Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

Division display 161 - 180 of about 220 ／ All the affair displays >>

Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. Reviewed

Kosei Takagi, Piotr Domagala, Robert J Porte, Ian Alwayn, Herold J Metselaar, Aad P van den Berg, Bart van Hoek, Jan N M Ijzermans, Wojciech G Polak

Journal of hepato-biliary-pancreatic sciences 27 ( 1 ) 26 - 33 2020.1

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. METHODS: A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. RESULTS: Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979-2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. CONCLUSIONS: Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.

DOI： 10.1002/jhbp.701

A novel modified hanging maneuver in laparoscopic left hemihepatectomy. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Takashi Kuise, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Yuma Tani, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 76 251 - 253 2020

Authorship：Lead author Language：English

INTRODUCTION: The liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, however it is often difficult in laparoscopic major hepatectomy. The present study describes a novel modified hanging maneuver in laparoscopic left hemihepatectomy. PRESENTATION OF CASE: A 29-year-old female underwent laparoscopic left hemihepatectomy for mucinous cystic neoplasm. After mobilizing the left lobe, the liver parenchyma was dissected along the demarcation line. For the hanging technique, the upper edge of the hanging tape was placed on the lateral side of the left hepatic vein, and fixed with the Falciform ligament. The lower edge of the tape was extracted outside the abdomen. Accordingly the hanging tape can be controlled extraperitoneally during the liver parenchyma dissection. DISCUSSION: This technique includes several advantages including no need of assistance using forceps, easy control of the hanging tape extraperitoneally, outflow control, better exposure of surgical field, and helpful guide of the liver dissection line toward the root of the left hepatic vein. CONCLUSION: Our novel modified hanging maneuver is easy and reproducible to use in laparoscopic left hemihepatectomy. Moreover, this technique can be applied to other laparoscopic hepatectomy.

DOI： 10.1016/j.ijscr.2020.10.002

Laparoscopic liver resection of segment seven: A case report and review of surgical techniques. Reviewed International journal

Kosei Takagi, Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Fuminori Teraishi, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 73 168 - 171 2020

Authorship：Lead author Language：English

INTRODUCTION: Laparoscopic liver resection of segment seven (LLR-S7) is a technically challenging procedure due to its anatomical location and difficult accessibility. Herein, we present our experience with LLR-S7, and demonstrate a literature review regarding surgical techniques. PRESENTATION OF CASE: A 28-year-old female was diagnosed with rectosigmoid cancer and synchronous liver metastases at the segment three (S3) and S7, which were treated with laparoscopic procedure. After the completely mobilization of the right lobe, the Glissonean pedicle of S7 (G7) was intrahepatically transected. The right hepatic vein was exposed to identify the venous branch of S7 (V7). Finally the liver parenchyma between RHV and dissection line was divided. DISCUSSION: Various laparoscopic approaches for S7 have been reported including the Glissonian approach from the hilum, the intrahepatic Glissonean approach, the caudate lobe first approach, and the lateral approach from intercostal ports. To perform LLR-S7 safely, it is important to understand the advantage of each technique including the trocar placement and approaches to S7 by laparoscopy. CONCLUSION: We present our experience of LLR-S7 for the tumor located at the top of S7, successfully performed with the intrahepatic Glissonean approach. LLR-S7 can be performed safely with advanced laparoscopic techniques and sufficient knowledge on various approaches for S7.

DOI： 10.1016/j.ijscr.2020.06.107

Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. Reviewed International journal

Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Jan N M Ijzermans

BMC gastroenterology 19 ( 1 ) 211 - 211 2019.12

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The clinical value of the controlling nutritional status (CONUT) score in hepatocellular carcinoma (HCC) has increased. The aim of this meta-analysis was to systematically review the association between the CONUT score and outcomes in patients undergoing hepatectomy for HCC. METHODS: Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar were systematically searched. Random effects meta-analyses were conducted to examine the prognostic value of the CONUT score in HCC patients. RESULTS: A total of five studies including 4679 patients were found to be eligible and analyzed in the meta-analysis. The CONUT score was significantly associated with overall survival (HR 1.78, 95%CI = 1.20-2.64, P = 0.004, I2 = 79%), recurrence-free survival (HR 1.34, 95%CI = 1.17-1.53, P < 0.001, I2 = 16%) and postoperative major complications (OR 1.85, 95%CI: 1.19-2.87, P = 0.006, I2 = 72%) in HCC patients. Moreover, the CONUT score was associated with the Child-Pugh classification, liver cirrhosis, ICGR15, and tumor differentiation. However, it was not associated with tumor size, tumor number, and microvascular invasion. CONCLUSIONS: The CONUT score is an independent prognostic indicator of the prognosis and is associated with postoperative major complications and hepatic functional reserve in HCC patients.

DOI： 10.1186/s12876-019-1126-6

Current evidence of nutritional therapy in pancreatoduodenectomy: Systematic review of randomized controlled trials. Reviewed

Kosei Takagi, Piotr Domagala, Hermien Hartog, Casper van Eijck, Bas Groot Koerkamp

Annals of gastroenterological surgery 3 ( 6 ) 620 - 629 2019.11

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

Aim: Evidence of nutritional therapies in pancreatoduodenectomy (PD) has been shown. However, few studies focus on the association between different nutritional therapies and outcomes. The aim of this review was to summarize the current evidence of nutritional therapies such as enteral nutrition (EN), immunonutrition, and synbiotics on postoperative outcomes after PD. Methods: A systematic literature search of Embase, Medline Ovid, and Cochrane CENTRAL was done to summarize the available evidence, including randomized controlled trials, meta-analyses and reviews, regarding nutritional therapy in PD. Results: A total of 20 randomized controlled trials were included in this review. Safety and tolerability of EN in PD was shown. Giving postoperative EN can shorten length of stay compared to parenteral nutrition; however, the effect of EN on postoperative complications remains controversial. Postoperative EN should be given only on selective indications rather than routinely used, and preoperative EN is indicated only in patients with severe malnutrition. Giving preoperative immunonutrition is considered to reduce the incidence of infectious complications; however, evidence level is moderate and recommendation grade is weak. The beneficial effect of perioperative synbiotics on postoperative infectious complications is limited. Furthermore, the effectiveness of other nutritional supplements remains unclear. Conclusion: Recently, evidence of enhanced recovery after surgery (ERAS) in PD has been increasing. Early oral intake with systematic nutritional support is an important aspect of the ERAS concept. Future well-designed studies should investigate the impact of systematic nutritional therapies on outcomes following PD.

DOI： 10.1002/ags3.12287

Grafts from selected deceased donors over 80 years old can safely expand the number of liver transplants: A systematic review and meta-analysis. Reviewed International journal

Piotr Domagala, Kosei Takagi, Jan N Ijzermans, Wojciech G Polak

Transplantation reviews (Orlando, Fla.) 33 ( 4 ) 209 - 218 2019.10

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

AIM: The aim of this systematic review and meta-analysis was to present the outcome of deceased adult liver transplantation from octogenarian (≥80 years old) donors compared to younger grafts. METHODS: A systematic search was performed on six databases to identify all available original papers that report the outcome of adult recipients who underwent liver transplantation from a deceased octogenarian donor. RESULTS: Overall, 39,034 liver transplantations from 12 studies were reported with 789 (2.02%) cases receiving grafts from octogenarian donors. Eight studies were included in the meta-analysis. There was no difference regarding the one, three, and five-year graft and patient survival between the recipients of livers <80 years old and octogenarian grafts. There were significantly more episodes of biliary complications in the recipients of octogenarian grafts (34/459; 7.4%) in comparison to the recipients of livers <80 years old (372/37074; 1.0%) (OR 0.53; 95% CI = 0.35-0.81; P 0.004; I2 = 0%). The incidence of primary non-function, vascular complications and re-transplantation did not differ between groups. CONCLUSIONS: The short- and medium-term graft and patient survival of octogenarian liver transplantation is not inferior compared to the liver transplantation with younger grafts, however with a higher rate of biliary complications.

DOI： 10.1016/j.trre.2019.06.004

Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. Reviewed International journal

Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Bas P L Wijnhoven, Jan N M Ijzermans

BMC surgery 19 ( 1 ) 129 - 129 2019.9

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In recent years, the clinical evidence of the controlling nutritional status (CONUT) score has increased in patients with gastrointestinal cancers. The purpose of this systematic review and meta-analysis was to investigate the association between the preoperative CONUT score and outcomes in patients undergoing gastrectomy for gastric cancer (GC). METHODS: A systematic literature search for studies reporting the prognostic impact of the CONUT score in patients with GC was conducted. Meta-analyses of survival, postoperative outcomes, and postoperative clinico-pathological parameters were conducted. RESULTS: Five studies with 2482 patients were found to be eligible and subsequently reviewed and analyzed. The CONUT score was significantly associated with overall survival (HR 1.85, 95%CI 1.38-2.48, P < 0.001), cancer-specific survival (HR 2.56, 95%CI 1.24-5.28, P = 0.01) and recurrence/relapse-free survival (HR 1.43, 95%CI 1.12-1.82, P = 0.004). Moreover, the CONUT score was associated with the incidence of postoperative complications (OR 1.39, P = 0.003) and mortality (OR 6.97, P = 0.04), and clinico-pathological parameters (T factor [OR 1.75, P < 0.001], N factor [OR 1.51, P < 0.001], TNM stage [OR 1.73, P < 0.001], and microvascular invasion [OR 1.50, P = 0.006]), but not with tumor differentiation (OR 0.85, P = 0.13). CONCLUSIONS: The preoperative CONUT score is an independent prognostic indicator of survival and postoperative complications, and is associated with clinico-pathological parameters in patients with GC.

DOI： 10.1186/s12893-019-0593-6

Order of liver graft revascularization in deceased liver transplantation: A systematic review and meta-analysis. Reviewed International journal

Piotr Domagala, Kosei Takagi, Robert J Porte, Wojciech G Polak

Surgery 166 ( 3 ) 237 - 246 2019.9

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

BACKGROUND: The ideal order for liver graft revascularization during liver transplantation remains unknown. The majority of liver transplant centers prefer portal venous reperfusion followed by arterial reperfusion to shorten the warm ischemia time. The aim of this study was to review the different revascularization techniques used in clinical liver transplantation to identify any potential clinical benefits. METHODS: A systematic search of 5 databases was performed to identify all available original articles that reported liver transplantation and compared different techniques of reperfusion. The primary outcomes were patient and graft survival. Secondary outcomes were defined by postreperfusion syndrome, primary nonfunction, vascular complications, biliary complications, and retransplantation. RESULTS: A total of 1,160 patients undergoing liver transplantation from 15 studies were included in this review and meta-analysis. There were no differences regarding the 1-year patient and graft survival for the revascularization techniques. The incidence of primary nonfunction, vascular complications, and retransplantation did not differ between the groups. Although there were no differences regarding biliary complications between the different groups, there were more nonanastomotic strictures in patients with initial portal revascularization (9%) compared with those with simultaneous revascularization (2%; risk ratio 1.07; 95% confidence interval, 1.00-1.14; P = .05; I2 = 51%). CONCLUSION: The order of liver graft revascularization does not influence patient and graft survival. Each revascularization technique offers potential benefits that can be used under specific clinical situations.

DOI： 10.1016/j.surg.2019.03.024

乳児劇症肝炎に対して生体肝移植術を施行した1例

高木弘誠, 八木孝仁, 吉田龍一, 藤智和, 杭瀬崇, 渡辺信之, 信岡大輔, 楳田祐三, 篠浦先, 藤原俊義

肝臓 60 ( 6 ) 216 - 216 2019.6

Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial. Reviewed International journal

Kosei Takagi, Ryuichi Yoshida, Takahito Yagi, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Shiro Hinotsu, Takashi Matsusaki, Hiroshi Morimatsu, Jun Eguchi, Jun Wada, Masuo Senda, Toshiyoshi Fujiwara

Clinical nutrition (Edinburgh, Scotland) 38 ( 1 ) 174 - 181 2019.2

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND & AIMS: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. METHODS: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. RESULTS: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). CONCLUSIONS: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. REGISTRATION NUMBER: UMIN000014068.

DOI： 10.1016/j.clnu.2018.01.002

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Takuro Fushimi, Toshiyoshi Fujiwara, Takahito Yagi

Digestive surgery 36 ( 3 ) 226 - 232 2019

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. METHODS: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. -Results: The high CONUT group had a significantly higher -incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). CONCLUSIONS: Preoperative assessment of the CONUT score is helpful for evaluating patients' nutritional status and mortality risk after liver surgery.

DOI： 10.1159/000488215

The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Takuro Fushimi, Toshiyoshi Fujiwara, Takahito Yagi

Digestive surgery 36 ( 4 ) 323 - 330 2019

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND/AIMS: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. METHODS: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. RESULTS: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). CONCLUSIONS: Although elderly -patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

DOI： 10.1159/000489826

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis. Reviewed International journal

Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Jan N M Ijzermans

Annals of nutrition & metabolism 74 ( 4 ) 303 - 312 2019

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower -CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19-13.2, p < 0.001, I2 = 0%), postoperative major complications (RR 1.56, 95% CI 1.05-2.33, p= 0.03, I2 = 79%), and overall complications (RR 1.38, 95% CI 1.16-1.63, p < 0.001, I2 = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97-23.5, p= 0.05, I2 = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

DOI： 10.1159/000500233

Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis? Reviewed International journal

Masashi Utsumi, Yuzo Umeda, Takahito Yagi, Takeshi Nagasaka, Susumu Shinoura, Ryuich Yoshida, Daisuke Nobuoka, Takashi Kuise, Tomokazu Fuji, Kosei Takagi, Akinobu Takaki, Toshiyoshi Fujiwara

Digestive surgery 36 ( 1 ) 59 - 66 2019

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

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. METHODS: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. RESULTS: During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. CONCLUSION: Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.

DOI： 10.1159/000486548

Prognostic Factors for Pediatric Living Donor Liver Transplantation: Impact of Zero-mortality Transplant for Cholestatic Diseases. Reviewed

Takahito Yagi, Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara

Acta medica Okayama 72 ( 6 ) 567 - 576 2018.12

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

Living donor liver transplantation (LDLT) is the final therapeutic arm for pediatric end-stage liver diseases. Toward the goal of achieving further improvement in LDLT survival, we investigated factors affecting recipient survival. We evaluated the prognostic factors of 60 pediatric recipients (< 16 years old) who underwent LDLT between 1997 and 2015. In a univariate analysis, non-cholestatic (NCS) disease, graft/recipient body weight ratio, cold and warm ischemic times, and intraoperative blood loss were significant factors impacting survival. In a multivariate analysis, NCS disease was the only significant factor worsening survival (p=0.0021). One-and 5-year survival rates for the cholestatic disease (CS, n=43) and NCS (n=17) groups were 100% vs. 70.6% and 97.4% vs. 58.8% (p=0.004, log-rank). Intergroup comparisons revealed that CS was significantly associated with operation time, cold ischemia, hepatomegaly of the native liver, and portal plasty. These data suggest that a cirrhotic, swollen, artery-dominant liver did not increase graft size-related risks despite the surgical complexity of preceding operations. The NCS group's poorer survival originated from recurrence of the primary disease and liver manifestation of systemic disease untreatable by transplantation. Improving the survival of pediatric recipients requires intensive efforts to prevent primary disease relapse and more rapid diagnoses to exclude contraindications from NCS disease.

DOI： 10.18926/AMO/56374

A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation. Reviewed International journal

Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Onishi, Hidenori Shiraha, Shinichiro Nakamura, Hiroshi Morimatsu, Hiroshi Ito, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada

BMC gastroenterology 18 ( 1 ) 62 - 62 2018.5

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

BACKGROUND: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). METHODS: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n = 34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2 < 80 mmHg and an alveolar-arterial oxygen gradient (AaDO2) ≥ 15 mmHg were categorized as potentially having HPS (subclinical HPS; n = 29). The clinical course after LDLT was investigated according to subclinical high TRPG. RESULTS: A subclinical high TRPG (p = 0.012) and older donor age (p = 0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. CONCLUSION: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

DOI： 10.1186/s12876-018-0793-z

New Left Lobe Transplantation Procedure with Caval Reconstruction Using an Inverted Composite Graft for Chronic Budd-Chiari Syndrome in Living-Donor Liver Transplantation—A Case Report Reviewed

T. Yagi, K. Takagi, R. Yoshida, Yuzo Umeda, D. Nobuoka, T. Kuise, T. Fujiwara, A. Takaki

Transplantation Proceedings 50 ( 4 ) 1192 - 1195 2018.5

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

When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC.

DOI： 10.1016/j.transproceed.2017.11.078

膵頭十二指腸切除術におけるERAS(Enhanced recovery after surgery)の有効性に関するランダム化比較試験

高木弘誠, 吉田龍一, 八木孝仁, 楳田祐三, 信岡大輔, 杭瀬崇, 樋之津史郎, 松崎孝, 森松博史, 江口潤, 和田淳, 千田益生, 藤原俊義

日本静脈経腸栄養学会雑誌 33 ( Suppl. ) 227 - 227 2018.1

胆道閉鎖症に対するABO不適合移植術後に遷延する肝機能異常を認めた一例

國府島健, 信岡大輔, 楳田祐三, 吉田龍一, 杭瀬崇, 熊野健二郎, 高木弘誠, 伏見卓郎, 吉田真理, 田中健大, 藤原俊義, 八木孝仁

移植 52 ( 4-5 ) 477 - 478 2017.11

肝移植後C型肝炎再発に対するソホスブビル含有治療の有効性

大山淳史, 高木章乃夫, 安中哲也, 足立卓哉, 池田房雄, 和田望, 竹内康人, 大西秀樹, 中村進一郎, 白羽英則, 高木弘誠, 杭瀬崇, 信岡大輔, 吉田龍一, 楳田祐三, 吉田真理, 有森千聖, 八木孝仁, 岡田裕之

肝臓 58 ( 11 ) 599 - 604 2017.11

Language：Japanese Publisher：(一社)日本肝臓学会

肝移植後C型肝炎に対するDirect Acting Antivirals(DAA)治療効果を検討した。Genotypelは29症例で、ダクラタスビル+アスナプレビル(DCV+ASV)5例、ソホスブビル+レジパスビル(SOF+LDV)25例(含DCV+ASV無効1例)、Genotype2が2症例でSOF+リバビリン治療を行った。DCV+ASVは5例中4例で治療完遂、3例でSustained viral response(SVR)24を達成。SOF+LDVは全例SVR24を達成、移植後2ヵ月以内の肝炎再燃例も含まれているが問題なく治療完遂可能であった。Genotype2はSVR24を達成。SOF中心レジメンで100%のSVR24達成率であり、移植後早期においても問題なくウイルス駆除達成可能であった。C型肝硬変の肝移植適応評価においてC型肝炎のネガティブインパクトはなくなったと言っても過言ではない。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00263&link_issn=&doc_id=20171128110001&doc_link_id=10.2957%2Fkanzo.58.599&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.58.599&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

　 PREV - NEXT 　

1
2
3
4
5
6
7
8
9
10
11