2023/04/24 更新

写真a

フジモト ヤスヒロ
藤本 康弘
FUJIMOTO, Yasuhiro
所属
医学部附属病院 移植外科 病院准教授
職名
病院准教授

学位 1

  1. 博士(医学) ( 2002年7月   京都大学 ) 

研究キーワード 9

  1. 肝移植

  2. 肝再生

  3. 小腸移植

  4. liver transplantation

  5. liver regeneration

  6. C型肝炎

  7. ポリアミン

  8. 臓器保存

  9. 間葉系幹細胞

研究分野 2

  1. ライフサイエンス / 消化器外科学

  2. ライフサイエンス / 外科学一般、小児外科学

経歴 10

  1. 名古屋大学医学部附属病院 移植外科 助教

    2007年4月

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    国名:日本国

  2. 名古屋大学医学部附属病院 移植外科 助手

    2004年10月 - 2007年3月

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    国名:日本国

  3. 京都大学医学部移植免疫医学講座 助手

    2001年7月 - 2004年9月

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    国名:日本国

  4. アルバータ大学外科 クリニカルフェロー

    2000年7月 - 2001年6月

  5. アルバータ大学外科 リサーチフェロー

    1999年8月 - 2000年6月

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    国名:日本国

  6. 島根県立中央病院小児外科 医員

    1995年6月 - 1996年3月

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    国名:日本国

  7. 島根県立中央病院外科 研修医

    1993年4月 - 1995年5月

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    国名:日本国

  8. 京都大学医学部附属病院第2外科 研修医

    1993年1月 - 1993年3月

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    国名:日本国

  9. 丹後中央病院外科 研修医

    1992年10月 - 1992年12月

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    国名:日本国

  10. 京都大学医学部附属病院第1外科 研修医

    1992年6月 - 1992年9月

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    国名:日本国

▼全件表示

学歴 5

  1. 京都大学   医学研究科   移植外科

    1996年4月 - 2000年3月

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    国名: 日本国

  2. 京都大学   医学系研究科   外科系

    - 2000年

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    国名: 日本国

  3. 京都大学   医学部

    1986年4月 - 1992年4月

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    国名: 日本国

  4. 京都大学   医学部   医学科

    - 1992年

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    国名: 日本国

  5. 私立灘高等学校

    1980年4月 - 1986年3月

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    国名: 日本国

所属学協会 5

  1. 日本外科学会

  2. 日本肝臓学会

  3. 日本肝胆膵外科学会

  4. 日本移植学会

  5. 日本消化器外科学会

 

論文 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   77 巻 ( 1 ) 頁: 53 - 60   2023年1月

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    出版者・発行元:金原出版  

    DOI: 10.18888/op.0000003117

    CiNii Research

  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   6 巻 ( 1 ) 頁: 1 - 7   2023年

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    記述言語:英語   出版者・発行元: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

    CiNii Research

  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   172 巻 ( 2 ) 頁: 691 - 699   2022年8月

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    記述言語:英語  

    DOI: 10.1016/j.surg.2022.02.010

    PubMed

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

    Toriguchi K, Miyashita S, Kawabata Y, Kurimoto A, Okuno M, Iwama H, Iida K, Okamoto T, Sueoka H, Tada M, Nakamura I, Fujimoto Y, Nishimura T, Iijima H, Hatano E

    Surgery today   52 巻 ( 5 ) 頁: 822 - 831   2022年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1007/s00595-021-02392-5

    PubMed

  5. Mesenchymal Stem Cells Secretions Enhanced ATP Generation on Isolated Islets during Transplantation. 査読有り 国際誌

    Teratani T, Kasahara N, Fujimoto Y, Sakuma Y, Miki A, Goto M, Sata N, Kitayama J

    Islets   14 巻 ( 1 ) 頁: 69 - 81   2022年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1080/19382014.2021.2022423

    PubMed

  6. Activation of whole body by high levels of polyamine intake in rats 査読有り 国際誌

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

    Amino Acids   53 巻 ( 11 ) 頁: 1695 - 1703   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元: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

    PubMed

    その他リンク: 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

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

    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES   26 巻 ( 2 ) 頁: 73 - 81   2019年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Hepato-Biliary-Pancreatic Sciences  

    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 国際誌

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

    EUROPEAN SURGICAL RESEARCH   60 巻 ( 1-2 ) 頁: 63 - 73   2019年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Surgical Research  

    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 国際誌

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

    HEPATOLOGY RESEARCH   47 巻 ( 5 ) 頁: 425 - 434   2017年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Hepatology Research  

    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 国際誌

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

    ANNALS OF SURGICAL ONCOLOGY   24 巻 ( 4 ) 頁: 1037 - 1045   2017年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Surgical Oncology  

    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? 国際誌

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

    SURGERY   159 巻 ( 6 ) 頁: 1623 - 1630   2016年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery (United States)  

    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 国際誌

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

    CLINICS AND RESEARCH IN HEPATOLOGY AND GASTROENTEROLOGY   40 巻 ( 2 ) 頁: 179 - 185   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Clinics and Research in Hepatology and Gastroenterology  

    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 defence and its inhibition by additive steroid administration in high-risk liver transplant recipients 査読有り

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

    CLINICAL AND EXPERIMENTAL IMMUNOLOGY   184 巻 ( 1 ) 頁: 126 - 136   2016年4月

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    記述言語:英語   出版者・発行元:Clinical and Experimental Immunology  

    Our previous work revealed that the recipients with the highest pre-existing numbers of CD8+ effector T cells (TE) [hyperparathyroidism (HPT)E recipients] occupied approximately 30% of adult transplant recipients performed in our hospital. HPTE recipients demonstrated very poor clinical outcome compared with the remaining 70% of recipients with the lowest pre-existing TE (LPTE recipient). This study aimed to clarify the best combined immunosuppressive regimen related to function of cytotoxic T lymphocytes (CTLs) for HPTE recipients. Eighty-one HPTE recipients were classified into three types, according to the immunosuppressive regimens: type 1, tacrolimus (Tac)/glucocorticoid (GC); type 2, Tac/mycophenolate mofetil (MMF)/GC; and type 3, Tac/MMF. Frequencies of severe infection, rejection and hospital death were the highest in types 1 and 2, whereas the lowest occurred in type 3. The survival rate in type 3 was the highest (100%) during follow-up until post-operative day 2000. Regarding the immunological mechanism, in type 1 TE perforin and interferon (IFN)-γ were generated through the self-renewal of CD8+ central memory T cells (TCM), but decreased in the early post-transplant period due to marked down-regulation of interleukin (IL)-12 receptor beta-1 of TCM. In type 2, the self-renewal TCM did not develop, and the effector function could not be increased. In type 3, in contrast, the effectors and cytotoxicity were correlated inversely with IL-12Rβ1+ TCM levels, and increased at the highest level around the pre-transplant levels of IL-12Rβ1+ TCM. However, the immunological advantage of Tac/MMF therapy was inhibited strongly by additive steroid administration.

    DOI: 10.1111/cei.12740

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

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

    SURGERY   159 巻 ( 3 ) 頁: 821 - 833   2016年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery (United States)  

    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 国際誌

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

    JOURNAL OF INFECTION AND CHEMOTHERAPY   22 巻 ( 1-2 ) 頁: 84 - 89   2016年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Infection and Chemotherapy  

    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.

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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

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

    TRANSPLANT INTERNATIONAL   28 巻   頁: 108 - 108   2015年11月

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    記述言語:英語  

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  17. Incidence and risk factors for herpes zoster in patients undergoing liver transplantation 査読有り

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

    TRANSPLANT INFECTIOUS DISEASE   17 巻 ( 5 ) 頁: 671 - 678   2015年10月

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    記述言語:英語   出版者・発行元:Transplant Infectious Disease  

    Background: Herpes zoster (HZ) is the most common manifestation of latent varicella zoster virus reactivation, which occurs naturally as a result of aging or in immunocompromised patients. Solid organ transplant recipients are at increased risk for HZ owing to their chronic immunosuppression. Although several reports investigated risk factors for the development of HZ in heart or renal transplantation, data in liver transplantation (LT) are limited. Methods: We evaluated clinical data retrospectively in 377 adult patients undergoing LT between January 2005 and December 2012 in our institution. We analyzed the incidence rate of HZ and the standardized incidence ratio (SIR) by comparing with the general Japanese population. We additionally investigated risk factors for HZ after LT. Results: HZ developed in 27 (7.16%) of the 377 patients after LT. The incidence rate of HZ after LT was 17.83 per 1000 person-years, which was significantly higher than in the general Japanese population (SIR = 4.61; 95% confidence interval [CI], 4.13-5.14). Multivariate analysis showed that older age (hazard ratio [HR] = 3.95; P < 0.001) and exposure to mycophenolate mofetil (HR = 3.03; P = 0.007) were independent risk factors for HZ after LT. Conclusions: This is the first and largest study, to our knowledge, to investigate the incidence rate of HZ and risk factors for development of HZ after LT in the Japanese population. Further investigations to focus on immunosuppressive regimens to reduce the risk for HZ incidence in this high-risk population could establish a new protocol of immunosuppression after LT.

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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

    Kitajima T., Hatano E., Mitsunori Y., Taura K., Fujimoto Y., Mizumoto M., Okajima H., Kaido T., Minamiguchi S., Uemoto S.

    Clinical Journal of Gastroenterology   8 巻 ( 5 ) 頁: 300 - 5   2015年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Clinical Journal of Gastroenterology  

    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.

    DOI: 10.1007/s12328-015-0594-7

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  19. Changes in Surgical Site Infections after Living Donor Liver Transplantation 国際誌

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

    PLOS ONE   10 巻 ( 8 ) 頁: e0136559   2015年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:PLoS ONE  

    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 p-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. Copyright:

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  20. Early coupled up-regulation of interleukin-12 receptor beta-1 in CD8(+) central memory and effector T cells for better clinical outcomes in liver transplant recipients 査読有り

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

    CLINICAL AND EXPERIMENTAL IMMUNOLOGY   181 巻 ( 2 ) 頁: 373 - 384   2015年8月

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    記述言語:英語   出版者・発行元:Clinical and Experimental Immunology  

    This study aimed to investigate the role of initial priming of interleukin (IL)-12 receptor beta-1 in CD8+central memory T cells (initial IL-12RTCM priming) and CCR7-negative subsets (CNS) in effector cell expansion and clinical outcome after living donor liver transplantation (LDLT). One hundred and six patients who underwent LDLT were classified into the following three groups according to hierarchical clustering of CD8+CD45 isoforms before LDLT: I, naive-dominant; II, effector memory-dominant; and III, effector-dominant. The pre-existing CD8+effector cells (TE) and activated immune status increased progressively from group I to group II to group III. Groups I, II and III received tacrolimus (Tac)/glucocorticoid (GC) regimens. Eighteen group III recipients received Tac/mycophenolate mofetil (MMF) and were defined as group IV. Initial IL-12RTCM priming was slightly, moderately and markedly decreased in droups I, II, and III, respectively. Initial priming of IL-12Rβ1 in CNS was decreased markedly in the three groups with marked decreases of TE, perforin and interferon (IFN)-γ; all parameters were restored by up-regulation of IL-12Rβ1+TCM through the self-renewal of TCM. The lag time required until coupled up-regulation of IL-12Rβ1 of TCM and CNS to above baseline was 12, 20 and 32 days in groups I, II and III, respectively. Inferior clinical outcomes were associated with increasing lag time. In contrast, the initial priming of IL-12Rβ1 in TCM and CNS remained above baseline in group IV due to MMF-mediated increase of IL-12Rβ1. Early coupled up-regulation of TCM and CNS leads to efficient TE differentiation and optimal clinical outcomes.

    DOI: 10.1111/cei.12588

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

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

    TRANSPLANTATION   99 巻   頁: 92 - 92   2015年7月

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    記述言語:英語  

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

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

    TRANSPLANTATION   99 巻   頁: 246 - 246   2015年7月

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    記述言語:英語  

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

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

    SURGERY   157 巻 ( 6 ) 頁: 1088 - 1098   2015年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery (United States)  

    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

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

    AMERICAN JOURNAL OF TRANSPLANTATION   15 巻   2015年5月

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    記述言語:英語  

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  25. Impact of Elderly Donors for Liver Transplantation: A Single-Center Experience 国際誌

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

    LIVER TRANSPLANTATION   21 巻 ( 5 ) 頁: 591 - 598   2015年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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.

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  26. High prevalence of carbapenem resistance among plasmid-mediated AmpC beta-lactamase-producing Klebsiella pneumoniae during outbreaks in liver transplantation units 国際誌

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

    INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS   45 巻 ( 1 ) 頁: 33 - 40   2015年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:International Journal of Antimicrobial Agents  

    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.

    DOI: 10.1016/j.ijantimicag.2014.08.015

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

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

    SURGERY TODAY   44 巻 ( 12 ) 頁: 2293 - 2299   2014年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery Today  

    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.

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  28. Impact of Quality as Well as Quantity of Skeletal Muscle on Outcomes After Liver Transplantation 国際誌

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

    LIVER TRANSPLANTATION   20 巻 ( 11 ) 頁: 1413 - 1419   2014年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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 LDLTat 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 国際誌

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

    TRANSPLANT INTERNATIONAL   27 巻 ( 11 ) 頁: 1205 - 1213   2014年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Transplant International  

    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   33 巻 ( 3 ) 頁: 238 - 238   2014年10月

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    記述言語:日本語   出版者・発行元:日本アフェレシス学会  

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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 国際誌

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

    PHARMACOGENETICS AND GENOMICS   24 巻 ( 7 ) 頁: 356 - 366   2014年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pharmacogenetics and Genomics  

    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. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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  32. Graft Reconditioning With Nitric Oxide Gas in Rat Liver Transplantation From Cardiac Death Donors 国際誌

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

    TRANSPLANTATION   97 巻 ( 6 ) 頁: 618 - 625   2014年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Transplantation  

    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. © 2014 by Lippincott Williams & Wilkins.

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  33. Chronic Rejection Associated with Antiviral Therapy for Recurrent Hepatitis C after Living-Donor Liver Transplantation 国際誌

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

    TRANSPLANTATION   97 巻 ( 3 ) 頁: 344 - 350   2014年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Transplantation  

    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. © 2014 Lippincott Williams & Wilkins.

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  34. Evaluation of Liver Preservation Solutions by Using Rats Transgenic for Luciferase 査読有り

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

    TRANSPLANTATION PROCEEDINGS   46 巻 ( 1 ) 頁: 63 - 65   2014年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Transplantation Proceedings  

    Introduction The solution in which graft tissue is stored (that is, preservation solution) is an important component of liver transplantation technology. Its protective effect is induced by substances in the solution, including radical scavengers, buffers, and energy-giving substances. New preservation solutions have proven to be effective in preventing organ damage during cold ischemia and in extending the time limits for storage. Aim This study determined the relationship between luminescence intensity and content of adenosine triphosphate (ATP) in liver tissue and proposes a new ex vivo screening system that uses Lewis rats transgenic for luciferase for evaluating the effectiveness of preservation solutions. Methods Samples (diameter, 2 mm) of liver were obtained from transgenic rats. The viability of these tissues after storage for as long as 6 hours in University of Wisconsin (UW) solution, extracellular trehalose solution of Kyoto, Euro-Collins (EC) solution, histidine-tryptophan-ketoflutarate solution, low potassium dextran solution, or normal saline was assessed by determining ATP content and luminescence intensity. Results Luminescence had a linear relationship (R = 0.88) with ATP levels. Regardless of the preservation solution used, the luminescence intensities of the liver tissue chips decreased linearly with time especially through a short span of time (0 to 2 hours; R2 = 0.58-1.0). The luminescence of liver chip tissues maintained long term (2 to 6 hours) in UW solution tended to be higher than those of tissues stored in other solutions (P <.05; 6 hours). On the basis of luminescence intensity, EC might be preferable to the other solutions tested for ultra-short-term storage (0.5 to 2 hours). Conclusion Our model, which combines the use of the bioimaging system and Lewis rats transgenic for luciferase, effectively assessed the viability of liver tissue samples. We believe that this ex vivo screening system will be an effective tool for evaluating preservation solutions for liver grafts. © 2014 by Elsevier Inc. All rights reserved.

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  35. Association between CYP3A5 Genotypes in Graft Liver and Increase in Tacrolimus Biotransformation from Steroid Treatment in Living-donor Liver Transplant Patients 国際誌

    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   29 巻 ( 1 ) 頁: 83 - 89   2014年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:日本薬物動態学会  

    We retrospectively examined whether cytochrome P450 (CYP) 3A5 genotypes are associated with high-dose steroid pulse treatment-induced functional gain of tacrolimus biotransformation in livingdonor liver transplant patients. Concentrations of tacrolimus and its 3 primary metabolites, 13-O-demethyl tacrolimus (M-I), 31-O-demethyl tacrolimus (M-II), and 15-O-demethyl tacrolimus (M-III), were measured in trough blood samples from 18 liver transplant patients, by liquid chromatographytandem mass spectrometry/mass spectrometry (LC-MS/MS). In patients engrafted with a CYP3A5*1-carrying liver but not with a CYP3A5*3/*3-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 LCMS/MS in patients engrafted with a CYP3A5*1-carrying liver, but not those engrafted with a CYP3A5*3/*3-carrying liver. This suggests that the increased ratio of tacrolimus metabolites/tacrolimus can be explained by induction of CYP3A5 via 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 CYP3A5*1-carrying graft liver. Copyright © 2014 by the Japanese Society for the Study of Xenobiotics (JSSX).

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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   36 巻 ( 11 ) 頁: 1814 - 1821   2013年11月

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

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

    TRANSPLANT INTERNATIONAL   26 巻   頁: 113 - 113   2013年11月

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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

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

    HEPATOLOGY   58 巻   頁: 1014A - 1014A   2013年10月

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

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

    HEPATOLOGY INTERNATIONAL   7 巻 ( 3 ) 頁: 916 - 922   2013年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Hepatology International  

    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. © 2013 Asian Pacific Association for the Study of the Liver.

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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   19 巻   頁: S97 - S97   2013年6月

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  41. Impact of Sarcopenia on Survival in Patients Undergoing Living Donor Liver Transplantation 査読有り

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

    AMERICAN JOURNAL OF TRANSPLANTATION   13 巻 ( 6 ) 頁: 1549 - 1556   2013年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:American Journal of Transplantation  

    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 < 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 < 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. Sarcopenia is closely involved with posttransplant mortality in patients undergoing living donor liver transplantation and perioperative nutritional therapy significantly improves overall survival, even in patients with sarcopenia. © 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

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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   13 巻   頁: 218 - 218   2013年4月

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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 国際誌

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

    AMERICAN JOURNAL OF SURGICAL PATHOLOGY   37 巻 ( 2 ) 頁: 178 - 184   2013年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:American Journal of Surgical Pathology  

    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. © 2012 by Lippincott Williams & Wilkins.

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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   93 巻   頁: S50 - S51   2013年2月

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

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

    TRANSPLANT IMMUNOLOGY   28 巻 ( 1 ) 頁: 14 - 17   2013年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Transplant Immunology  

    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. © 2012 Elsevier B.V.

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  46. 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 M., Hosokawa M., Shinke H., Hashimoto E., Takahashi T., Kawai T., Matsubara K., Ogawa K., Fujimoto Y., Okamoto S., Kaido T., Uemoto S., Masuda S.

    Biological & Pharmaceutical Bulletin   36 巻 ( 11 ) 頁: 1814 - 1821   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:公益社団法人 日本薬学会  

    Association between cytochrome P450 (CYP) 3A4*1G genotype of donors (n=412) and/or recipients (n=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 CYP3A4*1/*1 was significantly higher during 7 d after surgery than in that with CYP3A4*1/*1G (214 vs. 157 [ng/mL]/[mg/kg/day], p<0.01). After postoperative day 8, no significant difference was observed among CYP3A4*1G genotypes in the graft liver. However, the C/D ratio in CYP3A4*1/*1 of the intestine was significantly higher than that in CYP3A4*1G/*1G for 5 weeks after surgery (postoperative days 1-14; p<0.001, postoperative days 15-35; p<0.01). During postoperative days 14 and 26, acute cellular rejection incidences tended to be lower in the patients with graft liver carrying the CYP3A4*1/*1 allele than in the patients carrying CYP3A4*1G allele (8.7% vs. 14.6%, p=0.0973). However, CYP3A4*1G in the intestine had almost no effect on the incidence of rejection (9.9% in CYP3A4*1/*1 vs. 12.5% in CYP3A4*1G allele, p=0.4824). CYP3A4*1G was significantly related to mRNA expression of CYP3A5 rather than of CYP3A4 in the graft liver and intestine and was strongly linked with the CYP3A5*1. Thus, we elucidated that CYP3A4*1G 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. © 2013 The Pharmaceutical Society of Japan.

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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   48 巻 ( 4 ) 頁: 810   2012年

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    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本小児外科学会  

    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 査読有り 国際誌

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

    PLOS ONE   6 巻 ( 4 ) 頁: e19195   2011年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:PLoS ONE  

    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. © 2011 Kanazawa et al.

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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   25 巻 ( 2 ) 頁: 277 - 282   2011年

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    記述言語:英語   出版者・発行元:Clinical Transplantation  

    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. 'Hepaticized' Small Intestinal Graft: Possible Option for the Treatment of Liver Cirrhosis without Liver Transplantation.

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

    AMERICAN JOURNAL OF TRANSPLANTATION   10 巻   頁: 228 - 228   2010年4月

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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   111 巻 ( 1 ) 頁: 32 - 5   2010年1月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

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  52. DEVELOPMENT OF A PORTOCAVAL SHUNT USING A SMALL INTESTINAL SEGMENT IN RATS 国際誌

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

    MICROSURGERY   30 巻 ( 4 ) 頁: 302 - 306   2010年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Microsurgery  

    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. © 2010 Wiley-Liss, Inc.

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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   109 巻 ( 2 ) 頁: 705   2008年4月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

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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   109 巻 ( 2 ) 頁: 679   2008年4月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

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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   109 巻 ( 2 ) 頁: 80   2008年4月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

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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 査読有り

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

    LIVER TRANSPLANTATION   13 巻 ( 9 ) 頁: 1295 - 1301   2007年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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   20 巻   頁: 256 - 256   2007年9月

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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   20 巻   頁: 257 - 257   2007年9月

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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   7 巻 ( 7 ) 頁: 1788 - 1796   2007年7月

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    記述言語:英語   出版者・発行元:American Journal of Transplantation  

    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.

    DOI: 10.1111/j.1600-6143.2007.01849.x

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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   13 巻 ( 6 ) 頁: S83 - S84   2007年6月

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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   108 巻 ( 2 ) 頁: 490   2007年3月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

    CiNii Research

  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   108 巻 ( 2 ) 頁: 405   2007年3月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

    CiNii Research

  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   108 巻 ( 2 ) 頁: 407   2007年3月

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    記述言語:日本語   出版者・発行元:一般社団法人日本外科学会  

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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   39 巻 ( 7 ) 頁: 1119   2006年7月

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    記述言語:日本語   出版者・発行元:一般社団法人日本消化器外科学会  

    CiNii Research

  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   39 巻 ( 7 ) 頁: 1116   2006年7月

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    記述言語:日本語   出版者・発行元:一般社団法人日本消化器外科学会  

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  66. Classification of human liver transplant recipients by their preoperative CD8(+) T cell subpopulation and its relation to outcome 国際誌

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

    LIVER TRANSPLANTATION   12 巻 ( 5 ) 頁: 792 - 800   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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)-γ, 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. © 2006 AASLD.

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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   12 巻 ( 5 ) 頁: C60 - C60   2006年5月

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  68. A model of donors' decision-making in adult-to-adult living donor liver transplantation in Japan: Having no choice 国際誌

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

    LIVER TRANSPLANTATION   12 巻 ( 5 ) 頁: 768 - 774   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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. © 2006 AASLD.

    DOI: 10.1002/lt.20689

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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   12 巻 ( 5 ) 頁: C118 - C118   2006年5月

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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   107 巻 ( 2 ) 頁: 98   2006年3月

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    記述言語:英語   出版者・発行元:Japan Surgical Society (JSS)  

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

    Haga H, Egawa H, Fujimoto Y, Ueda M, Miyagawa-Hayashino A, Sakurai T, Okuno T, Koyanagi I, Takada Y, Manabe T

    LIVER TRANSPLANTATION   12 巻 ( 3 ) 頁: 457 - 464   2006年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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 (×64 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. © 2006 AASLD.

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

    Kamei H, Oike F, Fujimoto Y, Yamamoto H, Tanaka K, Kiuchi T

    LIVER TRANSPLANTATION   12 巻 ( 1 ) 頁: 140 - 145   2006年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Liver Transplantation  

    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.

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

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

    AMERICAN JOURNAL OF TRANSPLANTATION   5 巻 ( 6 ) 頁: 1339 - 1346   2005年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:American Journal of Transplantation  

    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. Copyright © Blackwell Munksgaard 2005.

    DOI: 10.1111/j.1600-6143.2005.00817.x

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  74. Auxiliary partial orthotopic living donor liver transplantation: Kyoto University experience 国際誌

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

    AMERICAN JOURNAL OF TRANSPLANTATION   5 巻 ( 3 ) 頁: 558 - 565   2005年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:American Journal of Transplantation  

    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. Copyright © Blackwell Munksgaard 2005.

    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

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

    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY   31 巻 ( 11 ) 頁: A223 - A223   2004年11月

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

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

    JOURNAL OF PEDIATRIC SURGERY   39 巻 ( 7 ) 頁: 1138 - 1141   2004年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Pediatric Surgery  

    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. © 2004 Elsevier Inc. All rights reserved.

    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   10 巻 ( 6 ) 頁: C65 - C65   2004年6月

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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   10 巻 ( 6 ) 頁: C63 - C63   2004年6月

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

    Takada Y, Ueda M, Ishikawa Y, Fujimoto Y, Miyauchi H, Ogura Y, Ochiai T, Tanaka K

    LIVER TRANSPLANTATION   10 巻 ( 6 ) 頁: 807 - 810   2004年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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   10 巻 ( 6 ) 頁: C60 - C60   2004年6月

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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   10 巻 ( 6 ) 頁: C7 - C7   2004年6月

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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

      38 巻 ( 1 ) 頁: 1 - 7   2004年2月

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    記述言語:英語  

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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   4 巻   頁: 173 - 173   2004年

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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   4 巻   頁: 169 - 169   2004年

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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

      37 巻 ( 3 ) 頁: 57 - 58   2003年6月

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    記述言語:英語  

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  86. Changes in portal venous pressure in the early phase after living-donor liver transplantation: Pathogenesis and clinical implications 国際誌

    Ito T, Kiuchi T, Yamamoto H, Oike F, Ogura Y, Fujimoto Y, Hirohashi K, Tanaka K

    TRANSPLANTATION   75 巻 ( 8 ) 頁: 1313 - 1317   2003年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1097/01.TP.0000063707.90525.10

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  87. Apheresis therapy for living-donor liver transplantation - Experience of apheresis use for living-donor liver transplantation at Kyoto university 国際誌

    Kozaki K, Kasahara M, Oike F, Ogawa K, Fujimoto Y, Ogura Y, Ueda M, Kaihara S, Fukatsu A, Tanaka K

    THERAPEUTIC APHERESIS   6 巻 ( 6 ) 頁: 478 - 483   2002年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1046/j.1526-0968.2002.00460.x

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    PubMed

  88. Budd-Chiari症候群に対して緊急生体肝移植を施工した1例

    小川 絵里, 笠原 群生, 木内 哲也, 尾池 文隆, 山本 栄和, 小倉 靖弘, 藤本 康弘, 貝原 聡, 江川 裕人, 田中 紘一

    移植   37 巻 ( 4 ) 頁: 177 - 181   2002年8月

     詳細を見る

    記述言語:日本語  

    CiNii Research

  89. Complete withdrawal of immunosuppression in living donor liver transplantation

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

    TRANSPLANTATION PROCEEDINGS   34 巻 ( 5 ) 頁: 1521 - 1521   2002年8月

     詳細を見る

    記述言語:英語   出版者・発行元:Transplantation Proceedings  

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

    Web of Science

    Scopus

    PubMed

  90. Defining the role of a tailored luminal solution for small bowel preservation. 国際誌

    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   2 巻 ( 3 ) 頁: 229 - 36   2002年3月

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

    PubMed

  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   32 巻 ( 2 ) 頁: 536   1999年2月

     詳細を見る

    記述言語:日本語   出版者・発行元:一般社団法人日本消化器外科学会  

    CiNii Research

  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   35 巻 ( 3 ) 頁: 574   1999年

     詳細を見る

    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本小児外科学会  

    DOI: 10.11164/jjsps.35.3_574_1

    CiNii Research

  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   34 巻 ( 5 ) 頁: 949   1998年

     詳細を見る

    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本小児外科学会  

    DOI: 10.11164/jjsps.34.5_949_1

    CiNii Research

  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   33 巻 ( 3 ) 頁: 575   1997年

     詳細を見る

    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本小児外科学会  

    DOI: 10.11164/jjsps.33.3_575_2

    CiNii Research

  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   31 巻 ( 3 ) 頁: 527   1995年

     詳細を見る

    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本小児外科学会  

    DOI: 10.11164/jjsps.31.3_527_1

    CiNii Research

▼全件表示

書籍等出版物 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( 担当: 共著 ,  範囲: Anatomical evaluation)

    Prous Science  2008年  ( ISBN:9788481242591

     詳細を見る

    総ページ数:XVI, 336 p.   記述言語:英語

    CiNii Books

  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年 

     詳細を見る

  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( 担当: 共著 ,  範囲: Living donor liver transplantation in Kyoto, 2001)

    UCLA Immunogenetics Center  2001年 

MISC 12

  1. 改訂:肝癌診療ガイドライン 治療後のサーベイランス・再発予防・再発治療について

    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11 巻 ( 1 )   2022年

     詳細を見る

  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63 巻 ( Supplement 1 )   2022年

     詳細を見る

  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50 巻 ( 4-5 ) 頁: 526 - 526   2015年10月

     詳細を見る

    記述言語:日本語   出版者・発行元:(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70回 巻   頁: P - 52   2015年7月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本消化器外科学会  

  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70回 巻   頁: P - 52   2015年7月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本消化器外科学会  

  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27回 巻   頁: 503 - 503   2015年6月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本肝胆膵外科学会  

  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27回 巻   頁: 389 - 389   2015年6月

     詳細を見る

    記述言語:英語   出版者・発行元:(一社)日本肝胆膵外科学会  

  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50回 巻   頁: 332 - 332   2014年8月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

  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115 巻 ( 臨増2 ) 頁: 77 - 77   2014年3月

     詳細を見る

    記述言語:英語   出版者・発行元:(一社)日本外科学会  

  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48 巻 ( 総会臨時 ) 頁: 235 - 235   2013年8月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

  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68回 巻   頁: O - 34   2013年7月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本消化器外科学会  

  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68回 巻 ( Supplement1 ) 頁: RS - 30   2013年7月

     詳細を見る

    記述言語:日本語   出版者・発行元:(一社)日本消化器外科学会  

    J-GLOBAL

▼全件表示

共同研究・競争的資金等の研究課題 1

  1. 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

    研究課題番号:14370356  2002年 - 2005年

    科学研究費助成事業 基盤研究(B)  基盤研究(B)

    藤本 康弘, 田中 紘一, 木内 哲也, 上本 伸二, 江川 裕人, 貝原 聡, 鍋島 紀滋, 羽賀 博典

      詳細を見る

    担当区分:研究代表者 

    配分額:14000000円 ( 直接経費:14000000円 )

    C型肝硬変に対する生体部分肝移植術後のウィルス学的再発は必至であり、組織学的再発も術後3年の時点で8割以上の症例にみられることから、再発治療ないしは再発予防が必要であるのは明らかである。
    京大移植外科における肝炎再発(組織学的にF1以上)症例の検討から、再発危険因子として明らかになったものは、女性レシピエント、男性ドナー、術前インターフェロン治療歴、グラフト重量の大きい症例であったが、非high risk groupでも再発率は80%前後と高く、治療不要群と位置づけられる訳ではない。なお、レシピエント年齢、MELDスコア、Child-Pugh分類、術前肝癌の有無、術前HCV-RNA量、HCV genotype、ドナー年齢、ABO適合性、HLA適合性、グラフト肝脂肪沈着の程度、免疫抑制療法、ステロイドパルスの有無、胆管合併症の有無では再発頻度に差がみられなかった。
    さらに名大移植外科での検討で明らかになったことは、術前、術終了時のウィルス量では、その後のウィルス増加傾向を予測することはできないこと、およびウィルス量(術前、術直後、術後1ヶ月)では組織学的再発を予測することはできない、ということである。
    内科からの知見として、「ウィルス量が低い程、抗ウィルス剤の効果が見込める」、がしかし、移植後早期に免疫賦活剤であるインターフェロンを使用するのは問題をはらんでいる。我々のデータでは「術後早期に肝機能正常なままに組織学的拒絶が起きていることがある」ことがわかっており、早期の抗ウィルス治療を検討する場合、拒絶反応を除外するために肝生検を施行する必要がある。
    本研究は、C型肝炎移植後再発の管理治療に貢献するものと考える。今後は、本研究の成果をふまえて、1)ウィルス学的再発のmagnitudeが緩和されることを期待して、ステロイドフリーの免疫抑制療法、2)術後ウィルス量のovershoot対策としてのウィルス除去療法、以上につき研究を進めていく必要があると考える。

科研費 4

  1. 脈管可視化技術を用いた次世代手術ナビゲーションシステムの開発

    研究課題/研究課題番号:21K08788  2021年4月 - 2024年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    波多野 悦朗, 多田 正晴, 鳥口 寛, 藤本 康弘, 多田 正晴, 鳥口 寛, 藤本 康弘

      詳細を見る

    担当区分:研究分担者 

    インドシアニングリーン(Indo-Cyanine Green:ICG)試薬を用いた手術ナビゲーションシステムが普及しつつあり、我々はICG蛍光画像をプロジェクタで投影し手術をナビゲーションするシステムを開発した。しかし、ICG蛍光法は血流などを定量的に評価できないという課題もあり、さらなる技術開発が望まれている。
    本研究は、近赤外光領域を活用し2つの波長下画像による生体観察の基礎技術を基に、脂肪や臓器に隠れた脈管の可視化の実現を目指している。更に、2つの波長の画像演算で酸素飽和度を可視化し、血流の定量化および動脈と静脈を色分け表示する次世代の手術ナビゲーションシステムの開発を目指すものである。

  2. 生体肝移植ドナーの安全性向上、肝再生

      詳細を見る

    資金種別:競争的資金

  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 

      詳細を見る

    資金種別:競争的資金

  4. -

    The Other Research Programs 

      詳細を見る

    資金種別:競争的資金

 

メディア報道 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 テレビ・ラジオ番組

    NHK名古屋放送局  2022年9月

     詳細を見る

    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。