjects of this study. The risk scores in the conventional and updated Mayo models ranged from 5.9 to 11.6 and 6.9 to 13.7, respectively., Results: The graft weight ranged from 330 to 533 g, corresponding to 33 to 55% of the recipient's standard liver volume. Two patients died of pneumonia, 1 died due to sepsis, and the remaining 15 patients survived. The risk scores for the conventional and updated Mayo models correlated well with the duration of hospitalization (P=0.01, R=0.67 for both). The scores of the dead patients by the two models were more than 10 and 12, respectively. The postoperative courses of all of the donors were uneventful., Conclusions: The risk score in the Mayo model adequately reflected the outcome of the patients. To achieve the best possible outcome, further therapeutic tactics are necessary for patients with conventional or updated Mayo risk scores of more than 10 or 12, respectively.
- Published
- 2001
- Full Text
- View/download PDF
32. Liver transplantation from situs inversus to situs inversus.
- Author
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Sugawara Y, Makuuchi M, Takayama T, Yoshino H, Mizuta K, and Kawarasaki H
- Subjects
- Adult, Biliary Atresia genetics, Child, Preschool, Dextrocardia complications, Dextrocardia genetics, Humans, Male, Biliary Atresia complications, Biliary Atresia surgery, Liver Transplantation, Living Donors, Situs Inversus complications, Situs Inversus genetics
- Abstract
Congenital anatomic anomalies often present technical obstacles during liver transplantation. Biliary atresia (BA) is the most common indication for liver transplantation in children, and up to 28% of children with situs inversus are complicated by BA. A boy aged 2 years 11 months with BA, situs inversus, and dextrocardia received a liver transplant from his father. The donor also had situs inversus and dextrocardia without other anomalies. Graft function was excellent postoperatively, and no significant complications were encountered. This is only the second report of the successful use of a living related donor graft for a patient with BA and situs inversus. This case was particularly rare because the donor also had situs inversus, which made the present procedure more feasible.
- Published
- 2001
- Full Text
- View/download PDF
33. Risk factors for acute rejection in pediatric living related liver transplantation: the impact of HLA matching.
- Author
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Sugawara Y, Mizuta K, Kawarasaki H, Takayama T, Imamura H, and Makuuchi M
- Subjects
- Acute Disease, Adolescent, Child, Female, Graft Rejection epidemiology, HLA-A Antigens analysis, Humans, Incidence, Male, Risk Factors, Graft Rejection etiology, HLA Antigens analysis, Histocompatibility Testing, Liver Transplantation, Living Donors
- Abstract
The influence of HLA compatibility on acute rejection in cadaveric liver transplantation is not clearly defined, and that in living related liver transplantation (LRLT) has only been poorly examined. Few studies have focused solely on a pediatric population. Fifty-eight cases of pediatric LRLT were analyzed. Patient and graft survival rates and postoperative complications were assessed. The relationship between the incidence of acute rejection and HLA matching and some preoperative and intraoperative transplant recipient factors, including age, preoperative aspartate aminotransferase level, total bilirubin level, prothrombin time, ascites, donor-recipient blood group type and sex match, donor age, surgical time, anhepatic phase duration, volume of blood loss, and graft weight to standard liver volume, was examined. Patients with HLA-A zero mismatching (P =.04) or a greater volume of blood loss per body weight (P =.004) had a significantly lower chance of rejection within 6 weeks after LRLT. Our results show that in LRLT, a graft from an HLA-A zero-mismatched donor may be advantageous because it provides a lower chance of early acute rejection.
- Published
- 2001
- Full Text
- View/download PDF
34. Restoration of portal vein flow by splenorenal shunt ligation and splenectomy after living-related liver transplantation.
- Author
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Cescon M, Sugawara Y, Kaneko J, Ohtsuka H, Takayama T, and Makuuchi M
- Subjects
- Adult, Blood Flow Velocity physiology, Collateral Circulation physiology, Female, Humans, Living Donors, Postoperative Complications diagnostic imaging, Reoperation, Splenic Vein diagnostic imaging, Ultrasonography, Doppler, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation, Portal Vein diagnostic imaging, Postoperative Complications surgery, Splenectomy, Splenic Vein surgery
- Abstract
We describe here a case of living-related liver transplantation with a spontaneous splenorenal shunt. On the third postoperative day, Doppler ultrasound follow-up revealed impairment of intrahepatic portal vein flow and reoperation was performed. Intraoperatively, simple compression of the collateral veins forming the splenorenal shunt resulted in an immediate change in the portal flow pattern, which suggested the absence of a portal thrombus. Splenectomy and ligature of the more dilated collateral veins were carried out and satisfactory portal flow was restored. Although the role of splenectomy was controversial, splenectomy provided an increased portal vein flow in the present case. The uneventful postoperative course validated our decision.
- Published
- 2001
35. Reversible hepatofugal portal flow after liver transplantation using a small-for-size graft from a living donor.
- Author
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Kita Y, Harihara Y, Sano K, Hirata M, Kubota K, Takayama T, Ohtomo K, and Makuuchi M
- Subjects
- Female, Humans, Middle Aged, Tissue Donors, Liver Circulation, Liver Transplantation, Portal Vein physiopathology, Vascular Resistance
- Abstract
We describe a case of reversible hepatofugal portal flow 1 week after transplantation of a small-for-size liver graft from a living donor. A transient increase in intrahepatic portal vascular resistance was the suspected cause. The portal venous flow normalized after residual collateral channels had been interrupted surgically. The patient was discharged on the 90th postoperative day. Liver transplant clinicians should be aware that hepatofugal flow can occur with small-for-size liver grafts, despite sufficient portal venous flow immediately after transplantation.
- Published
- 2001
- Full Text
- View/download PDF
36. Psychiatric disorders before and after living-related transplantation.
- Author
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, and Surman OS
- Subjects
- Adaptation, Psychological, Adjustment Disorders diagnosis, Adjustment Disorders epidemiology, Adolescent, Adult, Aged, Child, Child, Preschool, Cross-Sectional Studies, Female, Guilt, Humans, Infant, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Transplantation, Homologous, Adjustment Disorders psychology, Kidney Transplantation psychology, Liver Transplantation psychology, Living Donors psychology, Postoperative Complications psychology
- Abstract
The authors examined psychiatric disorders among two samples of patients who underwent living-related transplant (LRT) for kidney and liver failure. The postoperative prevalence of psychiatric disorders for adult transplant recipients was highest the first 3 months posttransplant. The incidence of psychiatric disorders in the adult recipients with living-related liver transplant (LRLT) was higher (54%, 22 of 41) than that of adult recipients with living-related kidney transplant (LRKT) (28%, 65 of 234). Twelve (80%) of the 15 adult LRLT recipients with adult child-to-parent donors exhibited paradoxical psychiatric syndrome (PPS). Among the 12 affected recipients, guilt-based psychiatric disorders of various types occurred despite successful operative outcome for both donor and recipient. The higher rate of psychiatric disorders among adult LRLT recipients was associated with the occurrence of PPS among recipients of an adult-child allograft. These results signal a new challenge for consultation psychiatrists working with transplant patients.
- Published
- 2001
- Full Text
- View/download PDF
37. Small-for-size grafts in living-related liver transplantation.
- Author
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Sugawara Y, Makuuchi M, Takayama T, Imamura H, Dowaki S, Mizuta K, Kawarasaki H, and Hashizume K
- Subjects
- Adolescent, Adult, Body Constitution, Body Surface Area, Child, Cholestasis etiology, Constriction, Pathologic etiology, Female, Graft Rejection etiology, Hepatic Veins, Humans, Japan epidemiology, Length of Stay statistics & numerical data, Liver Transplantation mortality, Liver Transplantation statistics & numerical data, Male, Middle Aged, Morbidity, Organ Size, Patient Selection, Retrospective Studies, Survival Analysis, Thrombosis etiology, Tissue and Organ Procurement methods, Liver Transplantation adverse effects, Liver Transplantation methods, Living Donors statistics & numerical data
- Abstract
Background: The problems associated with small-for-size grafts in living-related liver transplantation are not fully understood., Study Design: A consecutive series of 79 patients underwent 80 living-related liver transplantation procedures, including one retransplant, at the University of Tokyo from January 1996 to January 2000. They were divided into two groups by graft size: graft weight/recipient standard liver volume ratios of 40% or less (n = 24), and more than 40% (n = 56). Preoperative status, mortality, morbidity, duration of hospital stay, and postoperative graft function were examined and compared between the groups., Results: The rate of patients who were restricted to the intensive care unit preoperatively was comparable between the groups (33% versus 21%, p = 0.27). The mean standard liver volume ratios were 37% in the small graft group and 84% in the large group. Survival rates were 80% (5 of 24) for the small graft group, which was significantly lower than that for the large group (96%, 54 of 56, p = 0.02). The rate of acute rejection was comparable between the groups (33% versus 43%, p = 0.47). Vascular complication was observed in 17% of the small graft group patients and 23% of the large group (p = 0.77). No difference was observed in the frequency of bile leakage or bile duct stenosis (25% versus 21%, p=0.77). Hyper-bilirubinemia and elongation of prothrombin time persisted longer in the small graft group than in the large group (p < 0.0001 for both)., Conclusions: Our surgical results may suggest that a graft weight ratio of 40% or less provides a lower chance of survival after living-related liver transplantation.
- Published
- 2001
- Full Text
- View/download PDF
38. "Paradoxical psychiatric syndrome" of the recipient after child-to-parent living-related liver transplantation.
- Author
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Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarazaki H, Surman OS, and Kita Y
- Subjects
- Conversion Disorder diagnosis, Female, Humans, Middle Aged, Transplantation, Isogeneic psychology, Conversion Disorder etiology, Conversion Disorder therapy, Liver Transplantation psychology, Living Donors
- Published
- 2001
- Full Text
- View/download PDF
39. Psychiatric disorders in living-related liver transplantation.
- Author
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Kita Y, Fukunishi I, Harihara Y, Hirata M, Kubota K, Takayama T, Kawarasaki H, and Makuuchi M
- Subjects
- Adolescent, Adult, Age Factors, Child, Humans, Liver Transplantation psychology, Living Donors psychology, Mental Disorders epidemiology
- Published
- 2001
- Full Text
- View/download PDF
40. The influence of donor age to graft volume increase rate in living donor liver transplantation.
- Author
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Hirata M, Harihara Y, Kitamura T, Hisatomi S, Kato M, Dowaki S, Mizuta K, Sugawara Y, Kita Y, Kubota K, Takayama T, Kawarasaki H, Hashizume K, and Makuuchi M
- Subjects
- Adult, Age Factors, Bilirubin blood, Biomarkers blood, Child, Humans, Living Donors, Middle Aged, Time Factors, Liver Regeneration physiology, Liver Transplantation physiology
- Published
- 2001
- Full Text
- View/download PDF
41. Liver transplantation using a right lateral sector graft from a living donor to her granddaughter.
- Author
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Sugawara Y, Makuuchi M, Takayama T, Mizuta K, Kawarasaki H, Imamura H, and Hashizume K
- Subjects
- Age Factors, Anastomosis, Surgical, Child, Preschool, Female, Hepatectomy methods, Hepatic Veins surgery, Humans, Liver anatomy & histology, Liver Transplantation methods, Living Donors
- Abstract
One of the major concerns regarding living-related liver transplantation is graft-size disparity. The left liver graft is too small while the right is too large in some recipients. To overcome this problem, the right lateral sector (Segments VI and VII) was transplanted from a living donor (55 kg) to her granddaughter (17 kg). The common hepatic trunk had to be anastomosed end-to-end to the graft hepatic vein without being compressed by the graft overriding the vena cava and without unfavorable tension of the anastomosis. The anterior wall of the hepatic vein of the donor was resected as much as possible. The superficial left, left, middle and right hepatic veins of the recipient were made confluent by incision of the intervening venous walls, and the nicks were sutured to form a wide and long common venous trunk. The recipient received a graft corresponding to 75% of her standard liver volume. She was complicated with gastric dilation and acute rejection, but recovered with no signs of anastomotic stricture. Right lateral sector graft obtained by this innovative procedure may be useful for overcoming borderline graft-recipient size and shape differences.
- Published
- 2001
42. Adult-to-adult living-related liver transplantation for hepatitis B-related cirrhosis in Japan: two case reports.
- Author
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Kita Y, Harihara Y, Hirata M, Kusaka K, Sano K, Mori M, Ito M, Yoshino H, Nakao A, Takizawa H, Hirai H, Kubota K, Takayama T, Kawarasaki H, Maekawa K, and Makuuchi M
- Subjects
- Adult, Bilirubin blood, Biomarkers blood, Hepatectomy methods, Humans, Japan, Liver Cirrhosis virology, Liver Transplantation methods, Living Donors, Male, Middle Aged, Nuclear Family, Postoperative Complications classification, Postoperative Complications therapy, Radiography, Thoracic, Tissue and Organ Harvesting methods, Tomography, X-Ray Computed, Hepatitis B complications, Liver Cirrhosis surgery, Liver Transplantation physiology
- Published
- 2000
- Full Text
- View/download PDF
43. Living-related liver transplantation in adults compared with children.
- Author
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Harihara Y, Makuuchi M, Kawarasaki H, Takayama T, Kubota K, Ito M, Mizuta K, Yoshino H, Hirata M, Kita Y, Sano K, Hisatomi S, Kusaka K, Miura Y, Taniai N, Asato H, Nakatsuka T, and Hashizume K
- Subjects
- Adult, Child, Cytomegalovirus Infections epidemiology, Family, Graft Rejection epidemiology, Humans, Japan, Length of Stay, Liver Transplantation mortality, Postoperative Complications epidemiology, Retrospective Studies, Survival Rate, Liver Transplantation physiology, Living Donors
- Published
- 2000
- Full Text
- View/download PDF
44. Influence of donor age on the graft function after living-related liver transplantation.
- Author
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Harihara Y, Sano K, Makuuchi M, Kawarasaki H, Takayama T, Kubota K, Ito M, Mizuta K, Yoshino H, Hirata M, Kita Y, Hisatomi S, Kusaka K, Miura Y, and Hashizume K
- Subjects
- Adolescent, Adult, Age Factors, Child, Child, Preschool, Family, Female, Humans, Infant, Liver Transplantation mortality, Male, Middle Aged, Retrospective Studies, Spouses, Survival Rate, Graft Survival physiology, Liver Transplantation physiology, Living Donors
- Published
- 2000
- Full Text
- View/download PDF
45. Health status survey of adult patients undergoing living-related liver transplantation.
- Author
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Fukunishi I, Kita Y, Wakabayashi T, Fukuhara S, Harihara Y, Takayama T, Kubota K, Kawarasaki H, and Makuuchi M
- Subjects
- Adolescent, Adult, Attitude to Health, Female, Humans, Japan, Liver Transplantation psychology, Male, Mental Health, Middle Aged, Nuclear Family, Pain, Health Status, Liver Transplantation physiology, Living Donors psychology
- Published
- 2000
- Full Text
- View/download PDF
46. Pretransplant evaluation of bone mineral density in adult patients with end-stage cholestatic liver disease.
- Author
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Taniai N, Harihara Y, Kita Y, Akune T, Tanaka K, Hirata M, Sano K, Kusaka K, Kubota K, Takayama T, Kawarasaki H, Makuuchi M, Yoshida H, Akimaru K, Tajiri T, and Onda M
- Subjects
- Absorptiometry, Photon, Adult, Family, Female, Follow-Up Studies, Fractures, Bone epidemiology, Humans, Incidence, Living Donors, Male, Preoperative Care, Reference Values, Bone Density, Cholestasis physiopathology, Cholestasis surgery, Liver Transplantation physiology
- Published
- 2000
- Full Text
- View/download PDF
47. Impact of HLA matching in living-related liver transplantation.
- Author
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Hirata M, Harihara Y, Kita Y, Hisatomi S, Miura Y, Yoshino H, Mizuta K, Ito M, Sano K, Kusaka K, Kawarasaki H, Kubota K, Takayama T, Hashizume K, and Makuuchi M
- Subjects
- ABO Blood-Group System, Adolescent, Adult, Blood Group Incompatibility, Child, Child, Preschool, Family, Female, Follow-Up Studies, HLA-A Antigens immunology, HLA-B Antigens immunology, HLA-DR Antigens immunology, Humans, Infant, Male, Middle Aged, Retrospective Studies, Graft Rejection epidemiology, Histocompatibility Testing, Liver Transplantation immunology, Living Donors
- Published
- 2000
- Full Text
- View/download PDF
48. Living-related liver transplantation for patients with primary biliary cirrhosis.
- Author
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Hirata M, Harihara Y, Hisatomi S, Miura Y, Yoshino H, Mizuta K, Ito M, Sano K, Taniai N, Kusaka K, Kita Y, Kawarasaki H, Kubota K, Takayama T, Hashizume K, and Makuuchi M
- Subjects
- Female, Follow-Up Studies, Humans, Liver Transplantation mortality, Living Donors, Male, Middle Aged, Nuclear Family, Postoperative Complications, Retrospective Studies, Survival Rate, Time Factors, Liver Cirrhosis, Biliary surgery, Liver Transplantation physiology
- Published
- 2000
- Full Text
- View/download PDF
49. Influence of HLA compatibility on living-related liver transplantation.
- Author
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Harihara Y, Makuuchi M, Kawasaki S, Hashikura Y, Kawarasaki H, Takayama T, Kubota K, Ito M, Mizuta K, Yoshino H, Hirata M, Kita Y, Sano K, Hisatomi S, Kusaka K, and Hashizume K
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Family, Female, Follow-Up Studies, Graft Rejection epidemiology, HLA-A Antigens immunology, HLA-B Antigens immunology, HLA-DR Antigens immunology, Humans, Incidence, Infant, Liver Transplantation physiology, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Spouses, Time Factors, Histocompatibility Testing, Liver Transplantation immunology, Living Donors
- Published
- 2000
- Full Text
- View/download PDF
50. A case of esophageal variceal rupture following acute portal vein thrombosis three days after living-related liver transplantation.
- Author
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Hirata M, Harihara Y, Hisatomi S, Miura Y, Yoshino H, Mizuta K, Ito M, Sano K, Taniai N, Kusaka K, Kita Y, Kawarasaki H, Kubota K, Takayama T, and Makuuchi M
- Subjects
- Cholestasis surgery, Embolization, Therapeutic, Fathers, Female, Hepatic Artery, Hepatoblastoma surgery, Humans, Infant, Liver Neoplasms surgery, Living Donors, Male, Monitoring, Intraoperative, Postoperative Period, Treatment Outcome, Ultrasonography, Venous Thrombosis diagnosis, Esophageal and Gastric Varices surgery, Liver Transplantation, Portal Vein diagnostic imaging, Portal Vein surgery, Postoperative Complications, Venous Thrombosis diagnostic imaging, Venous Thrombosis surgery
- Published
- 2000
- Full Text
- View/download PDF
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