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S Uemoto

Publications and source records attributed to S Uemoto.

At least 127 records · Page 7Linked to original sources
PubMed1994

Long-term use of FK 506 in living related liver transplantation.

FK 506 (Tacrolimus) was used with steroids to treat 61 pediatric patients who received living related partial liver transplantation. Fifty-two recipients survived and 9 died between 6 months and 3 years after transplantation. In the surviving patients, oral doses of Tacrolimus were tapered from 0.298 +/- 0.277 mg/kg daily at 1 month after transplantation to 0.078 +/- 0.054 at 24 months after transplantation. The 12 h trough levels of Tacrolimus were 12.6 +/- 7.1 ng/ml and 4.1 +/- 2.4 at 1 and 24 months after transplantation, respectively. The percentage of recipients free from steroids was 77%, 97%, and 94% at 6, 12, and 24 months after transplantation, respectively. Liver allograft rejection was encountered in seven recipients, five of whom were treated by steroid pulse therapy and a dose increase of Tacrolimus; the remaining two required OKT3. However, there was no episode of rejection that required retransplantation. Infectious complications encountered in 34 patients included 12 bacterial, 3 fungal, and 19 viral infections. Two recipients died one of fungal pneumonia and one of Epstein-Barr virus-associated lymphoproliferative disorder. Regarding adverse reactions of Tacrolimus, hypertension was observed in 28 patients, diabetes mellitus in 3, pancreatitis in 3, convulsion in 1, tremor in 12, itching in 5, and pigmentation in the oral mucosa in 2. Slightly increased values of creatinine were observed in most of the patients; however, an abnormal increase of serum of serum creatinine (> 1.0 mg/dl) was confined to the complicated cases. Improvement of somatic growth was observed in 21 patients (62%) and 13 (75%) at 12 and 24 months after transplantation, respectively. The long-term use of Tacrolimus is highly effective in terms of its immunosuppressive potential and reduced adverse reaction. Steady growth development can be expected in pediatric recipients free from steroids.

Adolescent↗
PubMed1994

Living-related liver transplantation for fulminant hepatic failure in children.

Liver transplantation is increasingly accepted as a choice of treatment for fulminant hepatic failure (FHF) since it has been proved to significantly improve the survival rate in these patients compared with other therapeutic modalities. We have successfully performed a total of 76 living related liver transplantations (LRLT) three of which were for FHF. The first case was an 11-year-old boy with FHF due to an unidentified cause. He had required plasmapheresis a total of 24 times and haemofiltration to save his life before LRLT. He was transplanted with a left lobe (420 g) graft, calculated as 1.05% of his weight (40 kg). He recovered hepatic function uneventfully and was discharged from hospital after 7 weeks. The second case was a 13-year-old girl who developed FHF with grade III encephalopathy due to acute Wilson's disease, and was referred to us. She underwent LRLT with a left lobe graft (440 g), estimated as 0.95% of her weight (47 kg), which functioned well after surgery. The third case was a 13-year-old girl with grade II encephalopathy due to acute Wilson's disease. She was 27% obese with a body weight of 58 kg. She underwent LRLT with ABO blood group incompatibility with a left lobe (352 g), estimated as 0.80% of her weight (modified 44 kg). She was discharged with sensorimotor neuropathy due to vitamin B deficiency. The present results suggest that LRLT is feasible for FHF both clinically and ethically, and that a partial liver graft weighing around 1% of the recipient's weight can maintain the recipient's life. We limit the diagnostic indication for LRLT to chronic liver disease, since an urgent situation may affect a voluntary decision for the patient's parents to donate the partial liver. However, LRLT is thought to be an acceptable choice of treatment provided it is requested by the patient and family. Furthermore, it is a potential option for resolving the graft shortage in paediatric liver transplantation, being independent of cadaver donor availability.

Adolescent↗
PubMed1994

Cytomegalovirus infection in living related liver transplantation: rapid diagnosis by human monoclonal antibody staining of blood leucocytes.

Symptomatic cytomegalovirus (CMV) infection is a major cause of morbidity and mortality following orthotopic liver transplantation. Early detection and prompt treatment with appropriate medicine are crucial for successful outcome. As an early detection method, we used the CMV antigenemia test which is based on immunocytochemical detection of CMV immediate early antigens in blood leucocytes. CMV immediate early antigens were detected in blood leucocytes with direct immunoperoxidase technique using a horseradish peroxidase (HRP)-conjugated F(ab')2 fragment of human monoclonal antibody (humab C7), designated HRP-C7. Of the 37 living related liver transplantations we performed on pediatric patients between June 1990 and August 1992, we experienced four cases (10.8%) of symptomatic CMV infection: three CMV hepatitis and one CMV peritonitis. They were all treated successfully with a combination of ganciclovir and immunoglobulins. In ABO-incompatible cases ganciclovir was administered prophylactically. Early detection using this method is though to have led to these successful outcomes. It is concluded that HRP-C7 staining of blood leucocytes is useful for the rapid diagnosis of CMV infection.

ABO Blood-Group System↗
PubMed1993

Effect of total parenteral nutrition on liver mitochondrial function in mature rats.

To evaluate the effects of TPN on the hepatic function, the changes in hepatic energy charge levels, oxidative and phosphorylative activities of mitochondria and serum transaminase were studied, using male Sprague-Dawley rats 240 to 250 g in weight. The rats were randomized into three groups. The first group (TPN-V group, n = 6) was infused with TPN solution via the right jugular vein. The number of calories of TPN solution infused daily was adjusted to provide each rat with 80 kcal/kg/day on the 1st day, 160 kcal/kg/day on the 2nd day and 240 kcal/kg/day on the 3rd day. After the 4th day, 240 kcal/kg/day was given to both groups. The second group (TPN-G group, n = 5) was infused with the same solution via an intragastric route and was given the same calories as the TPN-V group. The third group (control group, n = 6) was given a chow diet with the same calories as the TPN group. At the 13th day, all groups were sacrificed, and the hepatic energy charge (EC) and phosphorylation rate (PR) of hepatic mitochondria were measured, and liver function tests were done. PR was 101.2 +/- 5.0 nmol/mg protein/min in control group, 120.8 +/- 2.7 in TNP-G group and 136.5 +/- 6.2 in TPN-V group. EC was 0.906 +/- 0.006, 0.889 +/- 0.008, 0.831 +/- 0.010, respectively. The liver function tests of all group were normal. In both TPN groups, despite evidence that liver function tests were normal, enhanced mitochondrial phosphorylative activity was observed during the early stage of TPN.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Living related liver transplantation across ABO blood groups with FK506 and OKT3.

In living related liver transplantation (LRLT), the use of graft livers across ABO blood groups is unavoidable since the organ donor is usually one of the recipient's parents. This report presents our initial experiences with LRLT, focusing on ABO-incompatible cases. From June 1990 to May 1992, we successfully performed a series of 34 LRLT on children (15 males and 19 females) ranging in age from 7 months to 15 years. Overall recipient survival rates were 90% (25/28) in elective LRLT and 50% (3/6) in emergency LRLT. These cases were classified into three groups: ABO blood group-identical (n = 21), compatible (n = 10), and incompatible (n = 3). The immunosuppressive regimen consisted of FK506 and low-dose steroids in the first two groups. In the incompatible cases, exchange transfusion was performed to decrease anti-A and/or -B antibody titers before LRLT, and prophylactic OKT3 was added to FK506 and steroids after LRLT. No significant difference in recipient and graft survival was observed among the groups. In the identical group, no rejection episodes have been observed thus far. Rejection occurred in two out of the ten compatible cases. Among the incompatible cases, one recipient had mild rejection and was treated. The remaining two recipients have had no rejection episodes thus far. Although all three recipients had cytomegalovirus (CMV) infection, they were successfully treated with ganciclovir, and no lethal infection has developed in any of these cases. The present results suggest that graft livers from living related donors across ABO blood groups can function well with FK506, low-dose steroids, and prophylactic OKT3 without causing lethal complications.

ABO Blood-Group System↗
PubMed1993

Short-term changes in lipid and protein metabolism in liver transplants from living-related donors.

The effects of liver transplantation involving living-related donors were investigated in 20 pediatric cases in terms of protein and lipid metabolism using the extent of cholesterol esterification and the levels of total cholesterol, lecithine-cholesterol acyltransferase, apolipoprotein A-I, cholinesterase, and rapid turnover proteins as parameters. Cholesterol esterification increased from preoperative values of 39% +/- 4% to 67% +/- 1% (mean +/- SEM, n = 17) at 3 weeks after liver transplantation in successful cases but decreased from the preoperative value of 45% +/- 10% to 26% +/- 6% (n = 3) at 3 weeks in unsuccessful cases. Cholinesterase, transferrin, and prealbumin levels remained low after 3 weeks even in successful cases. Patients who had partial liver transplantations from living-related donors showed rapid recovery of cholesterol esterification. However, patients with graft livers required an extensive period before normalization of protein metabolism occurred, indicating the necessity for long-term follow-up of recipient development.

Adolescent↗
PubMed1993

Lipid metabolism after liver transplantation from a living related donor.

1. The recovery of lipid metabolism was investigated in paediatric patients treated for terminal liver disease by liver transplantation from living related donors. 2. The cholesterol ester ratio (esterified cholesterol/total cholesterol) and the total cholesterol/phospholipid ratio increased from preoperative values of 0.35 +/- 0.04 and 0.59 +/- 0.03 to 0.65 +/- 0.01 and 0.68 +/- 0.01 at 3 weeks after liver transplantation in successful cases (means +/- SEM, n = 26), respectively, whereas these two parameters decreased in failed cases (n = 4). 3. Biochemical analysis indicated that weekly recoveries in the cholesterol ester ratio and the total cholesterol/phospholipid ratio are characteristic of successful liver transplantation with a graft from a living related donor.

Adolescent↗
PubMed1993

Surgical techniques and innovations in living related liver transplantation.

The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (16 cases), left lobe (16 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic artery reconstruction. There has been no occurrence of thrombosis since then. The current results with LRLT suggested that the meticulous management of surgical factors at each stage of the LRLT procedure is crucial for successful outcome. Living related liver transplantation is a promising option for resolving the graft shortage in pediatric liver transplantation and may be regarded as an independent modality to supplement cadaver donation.

Adolescent↗
PubMed1993

Experience with FK506 in living-related liver transplantation.

The new immunosuppressive agent FK506 was used with steroids to treat 22 pediatric patients who received living-related partial liver transplantation. Seventeen recipients survived and 5 died between one and 16 months after transplantation. Three of the 5 patients who died had required intensive care preoperatively. Autopsy findings showed no evidence of rejection. There was no episode of rejection that required retransplantation in any of the patients. Liver allograft dysfunction, which was suspected to be a rejection response, was encountered in 2 recipients with ABO-nonidentical but compatible grafts. However, their clinical and biochemical findings were ameliorated upon steroid pulse therapy or upon augmented FK506 administration without additional potent immunosuppressive agents. Steroid treatment has been discontinued in all surviving patients at 1-9 months after transplantation. Infectious complications encountered in 9 patients included 2 bacterial, 5 viral, and 2 fungal infections. One recipient died of fungal pneumonia. Abnormal increase of serum creatinine level was confined to the complicated patients. Hypertension was a temporary adverse reaction in the early postoperative period, and only one patient needed an antihypertensive drug at 2 months after transplantation. Acute pancreatitis with hyperamylasemia was observed in one patient who was treated successfully with reduction of FK506 administration. Tremor was observed in 8 patients, itching in 4, insomnia in 2, and vomiting in one. Hirsutism, gingival hypertrophy, and lymphoma were not observed. FK506 was highly effective in living-related partial liver transplantation not only in terms of immunosuppressive potential but also because it produced fewer adverse effects.

Adolescent↗
PubMed1993

Arterial ketone body ratio and glucose administration as an energy substrate in relation to changes in ketone body concentration after living-related liver transplantation in children.

Changes in the arterial ketone body ratio (AKBR [acetoacetate/3-hydroxybutyrate]), which reflect the redox state of the liver mitochondria (NAD+/NADH), as well as those in total ketone body concentration (TKB) and blood glucose level were studied in 30 living-related liver transplantations (LRLT) performed in pediatric patients at Kyoto University Hospital from June 1990 to January 1992. AKBR increased to over 1.0 within 6 hr after reperfusion of the graft in 11 cases (37%), within 12 hr in 7 (23%), on POD 1 in 8 (27%), and on POD 2 in the remaining 4 cases (13%). TKB significantly increased while AKBR remained below 0.7 (266 +/- 40 mumol/L), but it significantly decreased in accordance with the recovery of AKBR above 1.0 (61 +/- 6 mumol/L). This indicates the change in the predominant energy substrate for hepatic mitochondria from fatty acid to glucose during the AKBR recovery process. In 6 cases, the AKBR transiently decreased to below 1.0 after initial recovery concomitant with the fall in blood glucose level and the increase in TKB. However, the AKBR was rapidly restored to over 1.0 again immediately after the glucose administration was increased. This suggests that glucose administration to maintain blood glucose level between 150 and 250 mg/dl is essential for the AKBR recovery above 1.0 that accompanies the normalization of graft metabolic functions, and that, along with the postoperative minimal increase in serum enzymes and favorable outcome of the transplant with no incidence of a primary nonfunctioning graft, the prompt and successful recovery of AKBR reflects the expected high viability of the graft in our LRLT cases.

Adolescent↗
PubMed1993

Soluble CD23 as a sensitive marker for Epstein-Barr virus-related disorders after liver transplantation.

Plasma levels of the soluble fragments of Fc epsilon RII/CD23 (sCD23/IgE-binding factor) were measured to assess the level of activation of B lymphocytes associated with Epstein-Barr virus infection in 28 patients who received living-related liver transplantation and were treated with FK506 and steroids. In 6 patients with symptoms of EBV infection (EBV-related disorders), the plasma concentration of sCD23 increased to more than 9.8 ng/ml at the onset of symptoms. In a patient with B cell lymphoma, the plasma levels of sCD23 increased significantly when peripheral lymphadenopathy was noticed, and remained more than 10 ng/ml during the terminal period. In 4 of 6 patients, the increase of plasma levels of sCD23 preceded the increase of anti-EBV capsid antigen IgM. In the other 2 of 6 patients, there was no significant increase of the antibody, despite the integration of EBV DNA in the mononuclear cells in their ascites. The plasma levels of sCD23 of the patients without symptoms of EBV infection did not exceed 7.5 ng/ml. In contrast, the proportion of CD20+/CD23+ B lymphocytes in peripheral blood mononuclear cells was not significantly different in the patients with EBV-related disorders and those with latent asymptomatic EBV infection. Therefore, the plasma level of sCD23 is a sensitive and useful marker of EBV-related polyclonal and/or monoclonal B cell proliferation in transplanted patients with immunosuppression.

Adolescent↗
PubMed1993

Relief of hepatic vein stenosis by balloon angioplasty after living-related donor liver transplantation.

We have experienced 5 hepatic vein stenoses in 3 children (8 to 23 months old) after living-related liver transplantation (total 48 liver transplants for 48 children between June 1990 and November 1992). The initial symptoms of hepatic vein stenosis were ascites and/or edema. The blood flow of hepatic vessels was monitored by duplex sonography. The mean velocity of the hepatic vein and the portal vein was decreased and flow wave pattern of the stenotic hepatic vein was flat. The patients were treated by percutaneous transhepatic balloon angioplasty. After a successful angioplasty, the mean velocity of the hepatic vein and portal vein increased and pulsatile waves returned to the hepatic vein. Arterial ketone body ratio (acetoacetate/3-hydroxybutylate) increased, promptly followed by recovery of other liver function tests. In 1 patient, this complication occurred three times with intervals of 7 months and 3 months between episodes of hepatic vein stenosis. In conclusion, hepatic vein flow should be monitored routinely with duplex sonography after living-related donor liver transplantation. Percutaneous transhepatic balloon angioplasty is a primary treatment for the stenosis.

Anastomosis, Surgical↗
PubMed1993

Living-related liver transplantation for biliary atresia.

We reviewed our initial experience of 29 living-related liver transplantations (LRLT) for children with biliary atresia in terms of postoperative complications and management to analyze the factors that may influence the outcome. All patients underwent an initial portoenterostomy at 17-134 days of age. The age distribution at the time of LRLT ranged from 6 months to 12 years, following revised portoenterostomy 0 to 3 times, and with (n=5) or without enteric stoma (n=24). Living-related donors provided the partial liver grafts weighing 170 to 630 g according to recipient size. Twenty-six of the 29 recipients are alive and well with follow-up between 1 and 27 (mean=14) months. Three patients died of extrahepatic complications including aspiration asphyxia, Candida infection and lymphoproliferative disorder. Four of 5 children with enteric stoma had 9 incidences of postoperative complication, while only 4 incidences occurred in 4 out of 24 children without stoma (p=0.007). Children hospitalized at the time of transplantation seemed to have early postoperative complications more frequently than home-bound children (p=0.06). The present results indicated that LRLT could offer satisfactory outcome for children in whom repeated Kasai's operation could not attain adequate biliary diversion and for those who developed cirrhosis despite good initial bile drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary Atresia↗