The effect of preservation fluid on the blood flow of pediatric liver allografts.
Explore the source record for details and available documents.
Child↗
Biomedical subjects
K Yanaga
Publications and source records attributed to K Yanaga.
Liver transplantation: an unfinished product.
Liver transplantation has become an extraordinarily valuable and useful operation, but one that is not perfect and that has not been exploited to anything like its full potential. Better immunosuppression may become available soon as exemplified by developments with the Japanese drug, FK506. Improved preservation with the UW solution is already here. With these advantages, liver transplantation is certain to become far more widely used than at any time in the past. Examples were cited of innovative approaches using liver transplantation for the treatment of hepatic malignancies.
Animals↗
Significance of blood flow measurement in clinical liver transplantation.
Explore the source record for details and available documents.
Adult↗
Is hepatic artery thrombosis after liver transplantation really a surgical complication?
Explore the source record for details and available documents.
Adult↗
Significance of lecithin:cholesterol acyltransferase activity as a prognostic indicator of early allograft function in clinical liver transplantation.
Rapid and accurate assessment of allograft function in the early postoperative period is critical for successful liver transplantation. This study evaluated the efficacy of lecithin:cholesterol acyltransferase (LCAT) activity as an indicator of early allograft function in human orthotopic liver transplantation (OLTx). During a three-month period between September and November 1987, 9 of 11 adult OLTx recipients whose graft exhibited poor function were studied. Poor graft function was defined as primary nonfunction, need for retransplantation within a week after OLTx, or elevation of the prothrombin time over 20 sec early after OLTx. Plasma LCAT activities (measured pretransplant and at 0, 6, 12, 18, and 24 hr, as well as 3 days, after OLTx) and pretransplant clinical variables were compared with those of 15 control patients whose graft exhibited good function. A significant correlation was found between mean LCAT activities during the first 24-hr after OLTx and early allograft function (P less than 0.05, chi 2 = 5.23). When pretransplant histological findings of the 6 grafts with poor function and the 15 controls together were correlated with the mean LCAT activity within 24 hr following OLTx, a significant association was demonstrated (P less than 0.05). This study suggests that plasma LCAT activity is an effective and practical method for assessing early allograft function following OLTx.
Humans↗
Aplastic anemia complicating orthotopic liver transplantation for non-A, non-B hepatitis.
Aplastic anemia developed in 9 of 32 patients (28 percent) undergoing orthotopic liver transplantation for acute non-A, non-B hepatitis, at one to seven weeks after the procedure. No patient previously had evidence of hematologic dysfunction or conditions known to be associated with aplastic anemia. No other cases of aplastic anemia were identified among 1463 patients undergoing liver transplantation for all other indications at the four centers participating in the study (chi-square = 415, P less than 0.001; 95 percent confidence interval for the incidence of aplastic anemia after transplantation for non-A, non-B hepatitis, 13 to 44 percent, vs. 0.00 to 0.13 percent for all other indications). The operative and postoperative treatment of these patients was not otherwise different, indicating that the aplastic anemia was a complication of the hepatitis, not of the transplantation procedure. Four of the nine patients died of complications due to infections. Three of the surviving patients have been followed for less than six months, one for one year, and one for two years. The two patients followed the longest have recovered marrow function to an appreciable degree, and two of the others have evidence of early recovery. We conclude that patients undergoing orthotopic liver transplantation for non-A, non-B hepatitis are at a high risk for the development of aplastic anemia.
Adolescent↗
Hepatic resection for hepatocellular carcinoma in elderly patients.
Of 154 elective hepatectomies performed during the 13 year period from 1973 to 1985 for hepatocellular carcinoma, 27 (17.5 percent) were performed on patients 65 years of age or older. Among these elderly patients, 40.7 percent died in the hospital compared with 21.3 percent of the younger patients (p less than 0.05). Sepsis accounted for 72.7 percent of the hospital deaths among the elderly patients, in contrast to 25.9 percent among the younger patients. The overall incidence of hospital death due to sepsis was significantly higher in the elderly patients (p less than 0.001). Hepatic lobectomy or segmentectomy in the elderly patients with cirrhosis was followed by hospital death in 88.9 percent compared with 25 percent of the elderly patients without cirrhosis (p less than 0.01). A higher incidence of hospital death occurred among the elderly in Okuda's stage I (p less than 0.05), Child's class A (p less than 0.02), and in those with concomitant systemic disorders (p less than 0.05). We conclude that in patients 65 years of age or older with hepatocellular carcinoma, concomitant systemic disorders play a role in determining the outcome of hepatectomy. Elderly patients with cirrhosis are high-risk candidates for major hepatectomy for whom limited hepatic resection should be considered.
Age Factors↗
The indocyanine green test enables prediction of postoperative complications after hepatic resection.
Explore the source record for details and available documents.
Carcinoma, Hepatocellular↗
Esophageal stricture in Crohn's disease--a case report.
We treated a 46-year-old Japanese man with Crohn's disease of the esophagus and for whom medical therapy was adequate. Crohn's disease of the esophagus is a rare disease without specific clinical features and establishment of the diagnosis with guided biopsy is extremely difficult. Therefore, Crohn's disease of the esophagus should be considered in the differential diagnosis of biopsy-negative carcinoma of the esophagus in order to avoid major surgery. Treatment of Crohn's disease of the esophagus should primarily be medical and esophagectomy should only be considered in cases of complications, intractability or a suspicion of malignancy in the biopsied specimen.
Crohn Disease↗
Intraperitoneal septic complications after hepatectomy.
One hundred forty-nine elective hepatic resections were performed during the 12 years from 1973 to 1984. Nineteen of these patients (12.8%) developed intraperitoneal septic complications after hepatectomy (IPSCH), of whom 13 died of liver failure. Perioperative variables associated with IPSCH were as follows: (1) right or extended right lobectomy, (2) age greater than 65, (3) operation time greater than 5 h, (4) blood loss at operation greater than 3000 g, and (5) post-operative bleeding, which required laparotomy for hemostasis. Improved outcome of IPSCH since 1981 coincided with the emergence of opportunistic pathogens. Survivors of IPSCH had been diagnosed earlier, all by culture of the subphrenic drainage, and all had a lower bilirubin level at the time of diagnosis. It is concluded that secure hemostasis and avoidance of tissue devitalization during hepatectomy are essential to reduce the incidence of IPSCH and that routine culture of the subphrenic drainage will improve the outcome of IPSCH.
Aged↗
Hepatitis C virus infection among Japanese general surgical patients.
The incidence of hepatitis C virus (HCV) antibody positivity is unknown. The purpose of this study was to clarify the prevalence of HCV infection among surgical patients and to identify high risk surgical patients. HCV antibody tests were performed in 789 surgical patients between April 1991 and March 1992. Of these patients, 129 (16.3%) tested positive, which was much higher than the positivity of the ordinary Japanese. Hepatobiliary diseases and portal hypertension were associated with a higher positivity than other disease categories (94 of 206, 45.6% versus 35 of 583, 6%; p < 0.0001). Patients above 50 years of age had a higher positivity than their younger counterparts (118 of 578, 20.4% versus 11 of 211, 5.3%; p < 0.0001). The HCV positivity was as high as 54.1% (119 of 220) among surgical patients with known risk factors for hepatitis, in contrast to only 1.9% (10 of 569) among those without such risk factors. We conclude that surgical patients have a high incidence of HCV infection, for whom medical professionals should pay special attention to avoid disease transmission.
Adolescent↗
Characteristics of hepatocytes derived from early ES cells and treatment of surgically induced liver failure rats by transplantation.
BACKGROUND: Although liver transplantation has become a standard therapy for diseases such as fulminant hepatitis and cirrhosis, the lack of donor organs remains a major problem. One solution is the development of transplantable hepatocytes. The metabolic characteristics as well as function and adaptation of hepatocytes (R-EES-hep cell) derived from rat early embryonic stem cells were examined after transplantation into rats with surgically induced liver failure. METHODS: Rat hepatocyte cell lines were established from early embryonic stem cells cultured in the presence of embryotrophic factors by colony cloning methods. The cell lines were established from two cell embryos taken from spontaneous dwarf rats using the novel method of Ishiwata et al. Morphologic differentiation as well as albumin and bilirubin production were observed by immunostaining. R-EES-hep cells were transplanted into the spleens of 90% hepatectomized, surgically induced liver failure rats to analyze survival rates. RESULTS: When cultured in type I collagen gel the cells formed cordlike structures resembling the liver. Both albumin and bilirubin production were observed when transplanted; the spleen was converted into a liver-like structure with prolonged survival of the 90% hepatectomized rats for up to 3 months up to the time of killing. CONCLUSIONS: R-EES-hep cells showed many of the distinctive metabolic characteristics of the liver. These cells may be efficient for further research and application for hepatic cell transplantation to treat liver insufficiency patients and as biologic artificial organs.
Animals↗
Safety limit of small partial liver allografts for orthotopic transplantation.
Explore the source record for details and available documents.
Adult↗
Nutritional support after liver transplantation: a randomized prospective study.
Nutritional support in patients with advanced cirrhosis is difficult due to protein, fluid and salt restrictions. Successful liver transplantation should improve nutrient tolerance. We randomly assigned 28 hypoalbuminemic cirrhotic patients to receive, immediately after liver transplantation, one of three regimens: group 1, no nutritional support (n = 10); group 2, total parenteral nutrition (TPN) (35 kcal/kg/day) with standard amino acids (1.5 g/kg/day) (n = 8); or group 3, isocaloric isonitrogenous TPN with added branched-chain amino acids (n = 10). Therapy was continued for 7 days posttransplant. Jaundice resolution was unaffected by nutritional support. Nitrogen balance favored both TPN groups. Branched-chain amino acid (BCAA) aromatic amino acid ratios were highest in group 3. Coma scores and serum ammonia levels were similar in all groups. Both TPN groups achieved respirator independence earlier; this difference was not statistically significant. Group 1 patients stayed longest in ICU; the difference was statistically significant. TPN with either standard or BCAA- enriched amino acids is tolerated well immediately after successful liver transplant. Positive nitrogen balance is achieved; large protein loads do not worsen encephalopathy. Nutritional support may improve respiratory muscle function, allowing earlier weaning from ventilatory support. A shortened length of ICU stay justifies the expense of TPN.
Amino Acids, Branched-Chain↗
Intra-operative hyaluronic acid clearance predicts postoperative graft function in living related liver transplantation.
Although intra-operative hyaluronic acid (HA) clearance has been reported to be a predictive parameter for early graft function after the implantation of a cadaveric hepatic graft, it has yet to be evaluated as a parameter in assessing graft function in living related liver transplantation. The aim of this study was to evaluate whether intra-operative HA clearance can be a predictive parameter of early graft function in living related liver transplant patients. Eight consecutive patients, who underwent a living related liver transplantation, were entered into the study. The HA clearance 180 min after reperfusion of the graft was evaluated. Significantly higher serum HA levels were found in the patients with fulminant hepatitis than in the patients with non-fulminant hepatitis before operation (P < 0.01), just before reperfusion (P < 0.01), and 180 min after reperfusion (P < 0.05). The HA clearance correlated with the peak total bilirubin within 5 postoperative days (P < 0.05) and the lactic acid one day after operation (P < 0.01). The intra-operative HA clearance serves as a sensitive parameter for assessing the postoperative graft function after the implantation of the new liver. Based on our findings, measuring the HA clearance was thus found to be clinically useful in the assessment of graft function in living related liver transplantation.
Adult↗
Living-related auxiliary partial orthotopic liver transplantation for primary sclerosing chonangitis--subsequent removal of the native liver.
In Japan, living-related auxiliary partial orthotopic liver transplantation (APOLT) is mainly indicated for small-for-size grafts. We present the case of a 24 year-old patient with primary sclerosing cholangitis (PSC) who underwent a living-related auxiliary partial orthotopic liver transplantation for a small-for-size graft, that was subsequently excised. During the transplantation procedure, the native liver was freed from the surrounding tissues, and was only connected to the body by the right hepatic artery and right hepatic vein. The auxiliary extended left lobe graft, corresponding to 22% of the estimated recipient liver volume, was orthotopically transplanted after extended left lobectomy of the recipient native liver. Post-transplant CT-volumetry showed rapid increase of the graft volume with atrophy of the native liver, and GSA scintigraphy showed dominant function of the graft. Although hyper-bilirubinemia was prolonged by the removal of the native liver on the 18th post-transplantation day, it gradually subsided after plasmapheresis was performed twice, and the patient was discharged on the 77th post-transplantation day. We conclude, based on this case, that subsequent removal of the native liver is necessary in APOLT for patients with potential hepatic malignancies. The optimal timing of the removal of the remnant native liver should be determined based on CT-volumetry, GSA scintigraphy, and the liver biopsy specimen of the graft.
Adult↗
Doubly-armed short sutures are useful for microsurgical hepatic artery reconstruction in living-related liver transplantation.
Although microsurgical hepatic artery reconstruction has become the essential technique in pediatric and living-related liver transplantation, it remains a technical challenge. We describe here our microsurgical hepatic artery reconstruction technique in living-related liver transplantation using a doubly-armed short suture. From August 1998 to March 1999, 8 patients underwent living-related liver transplantation at the Kyushu University. For these 8 patients, microsurgical reconstruction with doubly-armed short sutures were undertaken. After preparing the operative field for microsurgery, operative microscopy with a continuous zoom magnification is introduced. Interrupted sutures using doubly-armed short sutures are performed in a biangular stay-sutured method with a double clip. None of the 8 patients developed hepatic artery thrombosis. We conclude that the use of doubly-armed sutures allows safe and reliable in microsurgical hepatic artery reconstruction in living related liver transplantation.
Adolescent↗
Application of liver transplantation for familial amyloid polyneuropathy combined with Crohn's disease.
We describe the case of a 31-year-old Japanese man with familial amyloid polyneuropathy combined with Crohn's disease, who underwent living-related orthotopic liver transplantation. Although he had a 2-year history of alternating constipation/diarrhea, his bowel symptoms exacerbated severely during the period he was in our ward for pretransplant evaluation. Small bowel barium examination and gastroduodenal endoscopy showed typical features of Crohn's disease. He was diagnosed as having active Crohn's disease, and the scheduled living-related orthotopic liver transplantation was postponed. After controlling the active disease with conservative therapy for two months, he underwent living-related orthotopic liver transplantation using a graft of the left lobe from his father. Postoperative medication consisted of azathioprine, aminosalicylates, tacrolimus and steroids. His postoperative course was uneventful, and he was discharged from hospital on the 25th postoperative day. Pre- and postoperative transplant management of patients with Crohn's disease is also discussed, because it influences the clinical course of inflammatory bowel diseases.
Adult↗