Faculty Profiles - CHEN-YOSHIKAWA Toyofumi

Papers - CHEN-YOSHIKAWA Toyofumi

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Physical activity level significantly affects the survival of patients with end-stage lung disease on a waiting list for lung transplantation Reviewed

Teruya Komatsu, Ayako Oshima, Toyofumi F. Chen-Yoshikawa, Shin-ichi Harashima, Akihiro Aoyama, Nobuya Inagaki, Hiroshi Date

SURGERY TODAY Vol. 47 ( 12 ) page： 1526 - 1532 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

Purpose Our objective was to investigate the factors predicting the survival of patients on the waiting list for lung transplantation (LT) during the waiting period, with a special emphasis on the physical activity level.
Methods The study included 70 patients with end-stage pulmonary disease who were on the waiting list for LT at Kyoto University Hospital. We examined the association between the baseline characteristics, including the body mass index and body composition, serum albumin, serum C-reactive protein (CRP), steroid administration, physical activity level (calculated by the food frequency questionnaire) and survival during the waiting period using Kaplan-Meier curves and Cox proportional hazard regression models.
Results A physical activity level of <= 1.2 was correlated with significantly decreased survival (1-year survival: 68 vs. 90.9%, p = 0.0089), with a hazard ratio (HR) of 2.24 (95% confidence interval (CI) 1.22-4.19, p = 0.0001). Hypo-albumin (HR 2.024, 95% CI 1.339-6.009, p = 0.004), a high level of CRP (HR 2.551, CI 1.229-4.892, p = 0.02), and the administration of steroids (HR 2.258, CI 1.907-5.032, p = 0.024) were also significant predictors of survival.
Conclusions Low levels of physical activity during the waiting period for LT led to decreased survival times among LT candidates.

DOI： 10.1007/s00595-017-1542-6

Clamping improves your judgment Reviewed

Toyofumi F. Chen-Yoshikawa

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Vol. 154 ( 5 ) page： E93 - E93 2017.11

Complications of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Reviewed

Hidenao Kayawake, Toyofumi F. Chen-Yoshikawa, Hiromi Oda, Hideki Motoyama, Masatsugu Hamaji, Toshi Menju, Akihiro Aoyama, Toshihiko Sato, Makoto Sonobe, Hiroshi Date

ANNALS OF THORACIC SURGERY Vol. 104 ( 5 ) page： E363 - E365 2017.11

Language：English Publisher：ELSEVIER SCIENCE INC

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered useful for the staging and diagnosis of lung cancer or thoracic lymph node enlargement; however, little is known about its complications. Between July 2009 and November 2016, 413 patients underwent EBUS-TBNA, and four complications (0.97%) occurred. Here we report four cases involving complications of EBUS-TBNA, including mediastinitis (n = 2), obstructive pneumonia (n = 1), and airway obstruction requiring admission to the intensive care unit (n = 1). All patients recovered with appropriate medical treatment. Despite their low incidence, the complications associated with EBUS-TBNA can be serious. (C) 2017 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2017.06.015

Cytomegalovirus infection in living-donor and cadaveric lung transplantations Reviewed

Keiji Ohata, Toyofumi F. Chen-Yoshikawa, Koji Takahashi, Akihiro Aoyama, Hideki Motoyama, Kyoko Hijiya, Masatsugu Hamaji, Toshi Menju, Toshihiko Sato, Makoto Sonobe, Shunji Takakura, Hiroshi Date

INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY Vol. 25 ( 5 ) page： 710 - 715 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS

OBJECTIVES: Cytomegalovirus (CMV) infection remains a major cause of morbidity after lung transplantation. Some studies have reported prognostic factors for the postoperative development of CMV infection in cadaveric lung transplantation (CLT), but no research has been performed in living-donor lobar lung transplantation (LDLLT). Therefore, we analysed the possible risk factors of post-transplant CMV infection and the differences between LDLLT and CLT.
METHODS: The development of CMV disease and viraemia in 110 patients undergoing lung transplantation at Kyoto University Hospital in 2008-2015 were retrospectively assessed. The prognostic factors in the development of CMV infection and the differences between LDLLT and CLT were analysed.
RESULTS: Among 110 patients, 58 LDLLTs and 52 CLTs were performed. The 3-year freedom rates from CMV disease and viraemia were 92.0% and 58.5%, respectively. There was no difference in the development of CMV infection between LDLLT and CLT (disease: 94.6% vs 91.0%, P = 0.58 and viraemia: 59.3% vs 57.2%, P = 0.76). In preoperative anti-CMV immunoglobulin status, R-D+ recipients (recipient: negative, donor: positive) and R-D-recipients (recipient: negative, donor: negative) tended to have higher and lower cumulative incidences, respectively, of CMV infection (disease: P = 0.34 and viraemia: P = 0.24) than that with R+ recipients (recipient: seropositive). Significantly lower cumulative incidence of CMV viraemia was observed in patients receiving 12-month prophylactic medication (70.6% vs 36.8%, P < 0.001). Twenty-eight patients (25.5%) had early cessation of anti-CMV prophylaxis due to toxicity; however, the extended prophylaxis duration did not increase the incidence of early cessation (P = 0.88). These trends were seen in both LDLLT and CLT.
CONCLUSIONS: We found that there was no difference in the development of CMV infection between LDLLT and CLT. Twelve-month prophylaxis protocol provides beneficial effect without increased toxicity also in LDLLT.

DOI： 10.1093/icvts/ivx226

Pulmonary Function and Exercise Capacity in Patients With Flat Chests After Lung Transplantation Reviewed

Ryo Miyoshi, Toyofumi F. Chen-Yoshikawa, Akihiro Takahagi, Yohei Oshima, Kyoko Hijiya, Hideki Motoyama, Akihiro Aoyama, Hiroshi Date

ANNALS OF THORACIC SURGERY Vol. 104 ( 5 ) page： 1695 - 1701 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Background. Severe chest wall deformation is generally a contraindication for lung transplantation; however, it is not known whether patients with flat chests have reduced postoperative exercise capacity and pulmonary function. This study's purpose was to investigate the relationship between preoperative thoracic shape and postoperative exercise capacity and pulmonary function in patients undergoing lung transplantation.& para;& para;Methods. Twenty recipients who underwent successful bilateral living-donor lobar lung transplantation were evaluated. To analyze postoperative graft function in relation to preoperative thoracic shape, 40 donor grafts implanted into 20 recipients were divided into two groups: flat chest group and normal chest group. Flat chest is diagnosed when the thoracic anteroposterior diameter to transverse diameter ratio is 1:3 or less.& para;& para;Results. The ratio of the postoperative forced vital capacity to the preoperatively estimated forced vital capacity was significantly lower in the flat chest group than in the normal chest group 1 year after lung transplantation (p = 0.002). However, there were no significant differences in postoperative 6-minute walk distances between the two groups. Furthermore, the thoracic anteroposterior diameter to transverse diameter ratio in the flat chest group significantly increased after lung transplantation (p = 0.02).& para;& para;Conclusions. Although postoperative pulmonary function was significantly poorer for patients with flat chests than for patients with normal chests, their postoperative exercise capacity was equivalent. We also found that flat chest severity significantly improved after lung transplantation. Our study, the first investigating post operative functional status in patients with flat chests, clearly shows that it is possible to perform lung transplantation in such patients with acceptable outcomes. (C) 2017 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2017.06.023

Pulmonary venoplasty with a pericardial conduit in living-donor lobar lung retransplantation Reviewed

Hidenao Kayawake, Toyofumi F. Chen-Yoshikawa, Hideki Motoyama, Hiroshi Date

INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY Vol. 25 ( 5 ) page： 830 - 831 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS

In living-donor lobar lung transplantation, donor lobectomies must be performed carefully for both donors and recipients. Furthermore, the recipients undergo pneumonectomies rather than lobectomies. Occasionally, anastomosis of the pulmonary vessels is difficult in living-donor lobar lung transplantation because of the limited length of the pulmonary vessels in the graft. This report describes a successful case of pulmonary venoplasty using an autologous pericardial conduit, which was interposed between the superior pulmonary vein of the recipient and the inferior pulmonary vein of the donor in living-donor lobar lung retransplantation. This technique may be required for the success of living-donor lobar lung retransplantation.

DOI： 10.1093/icvts/ivx122

Superior mesenteric artery syndrome after lung transplantation: a rare early gastrointestinal complication of lung transplantation Reviewed

Hidenao Kayawake, Toyofumi F. Chen-Yoshikawa, Akihiro Aoyama, Jitian Zhang, Hiroshi Date

SURGERY TODAY Vol. 47 ( 11 ) page： 1415 - 1418 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

Gastrointestinal complications sometimes occur after lung transplantation and remain a cause of postoperative morbidity. Superior mesenteric artery syndrome is caused by the compression of the duodenum by the superior mesenteric artery, but few reports have described superior mesenteric artery syndrome after lung transplantation. We herein report two cases of superior mesenteric artery syndrome as an early complication after lung transplantation. Both patients were emaciated and had lost weight before transplantation. They also lost an additional 2-4 kg early after transplantation. They were medically treated with enteral nutrition and recovered without recurrence of the syndrome. Since critically ill patients with pulmonary disease usually lose weight both before and early after lung transplantation, superior mesenteric artery syndrome is important to consider in the differential diagnosis of gastrointestinal complications after transplantation.

DOI： 10.1007/s00595-017-1513-y

Basiliximab for posterior reversible encephalopathy syndrome after lung transplantation Reviewed

Hiroya Yamagishi, Toyofumi F. Chen-Yoshikawa, Hiroshi Date

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Vol. 52 ( 4 ) page： 823 - 824 2017.10

Language：English Publisher：OXFORD UNIV PRESS INC

Posterior reversible encephalopathy syndrome is a neurological complication associated with calcineurin inhibitors. There is no consensus regarding the continuation of calcineurin inhibitors in the event of posterior reversible encephalopathy syndrome. We report 3 cases of posterior reversible encephalopathy syndrome among 155 lung transplant recipients (1.9%). The calcineurin inhibitor trough level exceeded the therapeutic range in only 1 case. Our findings demonstrate that temporary cessation of calcineurin inhibitors and administration of basiliximab may be effective strategies for managing posterior reversible encephalopathy syndrome.

DOI： 10.1093/ejcts/ezx151

Severe underweight decreases the survival rate in adult lung transplantation Reviewed

Teruya Komatsu, Toyofumi F. Chen-Yoshikawa, Ayako Oshima, Shin-ichi Harashima, Akihiro Aoyama, Nobuya Inagaki, Hiroshi Date

SURGERY TODAY Vol. 47 ( 10 ) page： 1243 - 1248 2017.10

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

The body mass index (BMI) before lung transplantation (LT) is a benchmark of the post-LT survival. The aim of the study is to determine the BMI inadequate for the post-LT survival.
We examined the survival after LT in patients grouped into the following BMI categories: < 18.5 kg/m(2) (underweight), 18.5-24.9 kg/m(2) (normal weight), 25-29.9 kg/m(2) (overweight), and 30.0 kg/m(2) (obese) according to the World Health Organization (WHO) criteria. A more detailed categorization was made for further evaluation of the underweight group: mild (17.0 BMI < 18.5 kg/m(2)) and severely underweight (BMI < 17.0 kg/m(2)).
There was no statistically significant difference in the post-LT survival between underweight and normal-weight patients (5-year survival: 78.7 vs. 76.1%). Patients with BMI < 17.0 kg/m(2) had a worse prognosis than those with 17.0 BMI < 18.5 kg/m(2) (5-year survival: 70.3 vs. 90.0%).
Standard BMI categorization per the WHO criteria is inadequate for determining the post-LT survival, especially in underweight patients. For the nutritional evaluation of underweight pre-LT patients, BMI < 17.0 kg/m(2) should be used instead of BMI < 18.5 kg/m(2).

DOI： 10.1007/s00595-017-1508-8

Prognostic factors and outcomes in Japanese lung transplant candidates with interstitial lung disease Reviewed

Kohei Ikezoe, Tomohiro Handa, Kiminobu Tanizawa, Toyofumi F. Chen-Yoshikawa, Takeshi Kubo, Akihiro Aoyama, Hideki Motoyama, Kyoko Hijiya, Shinsaku Tokuda, Yoshinari Nakatsuka, Yuko Yamamoto, Ayako Oshima, Shin-ichi Harashima, Sonoko Nagai, Toyohiro Hirai, Hiroshi Date, Kazuo Chin

PLOS ONE Vol. 12 ( 8 ) page： e0183171 2017.8

Language：English Publishing type：Research paper (scientific journal) Publisher：PUBLIC LIBRARY SCIENCE

Objective
Young patients with advanced interstitial lung disease (ILD) are potential candidates for cadaveric lung transplantation. This study aimed to examine clinical features, outcomes, and prognostic factors in Japanese ILD patients awaiting lung transplantation.
Methods
We investigated the clinical features and outcomes of 77 consecutive candidates with ILD who were referred to Kyoto University Hospital and subsequently actively listed for lung transplant in the Japan Organ Transplant Network between 2010 and 2014.
Results
Of the 77 candidates, 33 had idiopathic pulmonary fibrosis (IPF) and 15 had unclassifiable ILD. During the observational period, 23 patients (30%) received lung transplantations and 49 patients (64%) died before transplantation. Of the 33 patients with IPF, 13 (39%) had a family history of ILD and 13 (39%) had an inconsistent with usual interstitial pneumonia pattern on high-resolution computed tomography (HRCT). The median survival time from registration was 16.7 months, and mortality was similar among patients with IPF, unclassifiable ILD, and other ILDs. Using a multivariate stepwise Cox proportional hazards model, 6-min walking distance was shown to be an independent prognostic factor in candidates with ILD (per 10 m, hazard ratio (HR): 0.97; 95% confidence interval (CI): 0.95-0.99, p < 0.01), while lower body mass index (HR: 0.83; 95% CI: 0.72-0.95, p < 0.01) independently contributed to mortality in patients with IPF.
Conclusions
Japanese patients with ILD awaiting transplantation had very poor outcomes regardless of their specific diagnosis. A substantial percentage of IPF patients had an atypical HRCT pattern. 6-min walking distance in ILD patients and body mass index in IPF patients were independent predictors of mortality.

DOI： 10.1371/journal.pone.0183171

Immune function monitoring in lung transplantation using adenosine triphosphate production: time trends and relationship to postoperative infection Reviewed

Mamoru Takahashi, Akihiro Ohsumi, Keiji Ohata, Takeshi Kondo, Hideki Motoyama, Kyoko Hijiya, Akihiro Aoyama, Hiroshi Date, Toyofumi F. Chen-Yoshikawa

SURGERY TODAY Vol. 47 ( 6 ) page： 762 - 769 2017.6

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

Purpose The ImmuKnow (IK) assay is a comprehensive immune function test that involves measuring adenosine triphosphate produced by the cluster of differentiation 4+ T lymphocytes in peripheral blood. The aim of this study was to analyze the time trends of IK values and assess the relationship between IK values and infections in lung transplants.
Methods We prospectively collected 178 blood samples from 22 deceased-donor lung transplant (DDLT) recipients and 17 living-donor lobar lung transplant (LDLLT) recipients. A surveillance IK assay was performed postoperatively, then after 1 week and 1, 3, 6, and 12 months.
Results Time trends of IK values in stable recipients peaked 1 week after DDLT (477 +/- 247 ATP ng/ml), and 1 month after LDLLT (433 +/- 134 ng/ml), followed by a gradual decline over 1 year. The mean IK values in infections were significantly lower than those in the stable state (119 vs 312 ATP ng/ml, p = 0.0002).
Conclusions IK values increased sharply after lung transplantation and then decreased gradually over time in the first year, suggesting a natural history of immune function. IK values were also significantly reduced during infections. These results may provide new insights into the utility of immune monitoring after lung transplantation.

DOI： 10.1007/s00595-016-1440-3

Salvage video-assisted thoracoscopic lobectomy for isolated local relapse after stereotactic body radiotherapy for early stage non-small cell lung cancer: technical aspects and perioperative management. Reviewed

Hamaji M, Chen-Yoshikawa TF, Matsuo Y, Motoyama H, Hijiya K, Menju T, Aoyama A, Sato T, Sonobe M, Date H

J Vis Surg 2017.6

Association of Local Intrapulmonary Production of Antibodies Specific to Donor Major Histocompatibility Complex Class I With the Progression of Chronic Rejection of Lung Allografts Reviewed

Ei Miyamoto, Hideki Motoyama, Masaaki Sato, Akihiro Aoyama, Toshi Menju, Kei Shikuma, Terumasa Sowa, Akihiko Yoshizawa, Masao Saito, Akihiro Takahagi, Satona Tanaka, Mamoru Takahashi, Keiji Ohata, Takeshi Kondo, Kyoko Hijiya, Toyofumi F. Chen-Yoshikawa, Hiroshi Date

TRANSPLANTATION Vol. 101 ( 5 ) page： e156 - e165 2017.5

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background Antibody-mediated rejection may lead to chronic lung allograft dysfunction, but antibody-mediated rejection may develop in the absence of detectable donor-specific antibody (DSA) in recipient serum. This study investigated whether humoral immune responses develop not only systemically but locally within rejected lung allografts, resulting in local production of DSA.
Methods Lewis rats received orthotopic left lung transplantation from Lewis (syngeneic control) or Brown-Norway (major histocompatibility complex-mismatched allogeneic) donor rats. Rats that underwent allogeneic lung transplantation were subsequently administered cyclosporine until day 14 (short immunosuppression) or day 35 (long immunosuppression). The lung grafts and spleens of recipient animals were tissue cultured for 4 days, and the titer of antibody against donor major histocompatibility complex molecules was assayed by flow cytometry. Explanted lung grafts were also evaluated pathologically.
Results By day 98, DSA titers in supernatants of lung graft (P = 0.0074) and spleen (P = 0.0167) cultures, but not serum, from the short immunosuppression group were significantly higher than titers in syngeneic controls. Cultures and sera from the long immunosuppression group showed no production of DSA. Microscopically, the lung grafts from the short immunosuppression group showed severe bronchiole obliteration and parenchymal fibrosis, along with lymphoid aggregates containing T and B cells, accompanying plasma cells. These findings suggestive of local humoral immune response were not observed by days 28 and 63.
Conclusions DSA can be locally produced in chronically rejected lung allografts, along with intragraft immunocompetent cells. Clinical testing of DSA in serum samples alone may underestimate lung allograft dysfunction.

DOI： 10.1097/TP.0000000000001665

Right-to-left inverted living-donor lobar lung transplantation combined with sparing of native right upper lobe Reviewed

Yasufumi Goda, Hideki Motoyama, Akihiro Aoyama, Masatsugu Hamaji, Kyoko Hijiya, Toyofumi F. Chen-Yoshikawa, Hiroshi Date

JOURNAL OF HEART AND LUNG TRANSPLANTATION Vol. 36 ( 5 ) page： 483 - 485 2017.5

Gastric motility and emptying assessment by magnetic resonance imaging after lung transplantation: correlation with gastric emptying scintigraphy Reviewed

Nobuyuki Hayakawa, Yuji Nakamoto, Toyofumi F. Chen-Yoshikawa, Aki Kido, Takayoshi Ishimori, Koji Fujimoto, Tetsu Yamada, Masaaki Sato, Akihiro Aoyama, Hiroshi Date, Kaori Togashi

ABDOMINAL RADIOLOGY Vol. 42 ( 3 ) page： 818 - 824 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

Purpose: Gastroparesis is a frequent gastrointestinal complication after lung transplantation. Although gastric emptying scintigraphy (GES) is the standard technique to evaluate gastroparesis, magnetic resonance imaging (MRI) can also assess gastric motility and emptying. This study compared the results obtained by these two modalities.
Methods: Twenty-two lung transplant recipients underwent MRI and GES after ingesting a small pancake as a test meal. Parameters assessed on MRI included antral peristaltic wave velocity and frequency, and the ratios of gastric content volume at 15 and 35 min. GES parameters included retention rates (RR) in the stomach at 30, 60, and 120 min (RR30, RR60, and RR120) and half-time of emptying (T1/2) calculated by exponential curve fitting. Correlations between MRI and GES results were evaluated.
Results: Peristaltic wave velocity showed significant moderate negative correlations with RR120 (r = - 0.58, p < 0.05) and T1/2 (r = - 0.60, p < 0.05), indicating an association between reduced velocity and prolonged gastric emptying. Gastric content volume ratios on MRI showed significant moderate positive correlations with RR30 (r = 0.46, p < 0.05), RR60 (r = 0.60, p < 0.01), and T1/2 (r = 0.60, p < 0.01). There were no significant correlations between peristaltic wave frequency and GES parameters. MRI and GES parameters did not differ significantly between the six patients with and the 16 without upper gastrointestinal symptoms.
Conclusions: MRI-based determinations of gastric motility and gastric emptying correlate with GES-based gastric emptying in lung transplant recipients, suggesting that MRI is useful for evaluating patients with gastroparesis.

DOI： 10.1007/s00261-016-0959-5

Living-Donor Lung Transplantation After Bone Marrow Transplantation for Chediak-Higashi Syndrome Reviewed

Tetsu Yamada, Toyofumi F. Chen-Yoshikawa, Shigeharu Oh, Rieko Ito-Taniguchi, Fumiaki Gochi, Masaaki Sato, Akihiro Aoyama, Hiroshi Date

ANNALS OF THORACIC SURGERY Vol. 103 ( 3 ) page： E281 - E283 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

An 8-year-old girl with Chediak-Higashi syndrome (CHS) had pulmonary complications after hematopoietic stem cell transplantation (HSCT) for hemophagocytic lymphohistiocytosis (HLH) and eventually underwent single living-donor lobar lung transplantation (LDLLT). Electron micrographic findings showed vagus nerve tissue in extracted lung having granular inclusions, which are pathognomonic for CHS. Because her mother was the donor for both hematopoietic stem cell and lung transplantations, she was weaned from immunosuppression and is doing well 3 years after lung transplantation. Furthermore, an induced pluripotent stem (iPS) cell line was established from her skin fibroblasts for investigation and potential future treatment for CHS. (C) 2017 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2016.08.049

Immersing lungs in hydrogen-rich saline attenuates lung ischaemia-reperfusion injury Reviewed

Mamoru Takahashi, Toyofumi F. Chen-Yoshikawa, Masao Saito, Satona Tanaka, Ei Miyamoto, Keiji Ohata, Takeshi Kondo, Hideki Motoyama, Kyoko Hijiya, Akihiro Aoyama, Hiroshi Date

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Vol. 51 ( 3 ) page： 442 - 448 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

OBJECTIVES: Anti-oxidant effects of hydrogen have been reported in studies examining ischaemia-reperfusion injury (IRI). In this study, we evaluated the therapeutic efficacy of immersing lungs in hydrogen-rich saline on lung IRI.
METHODS: Lewis rats were divided into three groups: (i) sham, (ii) normal saline and (iii) hydrogen-rich saline. In the first experiment, the left thoracic cavity was filled with either normal saline or hydrogen-rich saline for 1 h. Then, we measured the hydrogen concentration in the left lung using a sensor gas chromatograph (N = 3 per group). In the second experiment, lung IRI was induced by occlusion of the left pulmonary hilum for 1 h, followed by reperfusion for 3 h. During the ischaemic period, the left thoracic cavity was filled with either normal saline or hydrogen-rich saline. After reperfusion, we assessed lung function, histological changes and cytokine production (N = 5-7 per group).
RESULTS: Immersing lungs in hydrogen-rich saline resulted in an elevated hydrogen concentration in the lung (6.9 +/- 2.9 mu mol/1 g lung). After IRI, pulmonary function (pulmonary compliance and oxygenation levels) was significantly higher in the hydrogen-rich saline group than in the normal saline group (P < 0.05). Similarly, pro-inflammatory cytokine levels (interleukin-1 beta and interleukin-6) in the left lung were significantly lower in the hydrogen-rich saline group than in the normal saline group (P < 0.05).
CONCLUSIONS: Immersing lungs in hydrogen-rich saline delivered hydrogen into the lung and consequently attenuated lung IRI. Hydrogen-rich solution appears to be a promising approach to managing lung IRI.

DOI： 10.1093/ejcts/ezw342

Bronchodilator Inhalation During Ex Vivo Lung Perfusion Improves Posttransplant Graft Function After Warm Ischemia Reviewed

Kyoko Hijiya, Toyofumi F. Chen-Yoshikawa, Takeshi Kondo, Hideki Motoyama, Akihiro Ohsumi, Daisuke Nakajima, Jin Sakamoto, Keiji Ohata, Mamoru Takahashi, Satona Tanaka, Ei Miyamoto, Akihiro Aoyama, Hiroshi Date

ANNALS OF THORACIC SURGERY Vol. 103 ( 2 ) page： 447 - 453 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Background. We hypothesized that an injured lung graft from donation after cardiac death donors could be reconditioned before transplantation using an ex vivo lung perfusion (EVLP) system and ventilation with highdose short-acting beta(2)-adrenergic receptor agonists.
Methods. Cardiac arrest was induced in a canine model by intravenous potassium chloride injection. Lungs were randomly assigned to two groups after 150 minutes of warm ischemia: inhalation of 1,400 mu g of procaterol (BETA group, n = 5) or control group receiving solvent (CON group, n = 5) during EVLP. Left lungs were transplanted after 120 minutes of EVLP. Functional variables, tissue adenosine 5 '-triphosphate levels, and tissue cyclic adenosine monophosphate levels were measured 240 minutes after transplantation.
Results. Physiologic pulmonary function was similar at the end of EVLP in both groups. However, significantly better graft oxygenation, dynamic pulmonary compliance, and reduced pulmonary vascular resistance were observed in the BETA group than in the CON group 240 minutes after transplantation. No severe adverse effects were observed after lung transplantation in the BETA group. Lung tissue adenosine 5 '-triphosphate levels and cyclic adenosine monophosphate levels were significantly higher in the BETA group than in the CON group at the end of EVLP and at 240 minutes after transplantation.
Conclusions. High-dose nebulized procaterol during EVLP ameliorated lung graft dysfunction at the early posttransplantation period without severe adverse effects. These data suggest that lung reconditioning with procaterol ventilation during EVLP improves lung graft function after transplantation. (C) 2017 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2016.07.066

Excellent outcome of donor lobectomy with various surgical techniques for the interlobar artery Reviewed

Hidenao Kayawake, Toyofumi F. Chen-Yoshikawa, Akihiro Aoyama, Hideki Motoyama, Kyoko Hijiya, Toshi Menju, Toshihiko Sato, Makoto Sonobe, Hiroshi Date

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Vol. 51 ( 2 ) page： 279 - 283 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

OBJECTIVES: Donor lobectomies in living-donor lobar lung transplantation sometimes require additional surgical procedures on the interlobar pulmonary artery. We retrospectively reviewed the surgical techniques and outcomes of living-donor lobectomy.
METHODS: Between 2008 and 2015, 116 living-donor lobectomies were performed in 64 consecutive living-donor lobar lung transplantations (52 bilateral, 12 single). The surgical techniques and outcomes were reviewed retrospectively.
RESULTS: Right lower lobectomies were performed in 69 donors, left lower lobectomies in 45 and middle lobectomies in 2. In 61 living donors (52.6%), small branches of the pulmonary artery were sacrificed for anatomical reasons. Pulmonary arterioplasties to preserve the pulmonary artery branches were performed in 13 donors (11.2%). Thirteen left lower lobectomies with pulmonary arterioplasty were performed to preserve lingular branches, as the lingular branch originated far distal to the superior segmental branch of the left lower lobe. Pulmonary arterioplasty with an autologous pericardial patch in 10 donors and with an end-to-end anastomosis in three donors was performed. All surgical procedures had no complications. Three months after lobectomy, the ratio of the pulmonary function test results to the preoperative values and the complication rate showed no significant differences between donors with and without pulmonary arterioplasties, and donors with and without sacrifice of small branches. All living donors resumed their previous lifestyles without restriction.
CONCLUSIONS: Although additional surgical procedures were often required in living-donor lobectomies, the donor outcomes were satisfactory. Arterioplasty to close the interlobar artery in the donor was needed in left-sided cases only.

DOI： 10.1093/ejcts/ezw298

Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation Reviewed

Hiroshi Date, Akihiro Aoyama, Kyoko Hijiya, Hideki Motoyama, Tomohiro Handa, Hideyuki Kinoshita, Shiro Baba, Toshiyuki Mizota, Kenji Minakata, Toyofumi F. Chen-Yoshikawa

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Vol. 153 ( 2 ) page： 479 - 486 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

Objectives: In standard living-donor lobar lung transplantation (LDLLT), the right and left lower lobes from 2 healthy donors are implanted. Because of the difficulty encountered in finding 2 donors with ideal size matching, various transplant procedures have been developed in our institution. The purpose of this retrospective study was to compare outcomes of nonstandard LDLLT with standard LDLLT.
Methods: Between June 2008 and January 2016, we performed 65 LDLLTs for critically ill patients. Functional size matching was performed by estimating graft forced vital capacity based on the donor's measured forced vital capacity and the number of pulmonary segments implanted. For anatomical size matching, 3dimensional computed tomography volumetry was performed. In cases of oversize mismatch, single-lobe transplant or downsizing transplant was performed. In cases of undersize mismatch, native upper lobe sparing transplant or rightleft inverted transplant was performed. In right-left inverted transplants, the donor's right lower lobe was inverted and implanted into the recipient's left chest cavity.
Results: Twenty-nine patients (44.6%) received nonstandard LDLLT, including 12 single-lobe transplants, 7 native upper lobe sparing transplants, 6 right-left inverted transplants, 2 sparing + inverted transplants, and 2 others. Thirty-six patients (57.4%) received standard LDLLT. Three-and five-year survival rates were similar between the 2 groups (89.1% and 76.6% after nonstandard LDLLT vs 78.0% and 71.1% after standard LDLLT, P = .712).
Conclusions: Various transplant procedures such as single, sparing and inverted transplants are valuable options when 2 donors with ideal size matching are not available for LDLLT.

DOI： 10.1016/j.jtcvs.2016.10.017

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