Updated on 2023/04/24

写真a

 
FUJIMOTO, Yasuhiro
 
Organization
Nagoya University Hospital Transplantation Surgery Associate professor of hospital
Title
Associate professor of hospital

Degree 1

  1. Doctor of Medical Science ( 2002.7   Kyoto University ) 

Research Interests 9

  1. polyamine

  2. organ preservation

  3. mesenchymal stem cells

  4. liver transplantation

  5. liver regeneration

  6. small bowel transplantation

  7. liver transplantation

  8. liver regeneration

  9. C型肝炎

Research Areas 2

  1. Life Science / Digestive surgery

  2. Life Science / General surgery and pediatric surgery

Research History 10

  1. Assistant Professor of Surgery, Transplant Surgery, Nagoya University Hospital

    2007.4

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    Country:Japan

  2. Assistant Professor of Surgery, Transplant Surgery, Nagoya University Hospital

    2004.10 - 2007.3

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    Country:Japan

  3. Assistant Professor of Surgery, Department of Transplantation and Immunology, Faculty of Medicine, Kyoto Univeristy

    2001.7 - 2004.9

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    Country:Japan

  4. Clinical Fellow, Department of Surgery, University of Alberta, Alberta, CANADA

    2000.7 - 2001.6

  5. Research Fellow, Surgical Medical Research Institute, Department of Surgery, University of Alberta

    1999.8 - 2000.6

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    Country:Japan

  6. 島根県立中央病院小児外科 医員

    1995.6 - 1996.3

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    Country:Japan

  7. resident, Surgery, Shimane Prefectural Hospital, Shimane, JAPAN

    1993.4 - 1995.5

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    Country:Japan

  8. Residient, 2nd Department of Surgery, Kyoto Univerisity Hospital

    1993.1 - 1993.3

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    Country:Japan

  9. residient, Surgery, Tango-Chuo Hospital, Kyoto, JAPAN

    1992.10 - 1992.12

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    Country:Japan

  10. Residient, 1st Department of Surgery, Kyoto Univerisity Hospital

    1992.6 - 1992.9

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    Country:Japan

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Education 5

  1. Kyoto University   Graduate School, Division of Medicine   Transplant Surgery

    1996.4 - 2000.3

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    Country: Japan

  2. Kyoto University

    - 2000

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    Country: Japan

  3. Kyoto University   Faculty of Medicine

    1986.4 - 1992.4

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    Country: Japan

  4. Kyoto University   Faculty of Medicine   Department of Medical Science

    - 1992

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    Country: Japan

  5. Nada High School

    1980.4 - 1986.3

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    Country: Japan

Professional Memberships 5

  1. 日本肝臓学会

  2. 日本肝胆膵外科学会

  3. 日本移植学会

  4. 日本消化器外科学会

  5. 日本外科学会

 

Papers 95

  1. 特集 肝移植手術を再考する 生体肝移植ドナー手術─後区域グラフト採取術

    小倉 靖弘, 倉田 信彦, 城原 幹太, 藤本 康弘

    手術   Vol. 77 ( 1 ) page: 53 - 60   2023.1

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    Publisher:金原出版  

    DOI: 10.18888/op.0000003117

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  2. Effects of Hochuekkito on Lenvatinib-Induced Fatigue in Mice

    Xu Jinyang, Nakamura Ikuo, Sudo Makoto, Noda Satoshi, Fujitsuka Naoki, Mogami Sachiko, Mitani Keiko, Tada Masaharu, Fujimoto Yasuhiro, Terada Tomohiro, Hirono Seiko, Hatano Etsuro

    BPB Reports   Vol. 6 ( 1 ) page: 1 - 7   2023

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    Language:English   Publisher:The Pharmaceutical Society of Japan  

    <p>Lenvatinib has been approved for treating various cancers; however, it exerts numerous adverse effects. Hochuekkito, a Japanese Kampo medicine, can alleviate these adverse effects. Here, we aimed to evaluate the effect of Hochuekkito on lenvatinib-induced chronic fatigue in a murine model. BALB/C mice were fed a control diet or a diet supplemented with 1.5% Hochuekkito for six weeks. On days 15–42, the mice were intraperitoneally injected with dimethyl sulfoxide or lenvatinib. Accordingly, the mice were divided into control/dimethyl sulfoxide, control/lenvatinib, 1.5% Hochuekkito/dimethyl sulfoxide, and 1.5% Hochuekkito/lenvatinib groups. Body weight and food intake were recorded daily. Nesting tests were performed once a week, and the serum interleukin-6 (IL-6) concentration was measured. Liver drug-metabolizing enzyme, CYP3A4, breast cancer resistance protein (BCRP), and P-glycoprotein (P-gp) levels were determined. The serum lenvatinib concentration and CYP3A4, BCRP, and P-gp levels did not differ significantly between the control/lenvatinib and 1.5% Hochuekkito/lenvatinib groups. The usage rate of nesting material on day 42 was higher in the 1.5% Hochuekkito/lenvatinib group than in the control/lenvatinib group (p < 0.05). The serum IL-6 level was lower in the control/dimethyl sulfoxide and 1.5% Hochuekkito/lenvatinib groups than in the control/lenvatinib group (p < 0.05). Overall, Hochuekkito may alleviate lenvatinib-induced fatigue through IL-6 inhibition.</p>

    DOI: 10.1248/bpbreports.6.1_1

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  3. Impact of the aberrant right hepatic artery on local recurrence of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy.

    Nakajima T, Ikuta S, Nakamura I, Aihara T, Kasai M, Iwama H, Fujimoto Y, Hatano E, Yamanaka N

    Surgery   Vol. 172 ( 2 ) page: 691 - 699   2022.8

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    DOI: 10.1016/j.surg.2022.02.010

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  4. Liver stiffness measured by virtual touch quantification predicts the occurrence of posthepatectomy refractory ascites in patients with hepatocellular carcinoma.

    Kan Toriguchi, Seikan Miyashita, Yusuke Kawabata, Ami Kurimoto, Masayuki Okuno, Hideaki Iwama, Kenjiro Iida, Tomohiro Okamoto, Hideaki Sueoka, Masaharu Tada, Ikuo Nakamura, Yasuhiro Fujimoto, Takashi Nishimura, Hiroko Iijima, Etsuro Hatano

    Surgery today   Vol. 52 ( 5 ) page: 822 - 831   2022.5

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    PURPOSE: This study assessed the significance of measuring liver stiffness using virtual touch quantification before hepatectomy to predict posthepatectomy refractory ascites. METHODS: A total of 267 patients with hepatocellular carcinoma who underwent hepatectomy were prospectively analyzed. Liver stiffness was defined as the median value of the virtual touch quantification (Vs; m/s) by acoustic radio-force-impulse-based virtual touch. RESULTS: A multivariate analysis showed that Vs and the aspartate aminotransferase-to-platelet ratio index were independent risk factors for postoperative refractory ascites (odds ratio = 3.27 and 3.08, respectively). The cutoff value for Vs was 1.52 m/s (sensitivity: 59.5%, specificity: 88.6%) as determined by the analysis of the receiver-operating characteristic curve, and the area under the receiver-operating characteristic curve was 0.79. The cutoff value for the aspartate aminotransferase-to-platelet ratio was 0.952 (sensitivity: 65.5%, specificity: 82.9%), and the area under the receiver-operating characteristic curve was 0.75. CONCLUSIONS: Vs is an independent risk factor for refractory ascites after hepatectomy. The measurement of liver stiffness by virtual touch quantification before hepatectomy can help estimate the risk of postoperative refractory ascites. Nonsurgical treatments should be considered for the management of patients who are at high risk for refractory ascites.

    DOI: 10.1007/s00595-021-02392-5

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  5. Mesenchymal Stem Cells Secretions Enhanced ATP Generation on Isolated Islets during Transplantation Reviewed International journal

    Takumi Teratani, Naoya Kasahara, Yasuhiro Fujimoto, Yasunaru Sakuma, Atsushi Miki, Masafumi Goto, Naohiro Sata, Joji Kitayama

    Islets   Vol. 14 ( 1 ) page: 69 - 81   2022.1

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Informa UK Limited  

    The success of islet transplantation in both basic research and clinical settings has proven that cell therapy has the potential to cure diabetes. Islets intended for transplantation are inevitably subjected to damage from a number of sources, including ischemic injury during removal and delivery of the donor pancreas, enzymatic digestion during islet isolation, and reperfusion injury after transplantation in the recipient. Here, we found that protein factors secreted by porcine adipose-tissue mesenchymal stem cells (AT-MSCs) were capable of activating preserved porcine islets. A conditioned medium was prepared from the supernatant obtained by culturing porcine AT-MSCs for 2 days in serum-free medium. Islets were preserved at 4°C in University of Wisconsin solution during transportation and then incubated at 37°C in RPMI-1620 medium with fractions of various molecular weights prepared from the conditioned medium. After treatment with certain fractions of the AT-MSC secretions, the intracellular ATP levels of the activated islets had increased to over 160% of their initial values after 4 days of incubation. Our novel system may be able to restore the condition of isolated islets after transportation or preservation and may help to improve the long-term outcome of islet transplantation.Abbreviations: AT-MSC, adipose-tissue mesenchymal stem cell; Cas-3, caspase-3; DAPI, 4,6-diamidino-2-phenylindole; DTZ, dithizone; ES cell, embryonic stem cell; FITC, fluorescein isothiocyanate; IEQ, islet equivalent; INS, insulin; iPS cell, induced pluripotent stem cell; Luc-Tg rat, luciferase-transgenic rat; PCNA, proliferating cell nuclear antigen; PDX1, pancreatic and duodenal homeobox protein-1; UW, University of Wisconsin; ZO1, zona occludens 1.

    DOI: 10.1080/19382014.2021.2022423

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  6. Activation of whole body by high levels of polyamine intake in rats Reviewed International journal

    Takumi Teratani, Naoya Kasahara, Tetsuo Ijichi, Yasuhiro Fujimoto, Yasunaru Sakuma, Naohiro Sata, Joji Kitayama

    Amino Acids   Vol. 53 ( 11 ) page: 1695 - 1703   2021.10

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Springer Science and Business Media LLC  

    <title>Abstract</title>Polyamines are important to the survival and activation of organs and tissues via a homeostatic cell-metabolic process, and the polyamine content in cytoplasm decreases with aging. Decreases in cellular polyamine have been known to augment mutagenesis and cell death. Thus, supplementary polyamine in food is important to the prevention of aging. Here we show the anti-aging effects of oral intake of polyamine using luciferase-transgenic rats. Healthy rats, 10–12 weeks old, were given foods containing 0.01% and 0.1% (w/w) of polyamine, as compared a control food without polyamine, for 4 weeks. Using a bioimaging system, the photon intensities seen in the whole bodies and livers of rats consuming 0.1% of polyamine in food were stronger than those in rats consuming 0.01% and 0% of polyamine. However, there were no differences between groups in other characteristics, such as liver damage and body weight. In conclusion, we found that polyamine intake can activate cells throughout the whole body, providing an anti-aging effect.

    DOI: 10.1007/s00726-021-03079-4

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    Other Link: https://link.springer.com/article/10.1007/s00726-021-03079-4/fulltext.html

  7. Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma.

    Kohei Ogawa, Toshimi Kaido, Hideaki Okajima, Yasuhiro Fujimoto, Atsushi Yoshizawa, Shintaro Yagi, Tomohide Hori, Taku Iida, Yasutsugu Takada, Shinji Uemoto

    Journal of hepato-biliary-pancreatic sciences   Vol. 26 ( 2 ) page: 73 - 81   2019.2

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    BACKGROUND: The purpose of this study was to examine the impact of pretreatments on outcomes after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). METHODS: From February 1999 to March 2015, 223 patients underwent LDLT for HCC. Until December 2006, there was no restriction in patient selection criteria regarding the number and size of tumors, following which we implemented the Kyoto criteria (tumor number ≤10, maximal diameter ≤5 cm, and des-gamma-carboxy prothrombin ≤400 mAU/ml) since January 2007. RESULTS: Of 223 patients, 156 had a history of pretreatments. Among 101 patients meeting the Milan criteria at the initial diagnosis, 38 progressed to beyond the criteria at liver transplantation (LT). Twenty-two out of 38 met the Kyoto criteria, and their survival and recurrence rates were significantly better than those of patients exceeding the Kyoto criteria (P = 0.004 and 0.035, respectively). Regarding the number of pretreatments (0 vs. 1-4 vs. ≥5), recurrence rate was significantly higher in the ≥5 pretreatments group than the 0 group. However, for patients meeting the Kyoto criteria, there were no significant differences in recurrence rates between these three groups. CONCLUSION: Better outcomes will be achieved by performing LT for HCCs meeting the Kyoto criteria even after repeated pretreatments.

    DOI: 10.1002/jhbp.602

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  8. Bolus Administration of Polyamines Boosts Effects on Hepatic Ischemia-Reperfusion Injury and Regeneration in Rats. International journal

    Junshi Doi, Yasuhiro Fujimoto, Takumi Teratani, Naoya Kasahara, Masashi Maeda, Tatsuaki Tsuruyama, Taku Iida, Shintaro Yagi, Shinji Uemoto

    European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes   Vol. 60 ( 1-2 ) page: 63 - 73   2019

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    BACKGROUND: It was demonstrated that polyamines ameliorate ischemia-reperfusion injury (IRI) and promote regeneration in the liver. An optimal protocol of polyamine treatment remains unknown in the clinical setting. We examined 2 types of administration methods using rat models. METHODS: Experiment 1: evaluation of pharmacokinetics of polyamines. Experiment 2: for 3 days preoperatively and 5 days postoperatively, polyamines were given to male Lewis rats in the following three groups: the control group, no polyamine administration; the chow group, 0.05% polyamines mixed in chow; the bolus group, polyamines (200 μmol/kg) given by gastric tube once a day. All rats received 70% hepatectomy after 40 min of warm IRI. Postoperatively, IRI and regeneration were evaluated with assessment of serum levels of hepatic enzymes, histology and immunohistochemistry of liver tissue, and measurement of remnant liver weight. RESULTS: The blood concentrations of polyamines in the portal vein increased at 1 h of bolus administration, while they did not increase without the bolus. The bolus group was significantly associated with lower serum levels of aspartate/alanine aminotransferases (p < 0.05), decreased hepatocyte congestion, vacuolization and necrosis in histopathological scoring (p < 0.05), a lower number of TUNEL-positive hepatocytes (p < 0.05), higher remnant liver weight at 24, 48, and 168 h (p < 0.05), and a higher Ki-67 labeling index (24 h, p < 0.01) compared with the chow group. CONCLUSION: The bolus administration of polyamines was more effective in ameliorating IRI and promoting regeneration than chow administration. Perioperative bolus administration of polyamines might be an optimal treatment, when clinically applied.

    DOI: 10.1159/000497434

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  9. Influence of hepatorenal syndrome on outcome of living donor liver transplantation: A single-center experience in 357 patients. International journal

    Yusuke Okamura, Koichiro Hata, Osamu Inamoto, Toyonari Kubota, Hirofumi Hirao, Hirokazu Tanaka, Yasuhiro Fujimoto, Kohei Ogawa, Akira Mori, Hideaki Okajima, Toshimi Kaido, Shinji Uemoto

    Hepatology research : the official journal of the Japan Society of Hepatology   Vol. 47 ( 5 ) page: 425 - 434   2017.4

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    AIM: Liver transplantation is the only curative treatment for hepatorenal syndrome (HRS); however, the influence of HRS on the patient and renal outcome after living donor liver transplantation (LDLT) is still unclear. The aim of the present study was to evaluate the influence of HRS on the outcome of LDLT. METHODS: We retrospectively analyzed 357 consecutive adult patients who underwent primary LDLT between January 2005 and March 2013 at Kyoto University Hospital. The outcome of the patients with HRS was compared with those without HRS. RESULTS: A total of 29 patients (8%) were diagnosed as HRS (Group-HRS) preoperatively, and the other 328 patients (92%) were not diagnosed as HRS (Group-Non-HRS). Group-HRS showed a significantly lower preoperative estimated glomerular filtration rate (22.1 vs 78.3 mL/min/1.73m2 , P < 0.001) and higher Child-Pugh-Turcotte score (13 vs 10, P < 0.001) than Group-non-HRS. After a median follow up of 60 months, the 1-, 3- and 5-year recipients' survival were 60.7%, 57.1% and 57.1% in Group-HRS, and 83.7%, 79.4% and 76.2% in Group-Non-HRS, respectively (P = 0.030). Concomitant HRS significantly elongated postoperative hospital stays (75 vs 50 days, P = 0.003), as well as predisposed patients to higher in-hospital mortality (41% vs 18%, P = 0.005). Multivariate analysis showed that preoperative renal dysfunction (estimated glomerular filtration rate on admission <40 mL/min/1.73m2 , OR 2.106, P = 0.03) was an independent risk factor for 1-year recipients' survival after LDLT, in addition to donor age ≥38 years (OR 3.114, P < 0.001), Child-Pugh-Turcotte score ≥13 (OR 2.929, P < 0.001) and left lobe graft (OR 2.225, P = 0.004). CONCLUSION: Coincidence of HRS is associated with significantly worse outcome after LDLT, especially in the early post-transplant period.

    DOI: 10.1111/hepr.12764

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  10. Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma. International journal

    Shinya Okumura, Toshimi Kaido, Yuhei Hamaguchi, Atsushi Kobayashi, Hisaya Shirai, Yasuhiro Fujimoto, Taku Iida, Shintaro Yagi, Kojiro Taura, Etsuro Hatano, Hideaki Okajima, Shinji Uemoto

    Annals of surgical oncology   Vol. 24 ( 4 ) page: 1037 - 1045   2017.4

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    BACKGROUND: Decrease in skeletal muscle mass and function, known as sarcopenia, is associated with poor prognosis. Visceral fat accumulation also is related to mortality. This study investigated the impact of preoperative skeletal muscle mass, muscle quality, and visceral adiposity on outcomes in patients undergoing resection of intrahepatic cholangiocarcinoma (ICC). METHODS: A retrospective analysis was performed of 109 patients undergoing resections of ICC between January 2004 and April 2015. Skeletal muscle mass [skeletal muscle index (SMI)], skeletal muscle quality [muscle attenuation (MA)], and visceral adiposity [visceral to subcutaneous adipose tissue area ratio (VSR)] were measured on preoperative computed tomography images. The impacts of these parameters on outcomes after ICC resections were analyzed. RESULTS: The overall survival rates were significantly lower in patients with low SMI (P = 0.002), low MA (P = 0.032), and high VSR (P = 0.026) compared with patients with high SMI, high MA, and low VSR, respectively. With multivariate analyses, in patients with stage I-III, low SMI (hazard ratio (HR) 3.29, P = 0.003) and low MA (HR 2.86, P = 0.010) were revealed as independent significant risk factors for mortality. In patients with stage IV, none of these parameters was identified as risk factors, with only the absence of adjuvant chemotherapy identified as an independent risk factor for mortality (HR 5.92, P = 0.001). CONCLUSIONS: Although stage was the most important factor, low skeletal muscle mass and quality were closely related to mortality after resection of ICC in patients with stage I-III.

    DOI: 10.1245/s10434-016-5668-3

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  11. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? International journal

    Tadahiro Uemura, Seidai Wada, Toshimi Kaido, Akira Mori, Yasuhiro Ogura, Shintaro Yagi, Yasuhiro Fujimoto, Kohei Ogawa, Koichiro Hata, Atsushi Yoshizawa, Hideaki Okajima, Shinji Uemoto

    Surgery   Vol. 159 ( 6 ) page: 1623 - 1630   2016.6

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    BACKGROUND: Smaller size grafts for living donor liver transplantation (LDLT) can enhance donor safety and expand donor availability. We previously reported that modulation of portal venous pressure (PVP) was key for successful LDLT with small grafts, and that it actively lowered graft-to-recipient weight ratio (GRWR) for adult-to-adult LDLT. This retrospective study investigated the outcome of LDLT using small grafts with PVP modulation. METHOD: This study analyzed 221 adult LDLT patients between March 2008 and December 2013 and divided them into 3 groups based on GRWR: large (L), GRWR ≥ 0.8% (n = 154), medium (M), ≥ 0.7% GRWR < 0.8% (n = 38); and small (S) GRWR < 0.7% (n = 29). Donor and recipient factors, PVP, pressure gradient between PVP and central venous pressure (CVP), occurrence of small for size syndrome (SFSS), ascites, and posttransplant laboratory data were compared across the 3 groups. Patient and graft survival were compared using Kaplan-Meier methods. RESULTS: There was no difference in patient or graft survival between the 3 groups. Amount of posttransplant ascites and posttransplant International Normalized Ratio were similar, but the S and M groups had more prolonged cholestasis. SFSS was identified in 17%, 13%, and 13% in the S, M, and L groups, respectively (P = NS). Patients with a final PVP of ≤15 mmHg had better survival than patients with a final PVP of >15 mmHg (P < .001). Multivariate analysis showed that donor age >40 years old, final PVP of >15 mmHg, and pressure gradient of PVP-CVP >5 mmHg were risk factors for inferior patient survival. CONCLUSION: We achieved satisfactory outcomes in LDLT with GRWR as low as 0.6% using PVP modulation. Thus, we currently set a lower limit of GRWR at 0.6% while protecting donor safety and expanding donor availability.

    DOI: 10.1016/j.surg.2016.01.009

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  12. Association of interleukin4 gene polymorphisms of recipients and donors with acute rejection following living donor liver transplantation. International journal

    Hideya Kamei, Satohiro Masuda, Masatoshi Ishigami, Taro Nakamura, Yasuhiro Fujimoto, Yasutsugu Takada, Nobuyuki Hamajima

    Clinics and research in hepatology and gastroenterology   Vol. 40 ( 2 ) page: 179 - 185   2016.4

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    BACKGROUND: Little is known as to whether the interleukin4 (IL4) gene polymorphisms in recipients or donors affect the incidence of acute cellular rejection (ACR) following living donor liver transplantation (LDLT). Therefore, we determined the effect of IL4 T-33C polymorphisms in recipients and donors on ACR in a large cohort of patients that underwent LDLT. METHODS: We examined 155 LDLT cases treated at Nagoya University or Kyoto University, Japan, between 2004 and 2009. IL4 T-33C polymorphisms were analyzed in recipients and donors. RESULTS: Forty-seven recipients (30.3%) developed early ACR. The genotype frequency of IL4 T-33C in the recipients was associated with ACR incidence (P=0.008, P<0.0125 considered significant). Patients with the IL4-33C carrier genotype (C/C or C/T) were significantly associated with a higher incidence of ACR relative to those with the T/T genotype (OR=3.27, 95% CI: 1.56-6.88, P=0.002). The genotype frequencies of IL4 T-33C in the donors were not associated with rejection incidence. In addition, there was no significant effect of IL4 T-33C genotype combinations on ACR incidence in donors and recipients. CONCLUSIONS: Genotyping of IL4 T-33C in recipients might be useful to stratify the liver transplant recipients according to their risk of ACR.

    DOI: 10.1016/j.clinre.2015.06.019

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  13. Advantage of tacrolimus/mycophenolate mofetil regimen for cytotoxic T cell-mediated defense and its inhibition by additive steroid administration in high riskful liver transplant recipients. Reviewed

    Uemoto S, Ozawa K, Kaido T, Mori A, Fujimoto Y, Ogawa K

    Clin Exp Immunol   Vol. 184 ( 1 ) page: 126 - 136   2016.4

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  14. Impact of the preoperative quantity and quality of skeletal muscle on outcomes after resection of extrahepatic biliary malignancies. International journal

    Shinya Okumura, Toshimi Kaido, Yuhei Hamaguchi, Yasuhiro Fujimoto, Atsushi Kobayashi, Taku Iida, Shintaro Yagi, Kojiro Taura, Etsuro Hatano, Shinji Uemoto

    Surgery   Vol. 159 ( 3 ) page: 821 - 833   2016.3

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    BACKGROUND: Skeletal muscle depletion, referred to as sarcopenia, predicts mortality after major surgery. This study investigated the impact of preoperative skeletal muscle quantity and quality on outcomes in patients undergoing resection of extrahepatic biliary cancer. METHODS: We performed a retrospective analysis of 207 patients undergoing resection for biliary cancer between 2004 and 2013. The quantity and quality of skeletal muscle, indicated by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), were measured on preoperative images of computed tomography. Overall survival (OS) and recurrence-free survival (RFS) rates were compared by PMI and IMAC, and prognostic factors after operation were assessed. RESULTS: The OS and RFS rates were less in patients with low PMI (low muscle quantity) than in those with normal PMI (P < .001 and P < .001; 5-year OS, 15.7 vs 53.5%). The OS and RFS rates were also less in patients with high IMAC (low muscle quality) than in those with normal IMAC (P < .001 and P < .001; 5-year OS, 23.8 vs 55.9%). Low PMI and high IMAC were independent factors predictive of poor OS (hazard ratio [HR], 2.921 [95% CI, 1.920-4.470; P < .001] and HR, 1.725 [95% CI, 1.159-2.590; P = .007]) and RFS (HR, 2.141 [95% CI, 1.464-3.129, P < .001] and HR, 1.492 [95% CI, 1.032-2.166, P = .034]). CONCLUSION: Preoperative sarcopenia, indicating a low quantity and quality of skeletal muscle, is related closely to mortality after resection of biliary cancer.

    DOI: 10.1016/j.surg.2015.08.047

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  15. Epidemiology of invasive fungal infections after liver transplantation and the risk factors of late-onset invasive aspergillosis. International journal

    Miki Nagao, Yasuhiro Fujimoto, Masaki Yamamoto, Yasufumi Matsumura, Toshimi Kaido, Shunji Takakura, Shinji Uemoto, Satoshi Ichiyama

    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy   Vol. 22 ( 1-2 ) page: 84 - 89   2016

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    Invasive fungal infection (IFI) in liver transplant recipients is associated with poor outcomes. Targeted antifungal prophylaxis is recommended for high-risk populations; however, the epidemiology of IFI has changed, and the risk criteria remain unclear. In addition, the risk factors for late-onset invasive aspergillosis (IA) have not been fully characterized. We examined 279 recipients over 16 years of age to uncover their IFI epidemiology, clinical characteristics and outcomes. In addition, a case-control study was performed to identify the risk factors of late-onset IA. Of the 279 recipients, 96.1% underwent living donor liver transplantation. Antifungal prophylaxis was administered to 80.6% of the recipients. IFI occurred in 15 patients, among which 8 cases were early-onset (≤90 days after liver transplantation) and 7 cases were late-onset (>90 days after liver transplantation). Five of the late-onset cases were invasive pulmonary aspergillosis, and 2 were fungemia cases. The mortality rate of late-onset IA was 80.0%. According to a multivariate analysis, steroid use before liver transplantation, bloodstream infection within 90 days after liver transplantation and reoperation within 90 days after liver transplantation were significant risk factors for late-onset IA after liver transplantation. The prevalence of IFI was low in our population given that over 80% of liver recipients received antifungal prophylaxis. The prognosis of late-onset IA remains poor, and predictors associated with late-onset IA, such as steroid use before liver transplantation, bloodstream infection and reoperation after liver transplantation, may help clinicians to optimize prevention measures for these devastating infections.

    DOI: 10.1016/j.jiac.2015.11.005

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  16. IMPACT OF DONOR AGE ON THE OUTCOME OF ADULT LIVING DONOR PARTIAL LIVER TRANSPLANTATION: SINGLE-CENTER EXPERIENCE IN 316 PATIENTS

    Toyonari Kubota, Koichiro Hata, Takashi Sozu, Hirokazu Tanaka, Hirofumi Hirao, Yusuke Okamura, Osamu Inamoto, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Hideaki Okajima, Toshimi Kaido, Shinji Uemoto

    TRANSPLANT INTERNATIONAL   Vol. 28   page: 108 - 108   2015.11

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  17. Incidence and risk factors for herpes zoster in patients undergoing liver transplantation Reviewed

    Hamaguchi Y, Mori A, Uemura T, Ogawa K, Fujimoto Y, Okajima H, Kaido T, Uemoto S

    Transpl Infect Dis.   Vol. 17 ( 5 ) page: 671 - 678   2015.10

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  18. Complete pathological response induced by sorafenib for advanced hepatocellular carcinoma with multiple lung metastases and venous tumor thrombosis allowing for curative resection.

    Toshihiro Kitajima, Etsuro Hatano, Yusuke Mitsunori, Kojiro Taura, Yasuhiro Fujimoto, Masaki Mizumoto, Hideaki Okajima, Toshimi Kaido, Sachiko Minamiguchi, Shinji Uemoto

    Clinical journal of gastroenterology   Vol. 8 ( 5 ) page: 300 - 5   2015.10

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    We report the first case of initially unresectable advanced hepatocellular carcinoma (HCC) with portal vein and hepatic venous tumor thrombosis and multiple lung metastases that allowed for curative hepatectomy after multidisciplinary treatment including sorafenib. A 54-year-old male presented with a large HCC in the right liver with tumor thrombosis of the left portal vein and middle hepatic vein (MHV) as well as multiple lung metastases. His serum alpha-fetoprotein level was elevated at 52,347 ng/mL and palliative treatment with sorafenib was initiated. One month later, a significant reduction in the serum AFP level, decrease in the tumor size with recanalization of the portal vein and the absence of lung metastases were noted. Three months after the start of sorafenib treatment, external-beam radiotherapy was performed to treat enlargement of the area of MHV thrombosis, and the thrombosis regressed. Five months after the initiation of sorafenib treatment, central bisegmentectomy associated with removal of the tumor thrombus in the inferior vena cava was performed. A microscopic examination revealed complete necrosis of the tumor. Sorafenib treatment may be a bridge to curative resection in selected patients with initially unresectable advanced HCC, even in cases involving multiple extrahepatic metastases.

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  19. Changes in Surgical Site Infections after Living Donor Liver Transplantation. International journal

    Masaki Yamamoto, Shunji Takakura, Yoshitsugu Iinuma, Go Hotta, Yasufumi Matsumura, Aki Matsushima, Miki Nagao, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Yasuhiro Ogura, Toshimi Kaido, Shinji Uemoto, Satoshi Ichiyama

    PloS one   Vol. 10 ( 8 ) page: e0136559   2015.8

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    Surgical site infections (SSIs) are a major threat for liver transplant recipients. We prospectively studied SSIs after living donor liver transplantation (LDLT) at Kyoto University Hospital from April 2001 to March 2002 (1st period) and from January 2011 to June 2012 (2nd period). We investigated the epidemiology of SSIs after LDLT and determined the differences between the two periods. A total of 129 adult recipients (66 during the 1st period and 63 during the 2nd period) and 72 pediatric recipients (39 and 33) were included in this study. The SSI rates for each period were 30.3% (1st period) and 41.3% (2nd period) among the adult recipients and 25.6% and 30.3% among the pediatric recipients. The overall rates of 30-day mortality among adult transplant recipients with SSIs were 10.0% (1st period) and 3.9% (2nd period). No pediatric recipient died from SSIs after LDLT in either period. The incidence of Enterococcus faecium increased from 5.0% to 26.9% in the adults and from 10.0% to 40.0% in the pediatric patients. Extended-spectrum β-lactamase-producing Enterobacteriaceae were emerging important isolates during the 2nd period. For this period, a univariate analysis showed that ABO incompatibility (P = 0.02), total operation duration (P = 0.01), graft-to-recipient body weight ratio (GRWR [P = 0.04]), and Roux-en-Y biliary reconstruction (P<0.01) in the adults and age (P = 0.01) and NHSN risk index (P = 0.02) in the children were associated with SSI development. In a multivariate analysis, lower GRWR (P = 0.02) and Roux-en-Y biliary reconstruction (P<0.01) in the adults and older age (P = 0.01) in the children were independent risk factors for SSIs during the 2nd period. In conclusion, SSIs caused by antibiotic resistant bacteria may become a major concern. Lower GRWR and Roux-en-Y biliary reconstruction among adult LDLT recipients and older age among pediatric LDLT recipients increased the risk of developing SSIs after LDLT.

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  20. Coupled Upregulation of IL-12 Receptor Beta-1 in CD8+ Central Memory and Effector T Cells for Better Clinical Outcomes in Liver Transplant Recipients. Reviewed

    Uemoto S, Ozawa K, Kaido T, Mori A, Fujimoto Y, Ogawa K

    Clin Exp Immunol   Vol. 181 ( 2 ) page: 373 - 384   2015.8

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  21. Impact of Preoperative Quality and Quantity of Skeletal Muscle On Outcomes After Living Donor Liver Transplantation

    Yuhei Hamaguchi, Toshimi Kaido, Shinya Okumura, Yasuhiro Fujimoto, Kohei Ogawa, Akira Mori, Hideaki Okajima, Yumiko Tamai, Nobuya Inagaki, Shinji Uemoto

    TRANSPLANTATION   Vol. 99   page: 92 - 92   2015.7

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  22. Acoustic Radiation Force Impulse Imaging for the Prediction of Graft Condition After Liver Transplantation

    Yukihiro Okuda, Kojiro Taura, Yoshinobu Ikeno, Takahiro Nishio, Gen Yamamoto, Kazutaka Tanabe, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Etsuro Hatano, Toshimi Kaido, Hideaki Okajima, Shinji Uemoto

    TRANSPLANTATION   Vol. 99   page: 246 - 246   2015.7

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  23. Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer. International journal

    Shinya Okumura, Toshimi Kaido, Yuhei Hamaguchi, Yasuhiro Fujimoto, Toshihiko Masui, Masaki Mizumoto, Ahmed Hammad, Akira Mori, Kyoichi Takaori, Shinji Uemoto

    Surgery   Vol. 157 ( 6 ) page: 1088 - 1098   2015.6

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    BACKGROUND: Skeletal muscle depletion, referred to as sarcopenia, is predictive of mortality in patients undergoing digestive operations. The impact of muscle quality on outcomes, however, is unclear. This retrospective study investigated the impact of preoperative skeletal muscle quantity and quality on survival in patients undergoing resection of pancreatic cancer. METHODS: We investigated 230 patients who underwent resection of pancreatic cancer between 2004 and 2013. The quantity and quality of skeletal muscle, indicated by psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), were measured in preoperative computed tomography images. Overall survival (OS) and recurrence-free survival (RFS) rates were compared according to PMI and IMAC, and prognostic factors after pancreatic resection were assessed. RESULTS: The OS and RFS rates in patients with low PMI were lesser than in those with normal/high PMI (P < .001, P < .001), with a mean survival time of 17.7 and 33.2 months, respectively. The OS and RFS rates in patients with high IMAC also were less than in those with normal/low IMAC (P < .001, P = .003) (mean survival time = 21.5 and 56.5 months, respectively). Low PMI (low muscle mass) and high IMAC (low muscle quality) were independent prognostic factors of poor OS (hazard ratio [HR] = 1.999, P < .001; HR = 2.527, P < .001) and RFS (HR = 1.607, P = .007; HR = 1.640, P = .004), respectively. CONCLUSION: Preoperative sarcopenia, indicating low quality and quantity of skeletal muscle, is closely related to mortality after resection of pancreatic cancer.

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  24. Impact of Pretransplant Sarcopenia and Sequential Changes in Sarcopenic Parameters After Living Donor Liver Transplantation

    T. Kaido, Y. Tamai, K. Ogawa, Y. Fujimoto, A. Mori, H. Okajima, N. Inagaki, S. Uemoto

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 15   2015.5

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  25. Impact of elderly donors for liver transplantation: A single-center experience. International journal

    Naoko Kamo, Toshimi Kaido, Ahmed Hammad, Kohei Ogawa, Yasuhiro Fujimoto, Tadahiro Uemura, Akira Mori, Etsuro Hatano, Hideaki Okajima, Shinji Uemoto

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 21 ( 5 ) page: 591 - 598   2015.5

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    Elderly donor grafts for liver transplantation (LT) are recognized to be marginal grafts. The present study investigated the impact of using elderly donors for LT. Between June 1990 and August 2012, 1631 patients received LT at Kyoto University Hospital. Out of 1631 patients, 1597 patients received living donor liver transplantation (LDLT), whereas the other 34 patients underwent deceased donor liver transplantation (DDLT). Seventy-five grafts that were used came from individuals who were ≥60 years old. We retrospectively analyzed the recipients' survival rates according to donor age. The overall survival rates of the recipients of all LDLT (P < 0.001), adult-to-adult LDLT (P = 0.007), all DDLT (P = 0.026), and adult-to-adult DDLT (P = 0.011) were significantly lower for the elderly donor group versus the younger group and especially for those who were hepatitis C-positive. A multivariate analysis revealed that donor age, ABO incompatibility, and preoperative intensive care unit stay were independent risk factors for poor patient survival in adult-to-adult LDLT. However, no significant differences existed between the 2 groups among those who received adult-to-adult LDLT in and after April 2006. No significant association was found between donor age and incidence of acute cellular rejection. In conclusion, donor age was closely related to the survival rate for LDLT and DDLT, although the impact of donor age was not shown in the recent cases.

    DOI: 10.1002/lt.24086

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  26. High prevalence of carbapenem resistance among plasmid-mediated AmpC β-lactamase-producing Klebsiella pneumoniae during outbreaks in liver transplantation units. International journal

    Yasufumi Matsumura, Michio Tanaka, Masaki Yamamoto, Miki Nagao, Kiyomasa Machida, Yutaka Ito, Shunji Takakura, Kohei Ogawa, Atsushi Yoshizawa, Yasuhiro Fujimoto, Shinya Okamoto, Shinji Uemoto, Satoshi Ichiyama

    International journal of antimicrobial agents   Vol. 45 ( 1 ) page: 33 - 40   2015.1

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    During a prospective surveillance using PCR for the detection of plasmid-mediated AmpC β-lactamase (pAmpC)-producing Enterobacteriaceae, outbreaks due to pAmpC-producing Klebsiella pneumoniae (pAmpC-Kp) occurred in an adult liver transplantation unit (aLTU) and a paediatric liver transplantation unit (pLTU), with carbapenem-resistant (CR) variants. Between April 2010 and March 2012, a total of 32 patients infected with pAmpC-Kp were found by prospective surveillance using PCR detection at a Japanese university hospital. Multilocus sequence typing, analysis of outer membrane proteins, and detection of carbapenemases were performed. Clinical courses of patients with bloodstream infection (BSI) were reviewed. Of 32 pAmpC-Kp isolates from each patient, 20 (18 from aLTU patients) were DHA-1-producing sequence type 11 (DHA-1-ST11), 9 were CMY-2-ST45/778 (all from pLTU patients) and the other 3 isolates had different sequence types. CR variants were isolated from 8 aLTU patients with DHA-1-ST11 and from 1 pLTU patient with CMY-2-ST45. All of the pAmpC-Kp isolates, including CR variants, were negative for carbapenemases. All of the DHA-1-ST11 and CMY-2-ST45 isolates lacked OmpK35, and seven CR variants also lacked OmpK36. BSIs due to DHA-1-ST11 isolates, including CR variants, occurred in six aLTU patients, four of whom died. The outbreaks were controlled after application of intensified infection control measures. During pAmpC-Kp outbreaks involving 27 liver transplants, CR variants with porin loss developed in nine patients, and DHA-1-ST11 K. pneumoniae caused BSIs with high mortality.

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  27. Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation.

    Kosuke Endo, Taku Iida, Shintaro Yagi, Atsushi Yoshizawa, Yasuhiro Fujimoto, Kohei Ogawa, Yasuhiro Ogura, Akira Mori, Toshimi Kaido, Shinji Uemoto

    Surgery today   Vol. 44 ( 12 ) page: 2293 - 2299   2014.12

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    PURPOSE: Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. METHODS: We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. RESULTS: Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. CONCLUSIONS: Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.

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  28. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. International journal

    Yuhei Hamaguchi, Toshimi Kaido, Shinya Okumura, Yasuhiro Fujimoto, Kohei Ogawa, Akira Mori, Ahmed Hammad, Yumiko Tamai, Nobuya Inagaki, Shinji Uemoto

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 20 ( 11 ) page: 1413 - 1419   2014.11

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    Intramuscular fat accumulation has come to be associated with loss of muscle strength and function, one of the components of sarcopenia. However, the impact of preoperative quality of skeletal muscle on outcomes after living donor liver transplantation (LDLT) is unclear. The present study evaluated the intramuscular adipose tissue content (IMAC) and psoas muscle mass index (PMI) in 200 adult patients undergoing LDLT at our institution between January 2008 and October 2013. Correlations of IMAC with other factors, overall survival rates in patients classified according to IMAC or PMI, and risk factors for poor survival after LDLT were analyzed. IMAC was significantly correlated with age (r = 0.229, P = 0.03) and PMI (r = -0.236, P = 0.02) in males and with age (r = 0.349, P < 0.001) and branched-chain amino acid (BCAA)-to-tyrosine ratio (r = -0.250, P = 0.01) in females. The overall survival rates in patients with high IMAC or low PMI were significantly lower than those for patients with normal IMAC or PMI (P < 0.001, P < 0.001, respectively). Multivariate analysis showed that high IMAC [odds ratio (OR) = 3.898, 95% confidence interval (CI) = 2.025-7.757, P < 0.001] and low PMI (OR = 3.635, 95% CI = 1.896-7.174, P < 0.001) were independent risk factors for death after LDLT. In conclusion, high IMAC and low PMI were closely involved with posttransplant mortality. Preoperative quality and quantity of skeletal muscle could be incorporated into new selection criteria for LDLT. Perioperative nutritional therapy and rehabilitation could be important for good outcomes after LDLT.

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  29. Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety. International journal

    Junji Iwasaki, Taku Iida, Masaki Mizumoto, Tadahiro Uemura, Shintaro Yagi, Tomohide Hori, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Toshimi Kaido, Shinji Uemoto

    Transplant international : official journal of the European Society for Organ Transplantation   Vol. 27 ( 11 ) page: 1205 - 1213   2014.11

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    This study investigated adequate liver graft selection for donor safety by comparing postoperative donor liver function and morbidity between the right and left hemilivers (RL and LL, respectively) of living donors. Between April 2006 and March 2012, RL (n = 168) and LL (n = 140) donor operations were performed for liver transplantation at Kyoto University Hospital. Postoperative hyperbilirubinemia and coagulopathy persisted in RL donors, whereas the liver function of LL donors normalized more rapidly. The overall complication rate of the RL donors was significantly higher than that of the LL donors (59.5% vs. 30.7%; P < 0.001). There were no significant differences in severe complications worse than Clavien grade IIIa or in biliary complication rates between the two donor groups. In April 2006, we introduced an innovative surgical procedure: hilar dissection preserving the blood supply to the bile duct during donor hepatectomy. Compared with our previous outcomes (1990-2006), the biliary complication rate of the RL donors decreased from 12.2% to 7.2%, and the severity of these complications was significantly lower. In conclusion, LL donors demonstrated good recovery in postoperative liver function and lower morbidity, and our surgical innovations reduced the severity of biliary complications in living donors.

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  30. 6. 肝性昏睡を伴った急性肝不全に対するon-line HDFの有用性(一般演題,日本アフェレシス学会第32回関西地方会抄録)

    秦浩一郎, 山田博之, 宮田仁美, 大江秀典, 冨山浩司, 植村忠廣, 藤本康弘, 小川晃平, 森章, 岡島英明, 海道利実, 塚本達雄, 柳田素子, 上本伸二

    日本アフェレシス学会雑誌   Vol. 33 ( 3 ) page: 238 - 238   2014.10

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  31. Impact of cytochrome P450 3A5 polymorphism in graft livers on the frequency of acute cellular rejection in living-donor liver transplantation. International journal

    Miwa Uesugi, Mio Kikuchi, Haruka Shinke, Tomohiro Omura, Atsushi Yonezawa, Kazuo Matsubara, Yasuhiro Fujimoto, Shinya Okamoto, Toshimi Kaido, Shinji Uemoto, Satohiro Masuda

    Pharmacogenetics and genomics   Vol. 24 ( 7 ) page: 356 - 366   2014.7

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    OBJECTIVE: We investigated whether the cytochrome P450 3A5*3 (CYP3A5*3) genotype affects tacrolimus pharmacokinetics and the risk of acute cellular rejection in living-donor liver transplant patients in Japan. MATERIALS AND METHODS: Between July 2004 and June 2011, we enrolled 410 living-donor liver transplant patients receiving tacrolimus. Biopsy specimens of intestinal mucosa and graft liver at surgery were obtained to examine the mRNA expression of CYP3A subfamilies as well as the genotyping of CYP3A5*3 polymorphism. RESULTS: The CYP3A5 genotype in the native intestine had no significant effect on the occurrence of acute cellular rejection between postoperative days 14 and 23 in cases with identical or compatible ABO blood types (11.5% for the CYP3A5*1 allele vs. 7.4% for CYP3A5*3/*3; P=0.2643), although the concentration/dose ratio of tacrolimus was significantly higher in patients with the intestinal CYP3A5*3/*3 genotype than in those with the CYP3A5*1 allele for 5 post-transplant weeks. However, patients who received a graft liver with the CYP3A5*1 allele showed a higher rate of acute cellular rejection than those who received a graft liver with the CYP3A5*3/*3 genotype (14.5 vs. 5.7%; P=0.0134). The relative risk for acute cellular rejection associated with the CYP3A5*1 liver allele was 2.629 (P=0.018, Cox regression model). Consequently, graft liver CYP3A5*1 genotype might increase the risk for acute cellular rejection after living-donor liver transplantation, possibly by associating with the local hepatic tacrolimus concentration. CONCLUSIONS: The target level of tacrolimus may be affected by the CYP3A5*3 genotype of the liver, rather than by that of the small intestine, after postoperative day 14.

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  32. Graft reconditioning with nitric oxide gas in rat liver transplantation from cardiac death donors. International journal

    Shoichi Kageyama, Shintaro Yagi, Hirokazu Tanaka, Shunichi Saito, Kazuyuki Nagai, Koichiro Hata, Yasuhiro Fujimoto, Yasuhiro Ogura, Rene Tolba, Uemoto Shinji

    Transplantation   Vol. 97 ( 6 ) page: 618 - 625   2014.3

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    BACKGROUND: Liver transplant outcomes using grafts donated after cardiac death (DCD) remain poor. METHODS: We investigated the effects of ex vivo reconditioning of DCD grafts with venous systemic oxygen persufflation using nitric oxide gas (VSOP-NO) in rat liver transplants. Orthotopic liver transplants were performed in Lewis rats, using DCD grafts prepared using static cold storage alone (group-control) or reconditioning using VSOP-NO during cold storage (group-VSOP-NO). Experiment I: In a 30-min warm ischemia model, graft damage and hepatic expression of inflammatory cytokines, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and endothelin-1 (ET-1) were examined, and histologic analysis was performed 2, 6, 24, and 72 hr after transplantation. Experiment II: In a 60-min warm ischemia model, grafts were evaluated 2 hr after transplantation (6 rats/group), and survival was assessed (7 rats/group). RESULTS: Experiment I: Group-VSOP-NO had lower alanine aminotransferase (ALT) (P<0.001), hyaluronic acid (P<0.05), and malondialdehyde (MDA) (P<0.001), hepatic interleukin-6 expression (IL-6) (P<0.05), and hepatic tumor necrosis factor-alpha (TNF-α) expression (P<0.001). Hepatic eNOS expression (P<0.001) was upregulated, whereas hepatic iNOS (P<0.01) and ET-1 (P<0.001) expressions were downregulated. The damage of hepatocyte and sinusoidal endothelial cells (SECs) were lower in group-VSOP-NO.Experiment II: VSOP-NO decreased ET-1 and 8-hydroxy-2'deoxyguanosine (8-OHdG) expression and improved survival after transplantation by 71.4% (P<0.01). CONCLUSION: These results suggest that VSOP-NO effectively reconditions warm ischemia-damaged grafts, presumably by decreasing ET-1 upregulation and oxidative damage.

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  33. Chronic rejection associated with antiviral therapy for recurrent hepatitis C after living-donor liver transplantation. International journal

    Yoshihide Ueda, Toshimi Kaido, Takashi Ito, Kohei Ogawa, Atsushi Yoshizawa, Yasuhiro Fujimoto, Akira Mori, Aya Miyagawa-Hayashino, Hironori Haga, Hiroyuki Marusawa, Tsutomu Chiba, Shinji Uemoto

    Transplantation   Vol. 97 ( 3 ) page: 344 - 350   2014.2

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    BACKGROUND: Chronic rejection (CR) has been reported to be associated with antiviral therapy for recurrent hepatitis C in liver transplant (LT) recipients. The aims of this study were to clarify the details of antiviral therapy-associated CR after living-donor liver transplantation (LDLT) and to identify the factors associated with CR. METHODS: A retrospective chart review was performed on 125 recipients who had received antiviral therapy for recurrent hepatitis C after LDLT between January 2001 and September 2012. The characteristics of patients who developed CR during or within 6 months after antiviral therapy were compared with those of 76 patients who did not develop CR despite receiving antiviral therapy for more than 1 year. RESULTS: Seven of 125 (6%) patients developed CR during or within 6 months after the end of antiviral therapy. CR was diagnosed after a median (range) of 9 (1-16) months of antiviral therapy. In five patients, rejection progressed rapidly and resulted in death within 3 months after diagnosis. Analysis revealed two significant factors associated with CR: reduction of the immunosuppressant dose during antiviral therapy and a low fibrosis score as the indication for antiviral therapy. CONCLUSIONS: CR developed in association with antiviral therapy for recurrent hepatitis C after LDLT. This complication may be prevented by ensuring that the immunosuppressant dose is not reduced during antiviral therapy.

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  34. Evaluation of Liver Preservation Solutions by Using Rats Transgenic for Luciferase Reviewed

    J. Doi, T. Teratani, N. Kasahara, T. Kikuchi, Y. Fujimoto, S. Uemoto, E. Kobayashi

    Transplantation Proceedings   Vol. 46 ( 1 ) page: 63 - 65   2014

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    DOI: 10.1016/j.transproceed.2013.07.077

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  35. Association between <i>CYP3A5</i> Genotypes in Graft Liver and Increase in Tacrolimus Biotransformation from Steroid Treatment in Living-donor Liver Transplant Patients International journal

    HOSOHATA Keiko, UESUGI Miwa, HASHI Sachiyo, HOSOKAWA Mio, INUI Ken-ichi, MATSUBARA Kazuo, OGAWA Kohei, FUJIMOTO Yasuhiro, KAIDO Toshimi, UEMOTO Shinji, MASUDA Satohiro

    Drug Metabolism and Pharmacokinetics   Vol. 29 ( 1 ) page: 83 - 89   2014

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      We retrospectively examined whether cytochrome P450 (CYP) 3A5 genotypes are associated with high-dose steroid pulse treatment-induced functional gain of tacrolimus biotransformation in living-donor liver transplant patients. Concentrations of tacrolimus and its 3 primary metabolites, 13-<i>O</i>-demethyl tacrolimus (M-I), 31-<i>O</i>-demethyl tacrolimus (M-II), and 15-<i>O</i>-demethyl tacrolimus (M-III), were measured in trough blood samples from 18 liver transplant patients, by liquid chromatography–tandem mass spectrometry/mass spectrometry (LC-MS/MS). In patients engrafted with a <i>CYP3A5*1</i>-carrying liver but not with a <i>CYP3A5*3/*3</i>-carrying liver, the concentration/dose ratio of tacrolimus significantly fell after therapy, while ratios of M-I/tacrolimus, M-II/tacrolimus, and M-III/tacrolimus were significantly higher after therapy than before (p = 0.032, p = 0.023, and p = 0.0078, respectively). After steroid pulse therapy, the concentration of tacrolimus measured by immunoassay was significantly higher than that measured by LC-MS/MS in patients engrafted with a <i>CYP3A5*1</i>-carrying liver, but not those engrafted with a <i>CYP3A5*3/*3</i>-carrying liver. This suggests that the increased ratio of tacrolimus metabolites/tacrolimus can be explained by induction of CYP3A5 <i>via</i> high-dose steroid pulse therapy. Further, the concentrations of tacrolimus measured by the immunoassays were overestimated, partly because of cross-reactivity of the monoclonal antibody they incorporated to detect tacrolimus, with the increased metabolites in patients with a <i>CYP3A5*1</i>-carrying graft liver.<br>

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  36. Influence of Cytochrome P450 (CYP) 3A4*1G Polymorphism on the Pharmacokinetics of Tacrolimus, Probability of Acute Cellular Rejection, and mRNA Expression Level of CYP3A5 Rather than CYP3A4 in Living-Donor Liver Transplant Patients

    Uesugi Miwa, Hosokawa Mio, Shinke Haruka, Hashimoto Emina, Takahashi Tamotsu, Kawai Tomoki, Matsubara Kazuo, Ogawa Kohei, Fujimoto Yasuhiro, Okamoto Shinya, Kaido Toshimi, Uemoto Shinji, Masuda Satohiro

    BIOLOGICAL & PHARMACEUTICAL BULLETIN   Vol. 36 ( 11 ) page: 1814 - 1821   2013.11

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  37. DONOR MORBIDITY IN RIGHT AND LEFT LOBE LIVING DONOR LIVER TRANSPLANTATION

    Junji Iwasaki, Taku Iida, Shintaro Yagi, Tomohide Hori, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Toshimi Kaido, Shinji Uemoto

    TRANSPLANT INTERNATIONAL   Vol. 26   page: 113 - 113   2013.11

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  38. Influence of the cytochrome P450 3A5*3 genotype in a graft liver on the occurrence of acute cellular rejection after living-donor liver transplantation

    Miwa Uesugi, Satohiro Masuda, Haruka Shinke, Yuki Nishioka, Kazuo Matsubara, Yasuhiro Fujimoto, Toshimi Kaido, Shinji Uemoto

    HEPATOLOGY   Vol. 58   page: 1014A - 1014A   2013.10

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  39. Cytokine gene polymorphisms in acute cellular rejection following living donor liver transplantation: analysis of 155 donor-recipient pairs. International journal

    Hideya Kamei, Satohiro Masuda, Taro Nakamura, Masatoshi Ishigami, Yasuhiro Fujimoto, Yasuhiro Ogura, Fumitaka Oike, Yasutsugu Takada, Nobuyuki Hamajima

    Hepatology international   Vol. 7 ( 3 ) page: 916 - 922   2013.7

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    PURPOSE: Despite improvements in immunosuppressive therapy, acute cellular rejection (ACR) remains an important cause of graft loss in patients undergoing liver transplantation. Recently, associations between cytokine gene polymorphisms in recipients and the occurrence of ACR have been reported. However, most studies did not investigate gene polymorphisms in donors or were limited by the number of cases investigated. METHODS: We examined 155 living donor liver transplantation (LDLT) patients treated at Nagoya University or Kyoto University from 2004 to 2009. The following gene polymorphisms in recipients and donors were analyzed: tumor necrosis factor A (TNF-A) T-1031C, interleukin 2 (IL-2) T-330G, IL-10C-819T, IL-13C-1111T, and transforming growth factor B (TGF-B) T29C. RESULTS: Forty-seven recipients (30.3 %) developed early ACR. Of the investigated gene polymorphisms, the IL-13 -1111C/C genotype in recipients was significantly associated with a higher incidence of ACR relative to the other two genotypes (OR = 2.64, 95 % CI 1.19-5.86, p = 0.017), while we showed the lack of association between investigated gene polymorphisms in donors and ACR incidence. CONCLUSION: The IL-13 -1111C/C genotype in recipients might be a risk factor for ACR in LDLT, and this might contribute to individualized immunosuppression strategies for recipients. On the other hand, the current study showed no associations of cytokine gene polymorphisms in donors with ACR incidence.

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  40. Impact of Sarcopenia on Survival in Patients Undergoing Living Donor Liver Transplantation.

    Kaido Toshimi, Ogawa Kohei, Fujimoto Yasuhiro, Ito Takashi, Tomiyama Koji, Mori Akira, Uemoto Shinji

    LIVER TRANSPLANTATION   Vol. 19   page: S97 - S97   2013.6

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  41. Impact of Sarcopenia on Survival in Patients Undergoing Living Donor Liver Transplantation Reviewed

    T. Kaido, K. Ogawa, Y. Fujimoto, Y. Ogura, K. Hata, T. Ito, K. Tomiyama, S. Yagi, A. Mori, S. Uemoto

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 13 ( 6 ) page: 1549 - 1556   2013.6

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    Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r=-0.254, p=0.005) and body cell mass (r=0.636, p&lt;0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p&lt;0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p=0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.

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  42. Impact of Sarcopenia on Survival in Patients Undergoing Living Donor Liver Transplantation

    Kaido T., Ogawa K., Fujimoto Y., Ito T., Tomiyama K., Mori A., Ogura Y., Uemoto S.

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 13   page: 218 - 218   2013.4

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  43. Histology of intestinal allografts: lymphocyte apoptosis and phagocytosis of lymphocytic apoptotic bodies are diagnostic findings of acute rejection in addition to crypt apoptosis. International journal

    Tatsuaki Tsuruyama, Shinya Okamoto, Yasuhiro Fujimoto, Atsushi Yoshizawa, Elena Yoshitoshi, Hiroto Egawa, Hiroshi Nakase, Wulamujiang Aini, Masashi Miyao, Keiji Tamaki, Hirohiko Yamabe, Hironori Haga, Shinji Uemoto

    The American journal of surgical pathology   Vol. 37 ( 2 ) page: 178 - 184   2013.2

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    Acute rejection of a small-bowel transplant is often difficult to diagnose due to complicated immune responses. The present study aimed to elucidate the specific immune responses involved in intestinal transplant rejection. We correlated immunohistologic findings with an increase in crypt apoptosis, which has been commonly accepted as a criterion for the diagnosis of acute cellular rejection (ACR). Of 8 patients who received an intestinal allograft at Kyoto University Hospital, biopsy specimens from 7 patients were assessed immunohistologically with antibodies against 20 types of lymphocytic antigens including CD3, CD4, CD8, CD79a, CD20, IgG, and T-cell receptor, along with assessment of the patients' clinical courses. It was revealed that, in addition to apoptotic crypts, T-lymphocyte apoptosis and phagocytosis of apoptotic bodies in the lamina propria of villi were findings of ACR; both were observed in all cases. Immunostaining of the Fas ligand, one of the apoptosis-inducing molecules, was useful for the identification of the apoptotic bodies in the lamina propria of villi. Apoptotic body phagocytosis may be a surrogate diagnostic finding of grafts undergoing ACR.

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  44. ASSOCIATION BETWEEN FREQUENCY OF ACUTE CELLULAR REJECTION AND CYTOCHROME P450 3A5 GENOTYPE OF THE GRAFT LIVER RATHER THAN THAT OF THE NATIVE INTESTINEIN LIVING-DONOR LIVER TRANSPLANT PATIENTS.

    Uesugi M., Hosokawa M., Shinke H., Matsubara K., Fujimoto Y., Kaido T., Uemoto S., Masuda S.

    CLINICAL PHARMACOLOGY & THERAPEUTICS   Vol. 93   page: S50 - S51   2013.2

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  45. Impact of glutathione S-transferase T1 gene polymorphisms on acute cellular rejection in living donor liver transplantation. International journal

    Hideya Kamei, Satohiro Masuda, Taro Nakamura, Yasuhiro Fujimoto, Fumitaka Oike, Yasuhiro Ogura, Yasutsugu Takada, Nobuyuki Hamajima

    Transplant immunology   Vol. 28 ( 1 ) page: 14 - 17   2013.1

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    It has previously been demonstrated that glutathione S-transferase T1 (GSTT1) genetic mismatch between recipient and donor is a risk factor for developing immune-mediated hepatitis following liver transplantation and for antibody-mediated rejection in renal transplantation. Little is known whether the GSTT1 gene polymorphism affects the incidence of acute cellular rejection (ACR) following living donor liver transplantation (LDLT). Patients underwent LDLT at Nagoya University or Kyoto University, Japan, between 2004 and 2009. Genotyping of GSTT1 genes (null or present genotype) was conducted in recipients and donors. A total of 155 LDLT cases were examined. Forty-seven recipients (30.3%) developed early ACR. There was no association of recipient GSTT1 genotype with ACR incidence. However, ACR incidence was significantly higher in recipients transplanted from GSTT1 present genotype donors than in those transplanted from GSTT1 null genotype donors [odds ratio (OR)=2.64, 95% confidence interval (CI)=1.12-5.83, p=0.016]. Moreover, GSTT1 recipient/donor genotype mismatch (present/null or null/present) was significantly associated with ACR development (OR=2.28, 95% CI=1.12-4.61, p=0.022). The genotyping of GSTT1 in recipients and donors might be useful to stratify the liver transplant recipients according to risk of ACR.

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  46. Influence of Cytochrome P450 (CYP) <i>3A4*1G</i> Polymorphism on the Pharmacokinetics of Tacrolimus, Probability of Acute Cellular Rejection, and mRNA Expression Level of CYP3A5 Rather than CYP3A4 in Living-Donor Liver Transplant Patients

    Uesugi Miwa, Hosokawa Mio, Shinke Haruka, Hashimoto Emina, Takahashi Tamotsu, Kawai Tomoki, Matsubara Kazuo, Ogawa Kohei, Fujimoto Yasuhiro, Okamoto Shinya, Kaido Toshimi, Uemoto Shinji, Masuda Satohiro

    Biological and Pharmaceutical Bulletin   Vol. 36 ( 11 ) page: 1814 - 1821   2013

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    Association between cytochrome P450 (CYP) <i>3A4*1G</i> genotype of donors (<i>n</i>=412) and/or recipients (<i>n</i>=410), and the pharmacokinetics of tacrolimus and the risk of acute cellular rejection was examined in Japanese living-donor liver transplant patients between 2004 and 2011. The concentration/dose (C/D) ratio of tacrolimus in patients carrying graft liver with <i>CYP3A4*1/*1</i> was significantly higher during 7 d after surgery than in that with <i>CYP3A4*1/*1G</i> (214 <i>vs.</i> 157 [ng/mL]/[mg/kg/day], <i>p</i><0.01). After postoperative day 8, no significant difference was observed among <i>CYP3A4*1G</i> genotypes in the graft liver. However, the C/D ratio in <i>CYP3A4*1/*1</i> of the intestine was significantly higher than that in <i>CYP3A4*1G/*1G</i> for 5 weeks after surgery (postoperative days 1–14; <i>p</i><0.001, postoperative days 15–35; <i>p</i><0.01). During postoperative days 14 and 26, acute cellular rejection incidences tended to be lower in the patients with graft liver carrying the <i>CYP3A4*1</i>/*<i>1</i> allele than in the patients carrying <i>CYP3A4*1G</i> allele (8.7% <i>vs.</i> 14.6%, <i>p</i>=0.0973). However, <i>CYP3A4*1G</i> in the intestine had almost no effect on the incidence of rejection (9.9% in <i>CYP3A4*1/*1</i> <i>vs.</i> 12.5% in <i>CYP3A4*1G</i> allele, <i>p</i>=0.4824). <i>CYP3A4*1G</i> was significantly related to mRNA expression of CYP3A5 rather than of CYP3A4 in the graft liver and intestine and was strongly linked with the <i>CYP3A5*1</i>. Thus, we elucidated that <i>CYP3A4*1G</i> genotype in the intestine was an important indicator of the pharmacokinetics of tacrolimus, whereas this genotype in the graft liver tended to influence the frequency of acute cellular rejection after transplantation.

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  47. 25. 当院での胆道閉鎖症に対する肝移植の適応について(第38回日本胆道閉鎖症研究会)

    岡本 晋弥, 金城 昌克, 吉利 エレーナ 幸江, 吉澤 淳, 小川 晃平, 藤本 康弘, 上本 伸二

    日本小児外科学会雑誌   Vol. 48 ( 4 ) page: 810   2012

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    DOI: 10.11164/jjsps.48.4_810_3

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  48. Bone marrow-derived mesenchymal stem cells ameliorate hepatic ischemia reperfusion injury in a rat model. Reviewed International journal

    Hiroyuki Kanazawa, Yasuhiro Fujimoto, Takumi Teratani, Junji Iwasaki, Naoya Kasahara, Kouji Negishi, Tatsuaki Tsuruyama, Shinji Uemoto, Eiji Kobayashi

    PloS one   Vol. 6 ( 4 ) page: e19195   2011.4

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    BACKGROUND: Ischemia-reperfusion (I/R) injury associated with living donor liver transplantation impairs liver graft regeneration. Mesenchymal stem cells (MSCs) are potential cell therapeutic targets for liver disease. In this study, we demonstrate the impact of MSCs against hepatic I/R injury and hepatectomy. METHODOLOGY/PRINCIPAL FINDINGS: We used a new rat model in which major hepatectomy with I/R injury was performed. Male Lewis rats were separated into two groups: an MSC group given MSCs after reperfusion as treatment, and a Control group given phosphate-buffered saline after reperfusion as placebo. The results of liver function tests, pathologic changes in the liver, and the remnant liver regeneration rate were assessed. The fate of transplanted MSCs in the luciferase-expressing rats was examined by in vivo luminescent imaging. The MSC group showed peak luciferase activity of transplanted MSCs in the remnant liver 24 h after reperfusion, after which luciferase activity gradually declined. The elevation of serum alanine transaminase levels was significantly reduced by MSC injection. Histopathological findings showed that vacuolar change was lower in the MSC group compared to the Control group. In addition, a significantly lower percentage of TUNEL-positive cells was observed in the MSC group compared with the controls. Remnant liver regeneration rate was accelerated in the MSC group. CONCLUSIONS/SIGNIFICANCE: These data suggest that MSC transplantation provides trophic support to the I/R-injured liver by inhibiting hepatocellular apoptosis and by stimulating regeneration.

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  49. Donor screening algorithm for exclusion of thrombophilia during evaluation of living donor liver transplantation

    Ogawa Hayato, Fujimoto Yasuhiro, Yamamoto Koji, Hata Taigo, Nagai Shunji, Kamei Hideya, Arikawa Takashi, Nakamura Taro, Kiuchi Tetsuya

    CLINICAL TRANSPLANTATION   Vol. 25 ( 2 ) page: 277 - 282   2011

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    Living donor liver transplantation (LDLT) has evolved based on the premise that donor safety is most important. In 2005, we encountered a donor who developed a pulmonary embolism during the early post-operative period. As it is important for donors to be healthy, most risk factors related to perioperative thrombosis, such as obesity, age, and malignancy are used as exclusion criteria during the evaluation process. We speculated that thrombophilia not detected by conventional laboratory examinations may cause post-operative thrombotic complications and should be investigated by application of additional parameters, including protein S, protein C, antithrombin III, anti-β2-glycoprotein I antibodies (anti-β2GPI), and lupus anticoagulant. From July 2005 to June 2007, we evaluated 44 donor candidates for LDLT using our novel algorithm for screening of thrombophilia, which revealed two suspected candidates (one with low protein S, one with low protein C, and positive anti-β2GPI findings), who were subsequently excluded from the donor pool. Thereafter, all donor hepatectomies, which included two borderline donors given anticoagulants perioperatively, were performed without complications. Four donors (two suspected, two borderline) would not have been recognized without additional screening. In conclusion, we were able to detect thrombophilia and avoid donor thrombosis using additional screening criteria and our novel algorithm. © 2010 John Wiley & Sons A/S.

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  50. &apos;Hepaticized&apos; Small Intestinal Graft: Possible Option for the Treatment of Liver Cirrhosis without Liver Transplantation.

    Junji Iwasaki, Yasuhiro Fujimoto, Hiroyuki Kanazawa, Takumi Teratani, Shinji Uemoto, Eiji Kobayashi

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 10   page: 228 - 228   2010.4

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  51. [Recent advances and future prospects in research of small bowel transplantation].

    Yasuhiro Fujimoto, Shinji Uemoto, Eiji Kobayashi

    Nihon Geka Gakkai zasshi   Vol. 111 ( 1 ) page: 32 - 5   2010.1

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  52. Development of a portocaval shunt using a small intestinal segment in rats. International journal

    Toshiyuki Hata, Junji Iwasaki, Shuji Hishikawa, Yasuhiro Fujimoto, Shinji Uemoto, Eiji Kobayashi

    Microsurgery   Vol. 30 ( 4 ) page: 302 - 306   2010

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    The transjugular portosystemic shunt, widely used to treat portal hypertension today, may increase the risk of encephalopathy and reduce effective hepatic flow. To address these issues, a strategy to produce a portocaval shunt (PCS) with hepatic function using intestinal grafts was conceived, and rat models were developed. We transplanted ileal grafts from wild-type and luciferase transgenic Lewis rats to wild-type Lewis rats, anastomosing the graft mesenteric artery (SMA) and portal vein (PV) to the recipient PV trunk and inferior vena cava, respectively. Recipient survival was significantly longer in the partial PCS model, in which the graft SMA was anastomosed to the recipient PV trunk in an end-to-side fashion, than in the total PCS model, with the end-to-end anastomosis. In the partial PCS model, histological and luminescence analyses showed graft survival for 1 month. These results suggest that intestinal grafts can be maintained in the particular conditions required for our strategy.

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  53. DP-180-7 急性期病院におけるNST活動維持の工夫(第108回日本外科学会定期学術集会)

    光吉 明, 伊藤 孝司, 瀬尾 智, 藤本 康弘, 新藏 信彦, 小濱 和貴

    日本外科学会雑誌   Vol. 109 ( 2 ) page: 705   2008.4

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  54. DP-167-6 門脈血栓合併症例に対する肝移植の検討(第108回日本外科学会定期学術集会)

    亀井 秀弥, 畑 太悟, 長井 俊次, 中村 太郎, 藤本 康弘, 木内 哲也

    日本外科学会雑誌   Vol. 109 ( 2 ) page: 679   2008.4

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  55. AM-1 小児外科 チーム小腸移植の栄光 : 日本国内における臨床小腸移植の最近の経験,取り組みと今後の課題(アカデミックマインドの涵養-若い外科医達の夢を育む-,第108回日本外科会定期学術集会)

    和田 基, 上野 豪久, 鈴木 友己, 星野 健, 中村 太郎, 阪本 靖介, 藤本 康弘, 西本 祐子, 松浦 俊治, 長谷川 利路, 林 富

    日本外科学会雑誌   Vol. 109 ( 2 ) page: 80   2008.4

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  56. Impact of non-congestive graft size in living donor liver transplantation: New indicator for additional vein reconstruction in right liver graft Reviewed

    Hideya Kamei, Yasuhiro Fujimoto, Shunji Nagai, Ryuichiro Suda, Hidekazu Yamamoto, Tetsuya Kiuchi

    Liver Transplantation   Vol. 13 ( 9 ) page: 1295 - 1301   2007.9

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    Addition of the middle hepatic vein (MHV) or reconstruction of its tributaries to increase noncongestive graft volume is expected to improve graft function in right liver living donor liver transplantation (LDLT). However, the relationship between noncongestive graft volume and graft function after transplantation has not been clarified and definitive criteria for the reconstruction of MHV tributaries have yet to be established. We analyzed 29 right liver LDLT cases. The noncongestive graft weight was calculated as the total weight of the graft regions drained by hepatic veins reconstructed without postoperative occlusion. We calculated the noncongestive graft-to-recipient weight ratio (ncGRWR) by comparing it to the GRWR. Indocyanine green (ICG) clearance results on days 1 and 3 were significantly correlated with ncGRWR, but not with GRWR. Patients were then divided into 2 groups based on ncGRWR: lower than the median (L-ncGRWR group) and above the median (H-ncGRWR group). ICG clearance in the H-ncGRWR group was significantly better on days 1 and 3. For a different analysis, the patients were again divided into 2 groups, those with and without prolonged cholestasis after transplantation. ncGRWR was significantly lower in patients with prolonged cholestasis, and 7 of 9 patients with an ncGRWR value lower than 0.65 suffered from prolonged cholestasis. Our results demonstrated that the noncongestive volume of a right liver graft has a significant association with early graft function. Further, ncGRWR can play a key role in preoperative determination for additional vein reconstruction of MHV tributaries. When the estimated ncGRWR value with reconstruction of only the right hepatic vein (RHV) (+ inferior right hepatic vein [IRHV]) is)ess than 0.65, additional vein reconstruction of MHV tributaries should be planned. © 2007 AASLD.

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  57. Difference of viremia and treatment effect between FK506 and cyclosporine a in posttransplant HCV recurrence in Japanese patients

    Ishigami Masatoshi, Katano Yoshiaki, Nakamura Taro, Fujimoto Yasuhiro, Kiuchi Tetsuya, Goto Hidemi

    TRANSPLANT INTERNATIONAL   Vol. 20   page: 256 - 256   2007.9

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  58. Challenge to save the dose of HBIg by frequent monitoring of HBsAB after liver trasplantation for HBV-positive patients

    Ishigami Masatoshi, Katano Yoshiaki, Nakamura Taro, Fujimoto Yasuhiro, Kiuchi Tetsuya, Goto Hidemi

    TRANSPLANT INTERNATIONAL   Vol. 20   page: 257 - 257   2007.9

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  59. Graft selection algorithm based on congestion volume for adult living donor liver transplantation

    Asakuma M., Fujimoto Y., Bourquain H., Uryuhara K., Hayashi M., Tanigawa N., Peitgen H.-O., Tanaka K.

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 7 ( 7 ) page: 1788 - 1796   2007.7

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    A major concern in adult-to-adult living donor liver transplantation is the selection of graft type; that is, is it is better to use the right lobe with or without the middle hepatic vein (MHV)? This choice has a considerable impact on donor safety, vascular reconstruction and graft function in the recipient. To facilitate making an appropriate choice, on the basis of a preliminary study (n = 17), we herein propose a graft selection algorithm using three parameters: graft-to-recipient body weight ratio (GRWR), percentage remnant liver volume (%RLV) and estimated congestion ratio (ECR). The algorithm was evaluated with 50 consecutive cases with respect to postoperative liver function of donors and recipients and survival of recipients. Postoperative recovery was comparable between the two groups (p = NS). The overall cumulative 18-month survival rate was 86.7% for the 'with MHV graft group', and 76.1% for the gwithout MHV graft grouph (p = NS). For 41 cases (82%), graft types were chosen according to the algorithm, whereas the remaining 9 cases (18%) needed detailed discussion of donor, recipient and operative factors. In conclusion, we constructed a graft selection algorithm based on congestion volume, which will contribute to objective graft-type selection in adult-to-adult LDLT. © 2007 The Authors.

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  60. Dynamics of hematological dataafter living donor liver transplantation in Japanese patients.

    Ishigami Masatoshi, Katano Yoshiaki, Fujimoto Yasuhiro, Kiuchi Tetsuya, Goto Hidemi

    LIVER TRANSPLANTATION   Vol. 13 ( 6 ) page: S83 - S84   2007.6

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  61. DP-082-5 当院における肝細胞癌に対する生体肝移植の成績 : 非移植症例との比較から(第107回日本外科学会定期学術集会)

    亀井 秀弥, 藤本 康弘, 杉浦 良子, 長井 俊志, 木内 哲也

    日本外科学会雑誌   Vol. 108 ( 2 ) page: 490   2007.3

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  62. DP-039-1 右葉グラフト生体肝移植ドナー安全性の評価(第107回日本外科学会定期学術集会)

    長井 俊志, 藤本 康弘, 亀井 秀弥, 杉浦 良子, 木内 哲也

    日本外科学会雑誌   Vol. 108 ( 2 ) page: 405   2007.3

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  63. DP-039-8 脂肪浸潤を有する生体肝移植ドナーの安全性評価(第107回日本外科学会定期学術集会)

    杉浦 良子, 長井 俊志, 亀井 秀弥, 藤本 康弘, 木内 哲也

    日本外科学会雑誌   Vol. 108 ( 2 ) page: 407   2007.3

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  64. 0660 成人生体肝移植におけるSmall-for-size graftへの戦略(生体肝移植4,一般演題,第61回日本消化器外科学会定期学術総会)

    山本 栄和, 藤本 康弘, 合田 良政, 長井 俊志, 亀井 秀弥, 木内 哲也

    日本消化器外科学会雑誌   Vol. 39 ( 7 ) page: 1119   2006.7

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  65. 0635 固有肝動脈閉塞肝癌症例に対して,術前下横隔動脈塞栓術の後,生体肝移植を施行した1例(生体肝移植1,一般演題,第61回日本消化器外科学会定期学術総会)

    合田 良政, 藤本 康弘, 山本 栄和, 長井 俊志, 亀井 秀弥, 太田 豊裕, 木内 哲也

    日本消化器外科学会雑誌   Vol. 39 ( 7 ) page: 1116   2006.7

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  66. Classification of human liver transplant recipients by their preoperative CD8+ T cell subpopulation and its relation to outcome. International journal

    Koichi Tanaka, Kazue Ozawa, Satoshi Teramukai, Yasutsugu Takada, Hiroto Egawa, Satoshi Kaihara, Yasuhiro Fujimoto, Yasuhiro Ogura, Mureo Kasahara, Masako Ono, Hiroshi Sato, Kenji Takai, Masanori Fukushima, Nagahiro Minato

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 12 ( 5 ) page: 792 - 800   2006.5

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    The primed status of T cells is markedly different among liver transplant recipients, due to a lifetime of antigen exposure and reduced thymopoiesis by aging, and diseases. This study aims to characterize the preoperative immunological status of CD8+ T cell subpopulations and relate it to the outcome for liver transplant recipients. We classified 112 liver transplant recipients into 5 groups, based on hierarchical clustering of the CD8+CD45 isoform proportion of T cells. In Groups I and II (pediatric), the naive T cell proportion was more than 50%. In adult recipients, Group III was characterized by a naive T cell proportion of 50%, Group IV had the greatest effector/memory T cells (EM), and Group V had the greatest proportion of effector T cells. In Groups IV and V, the effector T cell proportion was considerably higher, and was accompanied by marked downregulation of the CD27+CD28+ subsets and upregulation of interferon gamma (IFN)-gamma, tumor necrosis factor-alpha, and perforin expression. Group V recipients tended to be complicated postoperatively, with a significantly reduced survival rate (1 yr, 66.8%) and markedly reduced Eastern Cooperative Oncology Group performance status.

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  67. A case report of adult de novo AIH after liver transplantation for liver cirrhosis due to chronic hepatitis

    Ishigami M, Fujimoto Y, Oike F, Katano Y, Goto H, Tanaka K, Kiuchi T

    LIVER TRANSPLANTATION   Vol. 12 ( 5 ) page: C60 - C60   2006.5

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  68. A model of donors' decision-making in adult-to-adult living donor liver transplantation in Japan: having no choice. International journal

    Misao Fujita, Akira Akabayashi, Brian Taylor Slingsby, Shinji Kosugi, Yasuhiro Fujimoto, Koichi Tanaka

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 12 ( 5 ) page: 768 - 774   2006.5

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    This study examined the decision-making processes of donors in adult-to-adult living donor liver transplantation. Twenty-two donors were interviewed using a semi-structured format. Interview contents were transcribed verbatim and analyzed qualitatively using grounded theory. A decision-making model was developed consisting of 5 stages: (1) recognition, (2) digestion, (3) decision-making, (4) reinforcement, and (5) resolution. The second and the third stages described donors' experiences of "reaching a decision"; the fourth and fifth stages described those of "facing transplantation." The central theme of this model was "having no choice," which consisted of 4 codes: (1) priority of life, (2) only LDLT, (3) for family, and (4) only me. In conclusion, this model can help health care professionals to understand the donor experience and, based on that understanding, to provide sufficient support to the donor.

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  69. A model of donors' deicision-making in adult-to-adult living donor liver transplantation in Japan: Having no choice.

    Fujita M, Akabayashi A, Slingsby BT, Kosugi S, Fujimoto Y, Tanaka K

    LIVER TRANSPLANTATION   Vol. 12 ( 5 ) page: C118 - C118   2006.5

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  70. Functional volume in the living-donor liver graft : a potential indicator for posttransplant liver function

    Journal of Japan Surgical Society   Vol. 107 ( 2 ) page: 98   2006.3

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  71. Acute humoral rejection and C4d immunostaining in ABO blood type-incompatible liver transplantation. International journal

    Hironori Haga, Hiroto Egawa, Yasuhiro Fujimoto, Mikiko Ueda, Aya Miyagawa-Hayashino, Takaki Sakurai, Tomoko Okuno, Itsuko Koyanagi, Yasutsugu Takada, Toshiaki Manabe

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 12 ( 3 ) page: 457 - 464   2006.3

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    Complement C4d deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in kidney and other solid organ transplantation. The correlation of C4d deposits and humoral rejection in liver transplants, however, is not well understood. We investigated the C4d immunostaining pattern in 34 patients whose liver biopsy was taken within the first 3 postoperative weeks for suspected acute rejection after ABO blood type-incompatible liver transplantation. The staining pattern was classified as positive (portal stromal staining), indeterminate (endothelial staining only), and negative (no staining). Positive C4d immunostaining was seen in 17 (50%) patients and was significantly associated with high (x64 or more) postoperative antidonor A/B antibody (immunoglobulin M (IgM)) titers (88 vs. 35%, P = 0.002) and poorer overall survival rate (41 vs. 88%, P = 0.007). Ten of 11 (91%) cases with histological acute humoral rejection (periportal edema and necrosis (PEN) or portal hemorrhagic edema) were positive for C4d, all of which showed high postoperative antibody titers. The other histologies associated with C4d positivity was purulent cholangitis (n = 4), coagulative hepatocyte necrosis (n = 1), acute cellular rejection (n = 1), and hepatocanalicular cholestasis (n = 1). Full clinical recovery was observed in only 6 of 17 (35%) C4d-positive patients, and tended to be associated with a lower rejection activity index (RAI). In conclusion, our study indicates that C4d deposits in the portal stroma can be a hallmark of acute humoral rejection in ABO-incompatible liver transplantation, and allograft damage can be reversible in a minority of cases.

    DOI: 10.1002/lt.20652

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  72. Fatal graft-versus-host disease after living donor liver transplantation: Differential impact of donor-dominant one-way HLA matching Reviewed

    Hideya Kamei, Fumitaka Oike, Yasuhiro Fujimoto, Hidekazu Yamamoto, Koichi Tanaka, Tetsuya Kiuchi

    Liver Transplantation   Vol. 12 ( 1 ) page: 140 - 145   2006.1

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    Graft-versus-host disease (GVHD) is an uncommon but potentially devastating complication following liver transplantation. Recently, it was shown that use of a human leukocyte antigen (HLA)-homozygous donor leading to one-way HLA matching significantly increases the risk of GVHD after living donor liver transplantation (LDLT). However, the precise impact of HLA matching between donor and recipient on the risk of GVHD is not yet clear. We surveyed instances of fatal GVHD following LDLT in Japan and reviewed all 8 cases in detail, especially with respect to HLA matching. Serological typing showed that 7 of those cases had donor-dominant one-way HLA matching in the 3 loci of HLA-A, -B, and -DR, while one had donor-dominant one-way HLA matching in the 2 loci of HLA-A and -DR and identical alleles in the B locus. However, DNA typing revealed that the latter case had 1-way HLA matching in the 3 loci. Further, we analyzed HLA typing of 906 donor-recipient pairs who underwent LDLT. There were 5 cases with donor-dominant one-way matching in 2 loci and 2 with donor-dominant one-way matching in 1 locus. All of those cases except 1, who died from an unrelated cause, are alive without an obvious presentation of GVHD. In conclusion, our results suggest that the total number of loci with donor-dominant one-way HLA matching is important for determining the risk of fatal GVHD following LDLT, and that DNA typing of HLA alleles is indispensable in some cases to identify the true risk of donor-dominant 1-way HLA matching. © 2005 AASLD.

    DOI: 10.1002/lt.20573

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  73. Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation. International journal

    Mureo Kasahara, Yasutsugu Takada, Yasuhiro Fujimoto, Yasuhiro Ogura, Kohei Ogawa, Kenji Uryuhara, Yukihide Yonekawa, Mikiko Ueda, Hiroto Egawa, Koichi Tanaka

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons   Vol. 5 ( 6 ) page: 1339 - 1346   2005.6

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    Technical improvements in adult-to-adult living-donor liver transplantation (LDLT) have led to the use of right-lobe grafts to overcome the problems encountered with 'small-for-size grafts'. The major controversy remains that the venous drainage from anterior segment substantially depends on tributaries of the middle hepatic vein (MHV), and deprivation of such tributaries may critically influence the postoperative graft function. Right-lobe grafts with MHV could resolve the potential problem of congestion in anterior segment. From December 2000 to January 2004, we performed 217 right-lobe LDLTs for adult patients. Of these, 40 patients received a right lobe with MHV graft (18.4%). The overall cumulative 3-year graft survival rate of a right lobe with (n = 40) and without MHV (n = 177) was 86.2% and 74.8% (p = NS). The proximal side of the MHV and the drainage vein of segment IV to the MHV (the left medial superior vein) were preserved in 24 patients. All of them needed venous interposition graft for anastomosis. All patients had a patent right hepatic vein (RHV) and MHV anastomosis during the follow-up period. We adopted the right lobe with MHV graft in 40 LDLT cases. Vein graft is essential for safe MHV anastomosis in cases which preserve proximal side of the MHV.

    DOI: 10.1111/j.1600-6143.2005.00817.x

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  74. Auxiliary partial orthotopic living donor liver transplantation: Kyoto University experience. International journal

    Mureo Kasahara, Yasutsugu Takada, Hiroto Egawa, Yasuhiro Fujimoto, Yasuhiro Ogura, Kohei Ogawa, Koichi Kozaki, Hironori Haga, Mikiko Ueda, Koichi Tanaka

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons   Vol. 5 ( 3 ) page: 558 - 565   2005.3

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    Auxiliary partial orthotopic liver transplantation (APOLT) was initially indicated as a potentially reversible fulminant hepatic failure and non-cirrhotic metabolic liver disease to compensate for enzyme deficiency without complete removal of the native liver. We expand our indication of APOLT for small-for-size grafts to support the function of implanted grafts during the early post-operative period, and for ABO-incompatibility to sustain a patient's life if the patient has a graft failure. We retrospectively reviewed 31 patients undergoing APOLT from living donor. The indication of APOLT was fulminant hepatic failure in 6, non-cirrhotic metabolic liver disease in 6, small-for-size grafts in 13 and ABO-incompatible cases in 6. The cumulative survival rate for APOLT at 1 and 5 years was 57.9% and 50.6%, and 78.8% and 73.8% for standard LDLT. None of the patients who underwent transplantation with APOLT for fulminant hepatic failure had long-term patient survival. The incidence of acute cellular rejection was higher in APOLT (58.1%) than standard LDLT (35.0%). Biliary complication was higher and the need for retransplantation was greater in APOLT than standard LDLT (p < 0.01). The results suggest that the indications of APOLT should be reconsidered in view of the risk for complications and retransplantation.

    DOI: 10.1111/j.1600-6143.2005.00717.x

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  75. Application of mucosal MDR1 level for tacrolimus therapy in small bowel transplantat patients

    S Masuda, S Uemoto, M Goto, Y Fujimoto, K Tanaka, K Inui

    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY   Vol. 31 ( 11 ) page: A223 - A223   2004.11

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  76. Functional portal flow competition after auxiliary partial orthotopic living donor liver transplantation in noncirrhotic metabolic liver disease. International journal

    Mureo Kasahara, Yasutsugu Takada, Koichi Kozaki, Kenji Uryuhara, Yasuhiro Ogura, Kohei Ogawa, Yasuhiro Fujimoto, Koichi Tanaka

    Journal of pediatric surgery   Vol. 39 ( 7 ) page: 1138 - 1141   2004.7

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    Auxilliary partial orthotopic liver transplantation (APOLT) was introduced initially as a tentative or permanent support for patients with potentially reversible fulminant hepatic failure and has extended its indication to congenital metabolic disorder of the liver that has otherwise normal functional integrity. Postoperative management of APOLT is complicated because of functional portal flow competition between the native and graft liver. The native portal vein diversion to the graft is sometimes indicated to prevent functional competition; however, it is still an open question whether this technique can be theoretically indicated for APOLT patients. The authors report a on patient with ornithine transcarbamylase deficiency who received APOLT from a living donor without native portal vein diversion. Because of functional portal vein competition between the native and graft liver, the patient had to have portal vein diversion, portal vein embolization, and finally native hepatectomy to induce the graft regeneration after APOLT. After the experience of the current case, primary portal vein diversion for APOLT with noncirrhotic metabolic liver disease patients to prevent functional portal flow competition is recommended.

    DOI: 10.1016/j.jpedsurg.2004.03.079

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  77. Hepatic vein reconstruction in living-donor liver transplantation using right lobe graft with middle hepatic vein.

    Kasahara M, Uryuhara K, Fujimoto Y, Ogura Y, Egawa H, Takada Y, Tanaka K

    LIVER TRANSPLANTATION   Vol. 10 ( 6 ) page: C65 - C65   2004.6

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  78. Early recurrence but successful treatment of hepatitis C in a completely immunosuppression-free environment after living-donor syngeneic liver transplantation.

    Yoshizawa A, Fujimoto Y, Koshiba T, Pirenne J, Ogura Y, Kozaki K, Kasahara M, Ueda M, Takada Y, Tanaka K

    LIVER TRANSPLANTATION   Vol. 10 ( 6 ) page: C63 - C63   2004.6

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  79. End-to-side portocaval shunting for a small-for-size graft in living donor liver transplantation. International journal

    Yasutsugu Takada, Mikiko Ueda, Yukika Ishikawa, Yasuhiro Fujimoto, Hideaki Miyauchi, Yasuhiro Ogura, Takenori Ochiai, Koichi Tanaka

    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society   Vol. 10 ( 6 ) page: 807 - 810   2004.6

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    In the development of adult-to-adult living donor liver transplantation (LDLT), the small-for-size graft has been associated with poor clinical outcome. Persistent portal hypertension or portal venous overperfusion are considered to be causative factors, and partial diversion of portal flow to systemic circulation may be effective for avoiding injuries that occur in the small-for-size (SFS) graft. Recently, we constructed an end-to-side portocaval shunting using 1 of the portal branches and anastomosed the other branch with the portal vein of the graft in 2 cases of LDLT recipients transplanted with a SFS graft. With the suppression of portal hypertension, as well as sufficient portal flow to the graft, the recipients recovered successfully with favorable graft function. This new and simple technique may be able to be used as a feasible and effective method to attenuate the SFS syndrome.

    DOI: 10.1002/lt.20164

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  80. Examination of the prognosis predictor in adult living donor liver transplantation.

    Kozaki K, Kasahara M, Ogura Y, Uryuhara K, Fujimoto Y, Ogawa K, Ueda M, Egawa H, Takada Y, Tanaka K

    LIVER TRANSPLANTATION   Vol. 10 ( 6 ) page: C60 - C60   2004.6

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  81. Adult living donor liver transplantation for hepatitis C cirrhosis: Single center experience.

    Fujimoto Y, Ogawa K, Ogura Y, Kasahara M, Kozaki K, Uryuuhara K, Nabeshima M, Ueda M, Haga H, Egawa H, Takada Y, Tanaka K

    LIVER TRANSPLANTATION   Vol. 10 ( 6 ) page: C7 - C7   2004.6

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  82. Impact of Enteral Nutrition in Adult-to-Adult Living Donor Liver Transplantation : A Preliminary Study

    KASAHARA Mureo, OGURA Yasuhiro, KOZAKI Koichi, FUJIMOTO Yasuhiro, URYUHARA Kenji, YOSHIZAWA Atsushi, OGAWA Kohei, TAKADA Yasutsugu, TANAKA Koichi

      Vol. 38 ( 1 ) page: 1 - 7   2004.2

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  83. Impact of hepatic vein reconstruction in living-donor liver transplantation using right lobe graft with middle hepatic vein.

    Kasahara M, Takada Y, Fujimoto Y, Ueda M, Tanaka K

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 4   page: 173 - 173   2004

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  84. Guideline proposal for graft type selection with right lobe graft by the novel approach to volumetry in adult living-donor liver transplantation.

    Fujimoto Y, Bourquain H, Kasahara M, Ito T, Ogura Y, Ogawa K, Egawa H, Takada Y, Peitgen HO, Tanaka K

    AMERICAN JOURNAL OF TRANSPLANTATION   Vol. 4   page: 169 - 169   2004

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  85. Effectiveness of Enteral Nutrition after Adult-to-adult Living Donor Liver Transplantation

    KASAHARA Mureo, URYUHARA Kenji, FUJIMOTO Yasuhiro, OGAWA Kohei, OGURA Yasuhiro, KIUCHI Tetuya, TANAKA Koichi

      Vol. 37 ( 3 ) page: 57 - 58   2003.6

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  86. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. International journal

    Takashi Ito, Tetsuya Kiuchi, Hidekazu Yamamoto, Fumitaka Oike, Yasuhiro Ogura, Yasuhiro Fujimoto, Kazuhiro Hirohashi, And Koichi Tanaka

    Transplantation   Vol. 75 ( 8 ) page: 1313 - 1317   2003.4

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    BACKGROUND: Although living-donor liver transplantation (LDLT) has been accepted for adult populations, the occurrence and pathogenesis of small-for-size syndrome remain highly controversial. METHODS: Portal venous pressure (PVP) was measured in 79 cases of LDLT from anhepatic phase to day 14. PVP was monitored through a catheter inserted via the inferior mesenteric vein. In a separate series of seven cases of adult LDLT, the splenic artery was ligated following arterial reperfusion. RESULTS: For days 2 to 4 and 9 to 11, recipients of small-for-size graft (<0.8% of body weight) displayed significantly higher PVP than recipients of larger grafts. The 13 patients with elevated mean PVP (>or=20 mm Hg) early in the first week (days 0-4) demonstrated significantly worse survival (84.5% vs. 38.5% at 6 months; P < 0.01), but this was not applicable to elevated mean PVP late in the first week (days 5-7). Elevated PVP early in the first week was also associated with higher incidence of bacteremia, cholestasis, prolonged prothrombin time, and ascites. Splenic artery ligation (SAL) immediately reduced PVP from 10 to 20 mm Hg (median, 16 mm Hg) to 9 to 13 mm Hg (median, 11 mm Hg; P = 0.02). Posttransplant PVP was significantly lower in SAL patients than in non-SAL patients from days 2 to 7 despite small graft size. Early PVP in SAL patients was consistently below 20 mm Hg, and survival was significantly better than in non-SAL patients with high early PVP (P < 0.01). CONCLUSION: Elevated PVP in the early phase is strongly associated with poor patient survival attributable, at least in part, to small-for-size graft. Further elucidation of the pathogenesis behind this phenomenon and efforts to modify PVP will be key to improving results.

    DOI: 10.1097/01.TP.0000063707.90525.10

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  87. Apheresis therapy for living-donor liver transplantation: experience for apheresis use for living-donor liver transplantation at Kyoto University. International journal

    Koichi Kozaki, Mureo Kasahara, Fumitaka Oike, Kohei Ogawa, Yasuhiro Fujimoto, Yasuhiro Ogura, Mikiko Ueda, Satoshi Kaihara, Atushi Fukatsu, Koichi Tanaka

    Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis   Vol. 6 ( 6 ) page: 478 - 483   2002.12

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    Liver transplantation is a fundamental treatment for patients with end-stage hepatic failure. In order to perform living-donor liver transplantations under safer conditions, apheresis plays a major role in Japan due to the prevalence of living-donor liver transplantation wherein later retransplantation is difficult. In our department, the roles of apheresis in liver transplantation are as follows: as bridge therapy to liver transplantation (n = 45); as a supplement to the graft liver until the recovery of hepatic function (n = 77); as treatment for multiple organ failure including posttransplantation renal failure (n = 15); and as a means with which to reduce antibody titers for antibodies such as anti-A or anti-B in persons with ABO blood type = incompatible liver transplantation (n = 23). In our department, we have performed 822 liver transplantations at present. Of those cases, 183 were selected wherein apheresis was performed around the time of the operation. In all cases, transplantation with sufficient apheresis was performed before the surgical operation, however, 22 patients (48.9%) died after undergoing surgery. Among the patients who underwent the postoperative apheresis, those in the nonsurvivor group had lower grafted liver weights compared to those of the survivor group. The kidney was the organ that most frequently failed due to postoperative complications. In cases of ABO blood type-incompatible liver transplantations, patients with high preoperative anti-A/B IgM antibody titers sustained bile duct complications, patients with high preoperative anti-IgG antibody titers sustained hepatic necrosis, and patients with high postoperative anti-A/B IgM and anti-IgG antibody titers sustained hepatic necrosis most frequently.

    DOI: 10.1046/j.1526-0968.2002.00460.x

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  88. Urgent living Related Liver Transplantation for Budd-Chiari Syndrome: A Case Report

    OGAWA Eri, KASAHARA Mureo, KIUCHI Tetsuya, OIKE Fumitaka, YAMAMOTO Hidekazu, OGURA Yasuhiro, FUJIMOTO Yasuhiro, KAIHARA Satoshi, EGAWA Hiroto, TANAKA Koichi

      Vol. 37 ( 4 ) page: 177 - 181   2002.8

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  89. Complete withdrawal of immunosuppression in living donor liver transplantation

    F Oike, A Yokoi, E Nishimura, Y Ogura, Y Fujimoto, M Kasahara, S Kaihara, T Kiuchi, H Egawa, S Uemoto, K Tanaka

    TRANSPLANTATION PROCEEDINGS   Vol. 34 ( 5 ) page: 1521 - 1521   2002.8

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    DOI: 10.1016/S0041-1345(02)02980-9

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  90. Defining the role of a tailored luminal solution for small bowel preservation. International journal

    Yasuhiro Fujimoto, David W Olson, Karen L Madsen, Janice Zeng, Laurence D Jewell, Norman M Kneteman, David L Bigam, Thomas A Churchill

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons   Vol. 2 ( 3 ) page: 229 - 36   2002.3

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    The mucosal layer is the initial site of small bowel (SB) graft injury sustained during cold storage. Vascular administration of preservation solutions alone is unable to prevent ischemic injury of this layer during clinically relevant storage periods. The SB is unique in that it possesses both a vascular and a luminal route by which preservation solutions can be administered. We hypothesized that addition of a luminal-delivered solution, formulated on amino acid requirements for energy- and non-energy-related reactions, would provide site-specific preservation of mucosal energetics, barrier function and morphology throughout an extended period of cold storage. Of the three luminal solutions containing amino acids which were tested (UWG, AA1, AA2), only the two groups (AA1, AA2), containing glutamine plus 18 other amino acids, +/- osmotic agent (lactobionate) and buffer (BES), exhibited significant improvements in energetics, barrier function, and histology compared to the clinical standard of isolated vascular University of Wisconsin (UW) solution. Although the AA1 and AA2 groups preserved barrier function and morphology up to 24h better than all other solutions tested, AA2 proved to be the only luminal solution with values of permeability, conductance, and short-circuit current not significantly different from freshly isolated tissues. Furthermore, the greatest reduction in histologic injury was effected by AA2 treatment (median grade 2 compared to control, UW(v), grade 8). This study documents that a luminal-delivered solution, formulated on physiologic SB requirements, provides targeted preservation of the SB mucosa.

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  91. 649 生体部分肝移植における術前CT volumetryの意義

    瓜生原 健嗣, 笠原 群生, 藤本 康弘, 木内 哲也, 阿曽沼 克弘, 猪股 裕紀洋, 田中 紘一

    日本消化器外科学会雑誌   Vol. 32 ( 2 ) page: 536   1999.2

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  92. F38 いずれも幼児期に急激に進行した先天性肝繊維症(CHF)の同胞内発生例(肝・胆・脾)

    上田 幹子, 藤本 康弘, 平田 彰業, 倉科 彰夫, 菊池 清, 田中 紘一

    日本小児外科学会雑誌   Vol. 35 ( 3 ) page: 574   1999

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    DOI: 10.11164/jjsps.35.3_574_1

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  93. 19. 最近 5 年間の腹部腫瘍手術症例(第 39 回 中国四国小児がん研究会)

    上田 幹子, 倉科 彰夫, 藤本 康弘

    日本小児外科学会雑誌   Vol. 34 ( 5 ) page: 949   1998

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    DOI: 10.11164/jjsps.34.5_949_1

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  94. C-58 生体小腸移植における拒絶反応の診断と治療(小腸移植(2))

    上本 伸二, 猪股 裕紀洋, 阿曽沼 克弘, 江川 裕人, 木内 哲也, 藤本 康弘, 田中 紘一

    日本小児外科学会雑誌   Vol. 33 ( 3 ) page: 575   1997

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    DOI: 10.11164/jjsps.33.3_575_2

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  95. 3E15 Malignant Rhabdoid Tumor(MRT) of Liverの1例

    藤本 康弘, 倉科 彰夫, 長山 聡, 高村 通生, 漆畑 貴行, 橋本 幸直, 曳野 肇, 木元 道雄, 中山 博識, 森本 泰介, 中川 正久, 田中 紘一

    日本小児外科学会雑誌   Vol. 31 ( 3 ) page: 527   1995

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    DOI: 10.11164/jjsps.31.3_527_1

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Books 3

  1. Evolution of living-donor liver transplantation

    田中, 紘一(医学), 猪股, 裕紀洋, 上本, 伸二, 木内, 哲也( Role: Joint author ,  Anatomical evaluation)

    Prous Science  2008  ( ISBN:9788481242591

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    Total pages:XVI, 336 p.   Language:English

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  2. C型肝硬変に対する肝移植における、肝炎再発機序とその制御に関する臨床的研究

    藤本 康弘

    [出版者不明]  2006 

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  3. Clinical Transplants

    Kiuchi T, Uemoto S, Egawa H, Kaihara S, Oike F, Yokoi A, Ogura Y, Kasahara M, Fujimoto Y, Kozaki K, Tanaka K( Role: Joint author ,  Living donor liver transplantation in Kyoto, 2001)

    UCLA Immunogenetics Center  2001 

MISC 12

  1. Surveillance, prevention, and treatment of recurrence in hepatocellular carcinoma.

    中村育夫, 波多野悦朗, 多田正晴, 飯田健二郎, 末岡英明, 岡本共弘, 鳥口寛, 奥野将之, 岩間英明, 河端悠介, 藤本康弘

    月刊消化器・肝臓内科   Vol. 11 ( 1 )   2022

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  2. 二次医療圏を単位とした自治体,拠点病院,肝炎医療コーディネーターの配置と活動~肝疾患診療ネットワーク構築「Hモデル」の構築の基盤として~

    山本晴菜, 江口有一郎, 江口有一郎, 矢田ともみ, 大谷綾, 中筋幸司, 上野聖子, 平井香恵, 志原拓磨, 高嶋智之, 藤本康弘, 鄭浩柄, 金秀基, 多田俊史, 室井延之, 山本宗男, 米澤敦子, 飯島尋子

    肝臓   Vol. 63 ( Supplement 1 )   2022

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  3. C型肝硬変に対する肝移植における血清線維化マーカーFIB4-indexの有用性

    北嶋 俊寛, 海道 利実, 濱口 雄平, 八木 真太郎, 藤本 康弘, 小川 晃平, 森 章, 岡島 英明, 上本 伸二

    移植   Vol. 50 ( 4-5 ) page: 526 - 526   2015.10

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    Language:Japanese   Publisher:(一社)日本移植学会  

  4. C型肝硬変に対する肝移植におけるFIB4-indexの意義

    北嶋 俊寛, 海道 利実, 濱口 雄平, 八木 真太郎, 藤本 康弘, 小川 晃平, 森 章, 岡島 英明, 上本 伸二

    日本消化器外科学会総会   Vol. 70回   page: P - 52   2015.7

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  5. C型肝硬変に対する肝移植におけるFIB4-indexの意義

    北嶋 俊寛, 海道 利実, 濱口 雄平, 八木 真太郎, 藤本 康弘, 小川 晃平, 森 章, 岡島 英明, 上本 伸二

    日本消化器外科学会総会   Vol. 70回   page: P - 52   2015.7

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  6. C型肝硬変に対する肝移植における血清線維化マーカーFIB4-indexの有用性

    北嶋 俊寛, 海道 利実, 濱口 雄平, 八木 真太郎, 田浦 康二朗, 藤本 康弘, 小川 晃平, 森 章, 岡島 英明, 上本 伸二

    日本肝胆膵外科学会・学術集会プログラム・抄録集   Vol. 27回   page: 503 - 503   2015.6

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  7. Current status and controversy in liver transplantation 生体部分肝移植ドナー手術の安全性、質的向上への取り組み(Current status and controversy in liver transplantation Our strategy to improve safety of donor operation and quality of postoperative status of donor in living donor live

    藤本 康弘, 小川 晃平, 吉澤 淳, 田浦 康二朗, 飯田 拓, 堀 智英, 八木 真太郎, 秦 浩一郎, 森 章, 波多野 悦朗, 岡島 英明, 海道 利実, 上本 伸二

    日本肝胆膵外科学会・学術集会プログラム・抄録集   Vol. 27回   page: 389 - 389   2015.6

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  8. ABO抗体価が高値である血液型不適合生体肝移植の成績

    小川 晃平, 海道 利実, 岡島 英明, 藤本 康弘, 植村 忠廣, 秦 浩一郎, 吉澤 淳, 冨山 浩司, 上本 伸二

    日本移植学会総会プログラム抄録集   Vol. 50回   page: 332 - 332   2014.8

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  9. Budd-Chiari症候群に対する生体肝移植の長期治療成績と手術方法(Long-term outcomes and surgical techniques of living donor liver transplantation for budd-chiari syndrome)

    門野 賢太郎, 藤本 康弘, 小川 晃平, 冨山 浩司, 吉澤 淳, 秦 浩一郎, 植村 忠弘, 岡本 晋弥, 波多野 悦朗, 森 章, 岡島 英明, 小倉 靖弘, 海道 利実, 上本 伸二

    日本外科学会雑誌   Vol. 115 ( 臨増2 ) page: 77 - 77   2014.3

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  10. ABO不適合に対する肝移植の現状 短期成績/長期成績 京都大学におけるABO血液型不適合肝移植

    小川 晃平, 海道 利実, 岡島 英明, 藤本 康弘, 植村 忠廣, 秦 浩一郎, 吉澤 淳, 冨山 浩司, 上本 伸二

    移植   Vol. 48 ( 総会臨時 ) page: 235 - 235   2013.8

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  11. ERASを応用した生体肝移植手術

    海道 利実, 小川 晃平, 藤本 康弘, 伊藤 孝司, 冨山 浩司, 森 章, 波多野 悦朗, 上本 伸二

    日本消化器外科学会総会   Vol. 68回   page: O - 34   2013.7

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  12. 3cm3個以下肝細胞癌に対する治療法の選択

    森 章, 海道 利実, 波多野 悦朗, 小川 晃平, 藤本 康弘, 田浦 康二朗, 瀬尾 智, 石井 隆道, 伊藤 孝司, 上本 伸二

    日本消化器外科学会総会   Vol. 68回 ( Supplement1 ) page: RS - 30   2013.7

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Research Project for Joint Research, Competitive Funding, etc. 1

  1. Clinical research on the mechanism of hepatitis C recurrence and its management following liver transplantation for hepatitis C liver cirrhosis

    Grant number:14370356  2002 - 2005

    Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)  Grant-in-Aid for Scientific Research (B)

    FUJIMOTO Yasuhiro, TANAKA Koichi, KIUCHI Tetsuya, UEMOTO Shinji, EGAWA Hiroto, KAIHARA Satoshi

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    Authorship:Principal investigator 

    Grant amount:\14000000 ( Direct Cost: \14000000 )

    Virological recurrence after living-donor liver transplantation for Hep C liver cirrhosis is inevitable. Together with the fact that histological recurrence is evident with over 80% cases at 3 years after transplantation, it is obvious that effective treatment and/or effective prophylaxis are necessary.
    The analysis of recipients with Hep C recurrence (F1 and over) at Kyoto University Hospital revealed risk factors as follows : female recipient, male donor, preoperative interferon therapy, non-small graft. However, even with the recipients without risk factors, the recurrence rate reaches around 80%, therefore, they cannot be classified as group without necessity of treatment.
    Further investigation at Nagoya University Hospital showed : The extent of post-transplant viral growth is not predictable by the pre-transplant viral load or immediate post-transplant viral load. Viral load (pre-transplant, immediate post-transplant, 1 month after transplant) does not forecast histological recurrence.
    It is believed that "lower the viral load, greater the effect of anti-virals," however, the usage of interferon immediate after transplantation is fraught with risk of activation of immune system leading to rejection. Our data suggests that some cases encounter histological rejection in the absence of elevated liver function tests, therefore liver biopsy in order to exclude rejection in indispensable when we consider antiviral therapy immediately after transplantation.
    This research contributes to the management and treatment of Hep C recurrence after liver transplantation. Hereafter, continuing research is necessary regarding steroid-free immunosuppression or virus clearing therapy for viral overshoot after transplantation expecting the mitigation of magnitude of virological recurrence.

KAKENHI (Grants-in-Aid for Scientific Research) 4

  1. Development of a Next Generation Surgical Navigation System Using Vascular Visualization Technology

    Grant number:21K08788  2021.4 - 2024.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

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    Authorship:Coinvestigator(s) 

  2. 生体肝移植ドナーの安全性向上、肝再生

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    Grant type:Competitive

  3. C型肝炎 生体ドナーQOL 肝移植ドナー画像診断

    その他の研究制度 

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    Grant type:Competitive

  4. -

    The Other Research Programs 

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    Grant type:Competitive

 

Media Coverage 1

  1. 東海北陸地方で初 名大病院 肝臓と腎臓同時移植の患者退院へ TV or radio program

    NHK名古屋放送局  2022.9

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    名古屋大学病院で8月、脳死と判定された女性から提供された肝臓と腎臓を同時に移植する手術が、東海北陸地方では初めて行われました。
    手術を受けた50代の男性の術後の経過は順調で、今週末にも退院することになりました。

    名古屋大学病院では、8月16日、脳死と判定された女性から提供された肝臓と腎臓を、愛知県内に住む50代の男性に同時に移植する手術が行われました。
    手術は成功し、術後の経過も順調なことから、男性は今週末にも退院することになり、今月15日、NHKの取材に応じました。
    この中で、男性は、「本当にうれしい。まさかこんなに早く退院できるとは思わなかった」と語りました。
    また、肝臓と腎臓を同時に移植する手術を受けられたことについては「一緒にできると言われ、同時の方が負担が軽くなると思い、頼みました。心配をかけた家族と食事をしたり、長めの旅行をしたりしたい」と話していました。
    肝臓と腎臓を同時に移植する手術は、東海北陸地方では初めてで、全国では40例目だということです。
    執刀した移植外科の小倉靖弘病院教授は、「移植医療は病院の総合力が問われる治療なので、チームとしてうまく当たれた。今回の症例を見直して、改善点があれば今後につなげ、必要な移植医療が提供できるよう取り組んでいきたい」と話しています。