研究者総覧

岡田 憲樹 (オカダ ノリキ)

  • 外科学講座(消化器一般移植外科学部門) 助教
メールアドレス: r0906nojichi.ac.jp
Last Updated :2021/11/23

研究者情報

ホームページURL

J-Global ID

研究キーワード

  • 小児肝移植   新生児急性肝不全   常温酸素化灌流保存   胆道閉鎖症   肝移植   

研究分野

  • ライフサイエンス / 消化器外科学

経歴

  • 2018年04月 - 現在  自治医科大学消化器一般移植外科助教
  • 2011年04月  自治医科大学移植外科臨床助教
  • 2009年04月 - 2011年03月  自治医科大学附属病院初期研修医

学歴

  • 2012年04月 - 2016年03月   自治医科大学大学院   医学研究科
  • 2003年04月 - 2009年03月   東京慈恵会医科大学   医学部   医学科

研究活動情報

論文

  • Hiroki Yoshinari, Yuta Kawahara, Hitomi Niijima, Yukiko Oh, Yuta Hirata, Noriki Okada, Yukihiro Sanada, Yasuharu Onishi, Yasunaru Sakuma, Akira Morimoto
    International journal of hematology 2021年06月 
    Patients with hepatitis-associated aplastic anemia (HAA) who undergo living-donor liver transplantation (LDLT) have a poor prognosis with infections and bleeding complications. Rapid recovery of blood cells is critical for preventing these complications and improving the outcome. Immunosuppressive therapy (IST) combined with thrombopoietin receptor agonists is considered effective for aplastic anemia. However, there are no data on the benefits of adding thrombopoietin receptor agonists to IST for HAA. We present the case of a child with severe HAA who underwent LDLT, and who achieved rapid blood cell recovery with IST combined with romiplostim, a thrombopoietin receptor agonist. In addition, despite having undergone LDLT, the patient had no adverse events such as serious liver dysfunction or thrombosis. This case suggests that IST combined with thrombopoietin receptor agonists may be a promising treatment option for HAA patients undergoing LDLT.
  • Yukihiro Sanada, Yasunaru Sakuma, Yasuharu Onishi, Noriki Okada, Naoya Yamada, Yuta Hirata, Go Miyahara, Takumi Katano, Toshio Horiuchi, Takahiko Omameuda, Keiko Ogaki, Shinya Otomo, Alan Kawarai Lefor, Naohiro Sata
    Pediatric transplantation 25 4 e13997  2021年06月 
    BACKGROUND: Complications associated with ultrasonographically guided percutaneous transhepatic liver biopsy (PTLB) after liver transplantation (LT) have been rarely reported, and there is no consensus about its safety. We retrospectively reviewed the safety and outcomes of PTLB after pediatric LT. METHODS: Between January 2008 and December 2019, 8/1122 (0.71%) pediatric patients who underwent ultrasonographically guided PTLB after LT developed complications. The median age at PTLB was 7.8 years (range 0.1-17.9). Grafts included left lobe/left lateral segment in 1050 patients and others in 72. PTLB was performed using local anesthesia±sedation in 1028 patients and general anesthesia in 94. RESULTS: Complications after PTLB included acute cholangitis in 3 patients, sepsis in 2, respiratory failure due to over-sedation in 1, subcapsular hematoma in 1, and intrahepatic arterioportal fistula in 1. The incidence of complications of PTLB in patients with biopsy alone and those with simultaneous interventions was 0.49% and 3.19%, respectively (p = .023). Patients who developed acute cholangitis, respiratory failure, subcapsular hematoma, and arterioportal fistula improved with non-operative management. Of two patients with sepsis, one underwent PTLB and percutaneous transhepatic portal vein balloon dilatation and developed fever and seizures the following day. Sepsis was treated with antibiotic therapy. Another patient who underwent PTLB and exchange of percutaneous transhepatic biliary drainage catheter developed fever and impaired consciousness immediately. Sepsis was treated with antibiotic therapy, mechanical ventilation, and continuous hemofiltration. CONCLUSIONS: Percutaneous transhepatic liver biopsy after pediatric LT is safe. However, combining liver biopsy with simultaneous procedures for vascular and biliary complications is associated with an increased risk of complications.
  • Noriki Okada, Yuta Kawahara, Yukihiro Sanada, Yuta Hirata, Shinya Otomo, Hitomi Niijima, Akira Tanaka, Akira Morimoto, Alan K Lefor, Taizen Urahashi, Yoshikazu Yasuda, Koichi Mizuta, Yasunaru Sakuma, Naohiro Sata
    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2021年04月 
    Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X-linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X-linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux-en-Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X-linked SCID and liver failure.
  • Kanako Omata, Noriki Okada, Go Miyahara, Yuta Hirata, Yukihiro Sanada, Yasuharu Onishi, Shinya Fukuda, Hideki Kumagai, Alan Kawarai Lefor, Yasunaru Sakuma, Naohiro Sata
    Transplantation Proceedings 2021年01月
  • 平田 雄大, 眞田 幸弘, 大西 康晴, 岡田 憲樹, 宮原 豪, 片野 匠, 大豆生田 尚彦, 佐久間 康成, 佐田 尚宏
    移植 55 総会臨時 246 - 246 (一社)日本移植学会 2020年10月
  • 眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 吉田 幸世, 佐田 尚宏
    移植 55 総会臨時 273 - 273 (一社)日本移植学会 2020年10月
  • 大西 康晴, 眞田 幸弘, 佐久間 康成, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 吉田 幸世, 水田 耕一, 佐田 尚宏
    移植 55 総会臨時 342 - 342 (一社)日本移植学会 2020年10月
  • 宮原 豪, 眞田 幸弘, 大豆生田 尚彦, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 大西 康晴, 佐久間 康成, 佐田 尚宏
    移植 55 総会臨時 348 - 348 (一社)日本移植学会 2020年10月
  • Yuta Hirata, Yukihiro Sanada, Takahiko Omameuda, Takumi Katano, Go Miyahara, Naoya Yamada, Noriki Okada, Yasuharu Onishi, Yasunaru Sakuma, Naohiro Sata
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 18 5 612 - 617 2020年10月 
    OBJECTIVES: Predicting the risk of posthepatectomy liver failure is important when performing extended hepatectomy. However, there is no established method to evaluate liver function and improve preoperative liver function in pediatric patients. MATERIALS AND METHODS: We show the clinical features of pediatric patients who underwent living donor liver transplant for posthepatectomy liver failure in hepatoblastoma. The subjects were 4 patients with hepatoblastoma who were classified as Pretreatment Extent of Disease III, 2 of whom had distal metastasis (chest wall and lung). RESULTS: Hepatic right trisegmentectomy was performed in 3 patients and extended left hepatectomy in 1 patient. The median alpha-fetoprotein level at the diagnosis of hepatoblastoma was 986300 ng/mL (range, 22500-2726350 ng/mL), and the median alpha-fetoprotein level before hepatectomy was 8489 ng/mL (range, 23-22500 ng/mL). The remnant liver volume after hepatectomy was 33.3% (range, 20% to 34.9%). Four patients had cholangitis after hepatectomy and progressed to posthepatectomy liver failure. The peak serum total bilirubin after hepatectomy was 11.4 mg/dL (range, 8.7-14.6 mg/dL). Living donor liver transplant was performed for these 4 patients with posthepatectomy liver failure, and they did not have a recurrence. CONCLUSIONS: When the predictive remnant liver volume by computed tomography-volumetry before extended hepatectomy for patients with hepatoblastoma is less than 40%, the possibility of posthepatectomy liver failure should be recognized.
  • 眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 佐田 尚宏
    日本小児外科学会雑誌 56 5 784 - 784 (一社)日本小児外科学会 2020年09月
  • 平田 雄大, 眞田 幸弘, 大西 康晴, 岡田 憲樹, 佐久間 康成, 佐田 尚宏
    日本小児栄養消化器肝臓学会雑誌 34 Suppl. 62 - 62 (一社)日本小児栄養消化器肝臓学会 2020年09月
  • 眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 平田 雄大, 佐田 尚宏
    日本小児栄養消化器肝臓学会雑誌 34 Suppl. 84 - 84 (一社)日本小児栄養消化器肝臓学会 2020年09月
  • 小児肝移植後肝内結石症の診断と治療
    眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 佐田 尚宏
    日本外科学会定期学術集会抄録集 120回 SF - 1 (一社)日本外科学会 2020年08月
  • 脳死肝移植臓器摘出時の工夫 手術室看護師を交えた臓器摘出チーム編成
    大西 康晴, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 巧, 大豆生田 尚彦, 水田 耕一, 佐久間 康成, 佐田 尚宏
    日本外科学会定期学術集会抄録集 120回 DP - 8 (一社)日本外科学会 2020年08月
  • Yuta Hirata, Yukihiro Sanada, Takahiko Omameuda, Takumi Katano, Go Miyahara, Naoya Yamada, Noriki Okada, Yasuharu Onishi, Yasunaru Sakuma, Naohiro Sata
    Surgical case reports 6 1 159 - 159 2020年07月 
    BACKGROUND: There have been no reports on the effectiveness of the administration of antithrombin III (AT III) for post-transplant portal vein thrombosis (PVT). We herein report a case of post-transplant PVT that was resolved by AT III treatment after living donor liver transplantation (LDLT). CASE PRESENTATION: The patient was a 57-year-old man who had been diagnosed with decompensate liver cirrhosis by hepatitis C virus infection. He presented with repeated hepatic coma and refractory ascites. Computed tomography (CT) revealed PVT of Yerdel classification grade II before LDLT. He underwent ABO-identical LDLT using a right lobe graft. A liver function test revealed elevated liver enzyme levels on post-operative day (POD) 14. The CT examination on POD 15 revealed PVT in the left side of the main portal vein at the side of left gastric vein ligation. AT III treatment from POD 15 to POD 24 was performed. Magnetic resonance imaging revealed that the PVT had decreased 10% on POD 27. Furthermore, AT III treatment from POD 28 to POD 32 was performed. The CT examination demonstrated the disappearance of PVT on POD 69 and thereafter, he had no recurrence of PVT on 10 post-operative month (POM). CONCLUSIONS: The present case suggests that the administration of AT III is safe and suitable for the treatment of post-transplant PVT.
  • Itsuki Naya, Yukihiro Sanada, Takumi Katano, Go Miyahara, Yuta Hirata, Naoya Yamada, Noriki Okada, Yasuharu Onishi, Yasunaru Sakuma, Naohiro Sata
    Annals of transplantation 25 e921193  2020年06月 
    BACKGROUND The number of pregnancies after liver transplantation (LT) is increasing; however, the safety and incidence of complications associated with these pregnancies are still unclear. In this report, we retrospectively assessed the influences and problems associated with post-transplant pregnancy on allografts, recipients, and fetuses. MATERIAL AND METHODS A total of 14 pregnancies were identified in 8 female recipients between 2005 and 2018. The original disease was biliary atresia in all recipients. We provide a basic guide for the management of planned pregnancies in female recipients. RESULTS Of the 7 planned pregnancies, no recipients took mycophenolate mofetil (MMF) or had allograft liver dysfunction. Among the 7 unplanned conceptions, we judged that the pregnancy was inadequate to continue in 4 recipients due to taking MMF and 2 recipients due to allograft liver dysfunction at conception. However, 4 recipients who immediately stopped taking MMF continued with their pregnancies. Ten pregnancies resulted in live 11 births. Among obstetric complications or fetal and neonatal complications, gestational diabetes mellitus in 3 recipients was the most common. There were 3 miscarriages and 1 planned termination because of MMF medication and liver dysfunction. CONCLUSIONS Planned pregnancies in LT recipients can lead to the birth of a healthy baby and no influence on either the allograft or the recipient. However, unplanned pregnancies in LT recipients, such as recipients who take MMF or have allograft liver dysfunction, may have an adverse influence on the fetus.
  • 大西 康晴, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 藤原 エリ, 吉田 幸世, 大柿 景子, 大友 慎也, 今井 利美, 水田 耕一, 佐久間 康成, 佐田 尚宏
    日本小児外科学会雑誌 56 2 235 - 235 (一社)日本小児外科学会 2020年04月
  • 岡田 憲樹, 眞田 幸弘, 大豆生田 尚彦, 宮原 豪, 片野 匠, 平田 雄大, 山田 直也, 大西 康晴, 佐久間 康成, 佐田 尚宏
    日本小児栄養消化器肝臓学会雑誌 33 2 147 - 147 (一社)日本小児栄養消化器肝臓学会 2019年12月
  • 眞田 幸弘, 久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 佐田 尚宏
    日本小児栄養消化器肝臓学会雑誌 33 2 150 - 151 (一社)日本小児栄養消化器肝臓学会 2019年12月
  • 片野 匠, 眞田 幸弘, 大豆生田 尚彦, 宮原 豪, 平田 雄大, 岡田 憲樹, 山田 直也, 大西 康晴, 佐久間 康成, 佐田 尚宏
    日本小児栄養消化器肝臓学会雑誌 33 2 165 - 165 (一社)日本小児栄養消化器肝臓学会 2019年12月
  • Takumi Katano, Yukihiro Sanada, Yuta Hirata, Naoya Yamada, Noriki Okada, Yasuharu Onishi, Koshi Matsumoto, Koichi Mizuta, Yasunaru Sakuma, Naohiro Sata
    Pediatric surgery international 35 11 1185 - 1195 2019年11月 
    PURPOSE: Advances in interventional radiology (IVR) treatment have notably improved the prognosis of hepatic vein (HV) and portal vein (PV) complications following pediatric living donor liver transplantation (LDLT); however, graft failure may develop in refractory cases. Although endovascular stent placement is considered for recurrent stenosis, its indications are controversial. METHODS: We enrolled 282 patients who underwent pediatric LDLT in our department from May 2001 to September 2016. RESULTS: 22 (7.8%) HV complications occurred after LDLT. Recurrence was observed in 45.5% of the patients after the initial treatment, and 2 patients (9.1%) underwent endovascular stent placement. The stents were inserted at 8 months and 3.8 years following LDLT, respectively. After stent placement, both patients developed thrombotic obstruction and are currently being considered for re-transplantation. 40 (14.2%) PV complications occurred after LDLT. Recurrence occurred in 27.5% of the patients after the initial treatment, and 4 patients (10.0%) underwent endovascular stent treatment. The stents of all the patients remained patent, with an average patency duration of 41 months. CONCLUSION: Endovascular stent placement is an effective treatment for intractable PV complications following pediatric LDLT. However, endovascular stent placement for HV complications should be carefully performed because of the risk of intrastent thrombotic occlusion and the possibility of immunological venous injury.
  • 眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 大豆生田 尚彦, 横山 健介, 矢野 智則, 山本 博徳, 佐田 尚宏
    胆道 33 3 604 - 604 日本胆道学会 2019年10月
  • 岡田 憲樹, 寺谷 工, 眞田 幸弘, 大西 康晴, 菱川 修司, 佐久間 康成, 佐田 尚宏
    Organ Biology 26 3 93 - 93 (一社)日本臓器保存生物医学会 2019年10月
  • 眞田 幸弘, 佐久間 康成, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 宮原 豪, 片野 匠, 藤原 エリ, 吉田 幸世, 佐田 尚宏
    移植 54 総会臨時 152 - 152 (一社)日本移植学会 2019年09月
  • 岡田 憲樹, 眞田 幸弘, 宮原 豪, 片野 匠, 平田 雄大, 山田 直也, 大西 康晴, 今井 利美, 大友 慎也, 大柿 景子, 吉田 幸世, 藤原 エリ, 佐久間 康成, 佐田 尚宏
    移植 54 総会臨時 187 - 187 (一社)日本移植学会 2019年09月
  • 大西 康晴, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 宮原 豪, 藤原 エリ, 吉田 幸世, 大柿 景子, 大友 慎也, 今井 利美, 水田 耕一, 佐久間 康成, 佐田 尚宏
    移植 54 総会臨時 251 - 251 (一社)日本移植学会 2019年09月
  • 井原 欣幸, 大西 康晴, 眞田 幸弘, 岡田 憲樹, 平田 雄太, 佐久間 康成, 水田 耕一
    移植 54 総会臨時 256 - 256 (一社)日本移植学会 2019年09月
  • 小俣 佳菜子, 岡田 憲樹, 宮原 豪, 眞田 幸弘, 大西 康晴, 福田 真也, 小高 淳, 桑島 真理, 山形 崇倫, 笠原 群生, 佐久間 康成, 佐田 尚宏
    移植 54 総会臨時 269 - 269 (一社)日本移植学会 2019年09月
  • 平田 雄大, 眞田 幸弘, 大西 康晴, 岡田 憲樹, 山田 直也, 宮原 豪, 片野 匠, 大豆生田 尚彦, 水田 耕一, 佐久間 康成, 佐田 尚宏
    移植 54 総会臨時 270 - 270 (一社)日本移植学会 2019年09月
  • Yukihiro Sanada, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Yoshiyuki Ihara, Koichi Mizuta
    Transplantation 103 9 1863 - 1870 2019年09月 
    BACKGROUND: We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation, focusing on the risk factors, treatments, and long-term prognosis for posttransplant biliary complications (BCs). METHODS: Between May 2001 and December 2017, 290 living donor liver transplantations were performed. The median age was 1.4 years old. The median observation period was 8.4 years. Biliary strictures were classified as anastomotic stricture (AS) or non-AS (NAS). RESULTS: Overall incidence of biliary complications was 18.6%, including AS in 46 cases, NAS in 6, and other classifications in 2. The mean period to diagnosis of the AS was 641 ± 810 postoperative days. The multivariate analysis showed that hepaticojejunostomy without external stent was an independent risk factor for AS (P = 0.011). The first treatments for AS were percutaneous transhepatic biliary drainage (PTBD) in 25 cases, double-balloon enteroscopy (DBE) in 19, and surgical reanastomosis in 2. The success and recurrence rates of PTBD treatments were 90.9% and 22.7%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 93.6% and 75.3%, respectively. The 15-year graft survival rates in patients with and without AS were 95.7% and 89.1%, respectively (P = 0.255), but 2 patients with cholangitis due to multiple NAS underwent retransplantation. CONCLUSIONS: Posttransplant AS can be prevented by hepaticojejunostomy using external stent, and the long-term prognosis is good with early treatments using DBE or PTBD. However, the prognosis of multiple NAS is poor.
  • 眞田 幸弘, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 水田 耕一
    日本小児外科学会雑誌 55 5 1010 - 1010 (一社)日本小児外科学会 2019年08月
  • 生後3ヵ月以内の乳児に施行した生体肝移植 ハイリスク小児肝移植への挑戦
    大西 康晴, 眞田 幸弘, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 佐久間 康成, 水田 耕一
    日本消化器外科学会総会 74回 O22 - 1 (一社)日本消化器外科学会 2019年07月
  • 【肝胆膵】肝移植と合併症対策 当施設における小児生体肝移植後胆管合併症の現状と治療成績
    眞田 幸弘, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 大西 康晴, 佐久間 康成, 佐田 尚宏, 水田 耕一
    日本消化器外科学会総会 74回 WS12 - 5 (一社)日本消化器外科学会 2019年07月
  • Okada N, Sanada Y, Onishi Y, Urahashi T, Ihara Y, Yamada N, Hirata Y, Katano T, Imai T, Ushijima K, Ogaki K, Otomo S, Mizuta K
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 25 7 1066 - 1073 2019年07月 [査読有り][通常論文]
     
    Early relaparotomy of adult recipients after living donor liver transplantation (LDLT) is significantly associated with poor prognosis. However, there are few reports focusing on pediatric recipients after LDLT. The aim of this study is to clarify the causes and outcomes of early relaparotomy after pediatric LDLT. A total of 265 pediatric recipients (272 LDLTs) transplanted from May 2001 to October 2015 were retrospectively analyzed. Early relaparotomy was defined as surgical intervention performed within 3 months after LDLT. Early relaparotomy was performed 49 times for 33 recipients (12.5%). The recipient and graft survival rates in the early relaparotomy group were significantly lower than those in the nonearly relaparotomy group, respectively (75.0% and 63.6% versus 96.6% and 95.8%; both P < 0.001). Left lateral segment grafts were used significantly more frequently in the nonrelaparotomy group (P = 0.01). According to the multivariate analysis, the preoperative Pediatric End-Stage Liver Disease (PELD)/Model for End-Stage Liver Disease (MELD) score of the early relaparotomy group was significantly higher than that of the nonearly relaparotomy group (13.7 versus 6.3; P = 0.04). According to the receiver operating characteristic curve, the preoperative PELD/MELD score cutoff point was 17.2. Early relaparotomy due to infectious causes led to significantly poorer graft survival than that due to noninfectious causes (P = 0.04). In conclusion, the recipient and graft survival rates of the early relaparotomy group were significantly lower than those of the nonearly relaparotomy group. A high preoperative PELD/MELD score was a risk factor for early relaparotomy. In particular, early relaparotomy due to infection showed a poor prognosis.
  • Yukihiro Sanada, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Yasuharu Onishi, Yoshikazu Yasuda, Koichi Mizuta
    Clinical transplantation 33 6 e13570  2019年06月 
    BACKGROUND: We present a retrospective analysis of our experience with pediatric liver transplantation (LT), focusing on the long-term outcome of percutaneous transhepatic biliary drainage (PTBD) for post-transplant biliary strictures. METHODS: Fifty-three PTBDs were performed for 41 pediatric recipients with biliary strictures. The median ages at LT and PTBD were 1.4 and 4.4 years, respectively. The median observation period was 10.6 years. RESULTS: Post-transplant biliary strictures comprised anastomotic stricture (AS) in 28 cases, nonanastomotic stricture (NAS) in 12, anastomotic obstruction (AO) in 8, and nonanastomotic obstruction (NAO) in 5. The success rate of PTBD was 90.6%, and the 15-year primary patency rate of PTBD was 52.6%. The recurrence rate of biliary strictures after PTBD was 18.8% (9/48), and among the four NAS cases with recurrence, two underwent re-LT. The biliary obstruction rate was 27.1% (13/48). Among the eight cases with AO, five underwent the rendezvous method and three underwent surgical re-anastomosis. Among the five cases with NAO, one underwent re-LT. The recipient survival rate of PTBD treatment was 100%. CONCLUSIONS: The graft prognosis of AS by PTBD treatment is good and AO is curable by the rendezvous method and surgical re-anastomosis. However, the graft prognosis of NAS and NAO is poor.
  • 大友 慎也, 大柿 景子, 水田 耕一, 大西 康晴, 眞田 幸弘, 山田 直也, 岡田 憲樹, 平田 雄大, 牛島 健太郎, 森澤 雄司, 須藤 俊明
    TDM研究 36 2 73 - 73 (一社)日本TDM学会 2019年05月
  • 井原 欣幸, 大西 康晴, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    日本小児外科学会雑誌 55 3 570 - 570 (一社)日本小児外科学会 2019年05月
  • 眞田 幸弘, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 大豆生田 尚彦, 水田 耕一
    日本小児外科学会雑誌 55 3 592 - 592 (一社)日本小児外科学会 2019年05月
  • 平田 雄大, 眞田 幸弘, 大西 康晴, 山田 直也, 岡田 憲樹, 片野 匠, 大豆生田 尚彦, 水田 耕一
    日本小児外科学会雑誌 55 3 669 - 669 (一社)日本小児外科学会 2019年05月
  • 小児肝移植後胆道合併症に対する胆管空腸再吻合術
    眞田 幸弘, 安田 是和, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 大西 康晴, 水田 耕一
    日本外科学会定期学術集会抄録集 119回 PS - 1 (一社)日本外科学会 2019年04月
  • 生体肝移植後グラフト不全に対する再肝移植 特に血管吻合に関する検討
    大西 康晴, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 片野 匠, 山田 直也, 井原 欣幸, 菱川 修司, 浦橋 泰然, 水田 耕一
    日本外科学会定期学術集会抄録集 119回 PS - 6 (一社)日本外科学会 2019年04月
  • Yukihiro Sanada, Shuji Hishikawa, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Koichi Mizuta
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 25 3 510 - 514 2019年03月
  • Yukihiro Sanada, Itsuki Naya, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Yoshiyuki Ihara, Yasuharu Onishi, Koichi Mizuta
    Pediatric transplantation 23 2 e13352  2019年03月 
    BACKGROUND: Intracranial and pulmonary vascular anomalies are well-known complications and causes of mortality in AGS; however, visceral artery anomalies are less commonly recognized. Herein, we present a retrospective analysis of our experience with pediatric LDLT that focuses on the current problems with and treatments for visceral artery anomalies in AGS after LDLT. METHODS: Between May 2001 and December 2017, 294 LDLTs were performed for 285 pediatric recipients. Of these, 13 LDLTs (4.4%) for 12 AGS patients were performed. We classified the visceral artery anomalies into aneurysms and stenosis. RESULTS: The overall incidence of visceral aneurysm was 2 of 12 recipients (16.7%) and included a SMA aneurysm in one patient and an IPDA aneurysm with a subsequent SPA aneurysm in one patient; the ages of the diagnosis of visceral aneurysm were 16.3, 21.1, and 21.7 y, respectively. An endovascular treatment was performed for a progressive IPDA saccular aneurysm (12.0 × 14.5 × 15.0 mm). The overall incidence of visceral artery stenosis was 7 of 12 recipients (58.3%) and the median age at the diagnosis of visceral artery stenosis was 15.5 y (range 1.7-22.9 y). All 3 AGS patients with RA stenosis suffered from renal dysfunction (eGFR of 51, 78, and 51 mL/min/1.73m2 ). CONCLUSION: The morbidity of visceral artery anomalies is not negligible. The performance of periodic imaging examinations is necessary, even for infants, because it is difficult to detect visceral vascular anomalies in the infant stage.
  • FosfluconazoleによりTacrolimusの代謝阻害を認めた肝移植症例
    大柿 景子, 大友 慎也, 今関 稔, 鈴木 潤, 秋根 大, 大西 翼, 笹原 鉄平, 森澤 雄司, 須藤 俊明, 水田 耕一, 大西 康晴, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 今井 利美
    日本化学療法学会雑誌 67 Suppl.A 258 - 258 (公社)日本化学療法学会 2019年03月 [査読有り][通常論文]
  • Yamada N, Katano T, Hirata Y, Okada N, Sanada Y, Ihara Y, Urahashi T, Ushijima K, Karasawa T, Takahashi M, Mizuta K
    Journal of gastroenterology and hepatology 34 2 418 - 424 2019年02月 [査読有り][通常論文]
     
    BACKGROUND AND AIM: Serum Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel fibrosis marker for various chronic liver diseases. We investigated the ability of M2BPGi to predict liver fibrosis in liver transplant (LT) recipients. METHODS: A total of 116 liver biopsies were performed in 113 LT recipients. The serum level of M2BPGi was also measured on the same day. The median age at LT and liver biopsy was 1.1 and 11.8 years, respectively. Serum M2BPGi levels and liver fibrosis status using METAVIR fibrosis score were compared. Immunohistological evaluation by anti-α-smooth-muscle actin (αSMA) was performed, and the relationship between αSMA positive rate and serum M2BPGi levels was investigated. RESULTS: The median M2BPGi level was 0.78 (range, 0.22-9.50), and 65, 29, 16, 5, and 1 patient(s) had METAVIR fibrosis scores of F0, F1, F2, F3, and F4, respectively. In patients with F0 fibrosis, median M2BPGi level was 0.69 and was significantly lower than in patients with F1 (median 0.99, P < 0.01), F2 (median 1.00, P = 0.01), and F3 fibrosis (median 1.53, P < 0.01). Area-under-the-curve analysis of the ability of M2BPGi level to predict liver fibrosis grade were > F1: 0.716, > F2: 0.720, and > F3: 0.900. Three patients with acute cellular rejection showed high levels of M2BPGi, which decreased after the treatment. A positive correlation existed between M2BPGi levels and αSMA positive rate (r2  = 0.715, P < 0.01). CONCLUSION: Mac-2 binding protein glycosylation isomer is a novel liver fibrosis marker in LT recipients and is also increased in patients with acute liver injuries, especially acute cellular rejection, even when fibrosis is absent.
  • 腎機能障害をきっかけにCefmetazoleによる凝固異常を認めた肝移植後小児の経験
    大友 慎也, 今関 稔, 笹原 鉄平, 森澤 雄司, 須藤 俊明, 大柿 景子, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 片野 匠, 牛島 健太郎, 今井 利美
    日本化学療法学会雑誌 67 1 130 - 130 (公社)日本化学療法学会 2019年01月
  • 小児肝移植後の急性拒絶に対して高用量グロブリン療法を用いた一症例
    大柿 景子, 大友 慎也, 牛島 健太郎, 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 平田 雄大, 山田 直也, 岡田 憲樹, 片野 匠, 須藤 俊明
    日本小児臨床薬理学会雑誌 31 1 191 - 191 日本小児臨床薬理学会 2019年
  • 平田 雄大, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    日本小児外科学会雑誌 54 7 1414 - 1415 (一社)日本小児外科学会 2018年12月
  • 平田 雄大, 眞田 幸弘, 井原 欣幸, 山田 直也, 岡田 憲樹, 片野 匠, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 32 2 152 - 152 (一社)日本小児栄養消化器肝臓学会 2018年12月
  • 水田 耕一, 岡田 憲樹, 平田 雄大, 眞田 幸弘, 井原 欣幸, 佐々木 愛子
    日本小児栄養消化器肝臓学会雑誌 32 2 155 - 155 (一社)日本小児栄養消化器肝臓学会 2018年12月
  • Yukihiro Sanada, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Yoshiyuki Ihara, Keiko Ogaki, Shinya Otomo, Toshimi Imai, Kentraro Ushijima, Koichi Mizuta
    Transplant international : official journal of the European Society for Organ Transplantation 31 11 1216 - 1222 2018年11月 
    There are few long-term outcome reports for interventional radiology (IVR) treatments for vascular and biliary complications following pediatric living donor liver transplantation (LDLT). Herein, we presented our institution's experience and investigated the efficacy and issues of long-term outcome with IVR treatments. Between May 2001 and September 2016, 279 pediatric LDLTs were performed. The median age at LDLT was 1.4 years old, and the median observation period was 8.2 years. All the biliary reconstructions at LDLT were hepaticojejunostomy. The IVR treatments were selected as endovascular, radiological, or endoscopic interventions. Post-transplant hepatic vein, portal vein, hepatic artery, and biliary complications were present in 7.9%, 14.0%, 5.4%, and 18.3%, respectively. IVR treatment was the first treatment option in 81.8%, 94.9%, 46.7%, and 94.1%, respectively. The recurrence and cure rates following IVR treatment were 42.1%, 21.1%, 44.4%, and 34.0% and 84.2%, 97.4%, 100%, and 88.0%, respectively. The graft survival rates in patients with and without post-transplant vascular and biliary complications were 94.4% and 90.6%, respectively (P = 0.522). The IVR treatments for vascular and biliary complications following pediatric LDLT are the first choice option. Although the recurrence following IVR treatment is a major problem and it is necessary to carefully perform long-term follow-up, IVR treatments have good treatment outcomes.
  • Takumi Katano, Yukihiro Sanada, Noriki Okada, Koichi Mizuta
    Pediatrics international : official journal of the Japan Pediatric Society 60 11 1033 - 1034 2018年11月
  • 小児肝移植の現状とチャレンジ 小児生体肝移植術 術式の現状と今後の課題
    浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 菊地 健太, 五十嵐 昭宏, 池田 均, 水田 耕一
    日本臨床外科学会雑誌 79 増刊 326 - 326 日本臨床外科学会 2018年10月
  • 水田 耕一, 眞田 幸弘, 井原 欣幸, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 牛島 健太郎, 今井 利美, 大友 慎也, 大柿 景子, 吉田 幸世, 尾沼 恵梨香, 藤原 エリ
    日本小児栄養消化器肝臓学会雑誌 32 Suppl. 38 - 38 (一社)日本小児栄養消化器肝臓学会 2018年09月
  • 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 吉田 幸世, 尾沼 恵里香, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 32 Suppl. 61 - 61 (一社)日本小児栄養消化器肝臓学会 2018年09月
  • 眞田 幸弘, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 32 Suppl. 61 - 61 (一社)日本小児栄養消化器肝臓学会 2018年09月
  • 岡田 憲樹, 眞田 幸弘, 井原 欣幸, 山田 直也, 平田 雄大, 片野 匠, 佐々木 愛子, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 32 Suppl. 63 - 63 (一社)日本小児栄養消化器肝臓学会 2018年09月
  • 水田 耕一, 眞田 幸弘, 井原 欣幸, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 菊地 健太, 片野 匠, 牛島 健太郎, 今井 利美, 大友 慎也, 大柿 景子, 吉田 幸世, 尾沼 恵梨香, 藤原 エリ
    移植 53 総会臨時 285 - 285 (一社)日本移植学会 2018年09月
  • 岡田 憲樹, 眞田 幸弘, 大西 康晴, 井原 欣幸, 山田 直也, 平田 雄大, 片野 匠, 大友 慎也, 大柿 景子, 今井 利美, 牛島 健太郎, 尾沼 恵梨香, 吉田 幸世, 水田 耕一
    移植 53 総会臨時 401 - 401 (一社)日本移植学会 2018年09月
  • 片野 匠, 眞田 幸弘, 平田 雄大, 岡田 憲樹, 山田 直也, 井原 欣幸, 大西 康晴, 今井 利美, 牛島 健太郎, 大柿 景子, 大友 慎也, 水田 耕一
    移植 53 総会臨時 401 - 401 (一社)日本移植学会 2018年09月
  • 眞田 幸弘, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 水田 耕一
    移植 53 総会臨時 403 - 403 (一社)日本移植学会 2018年09月
  • 納屋 樹, 眞田 幸弘, 尾沼 恵梨香, 吉田 幸世, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 水田 耕一
    移植 53 総会臨時 408 - 408 (一社)日本移植学会 2018年09月
  • 吉田 幸世, 横塚 幸代, 尾沼 恵梨香, 井原 欣幸, 眞田 幸弘, 大西 康晴, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 高久 美子, 水田 耕一
    移植 53 総会臨時 461 - 461 (一社)日本移植学会 2018年09月
  • 生体肝移植周術期における血清プレセプシンの測定意義
    眞田 幸弘, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 浦橋 泰然, 水田 耕一
    日本消化器外科学会総会 73回 376 - 376 (一社)日本消化器外科学会 2018年07月
  • 低体重児に対する生体肝移植における過大グラフトへの対応
    岡田 憲樹, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 平田 雄大, 片野 匠, 牛島 健太郎, 大友 慎也, 水田 耕一
    日本消化器外科学会総会 73回 952 - 952 (一社)日本消化器外科学会 2018年07月
  • 生体肝移植における皮下注用人免疫グロブリン製剤の治療効果
    平田 雄大, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 片野 匠, 水田 耕一
    日本消化器外科学会総会 73回 991 - 991 (一社)日本消化器外科学会 2018年07月
  • 平田 雄大, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 片野 匠, 水田 耕一
    日本小児外科学会雑誌 54 3 804 - 804 (一社)日本小児外科学会 2018年05月
  • 納屋 樹, 眞田 幸弘, 片野 匠, 平田 雄大, 岡田 憲樹, 山田 直也, 井原 欣幸, 浦橋 泰然, 水田 耕一
    移植 53 1 57 - 62 (一社)日本移植学会 2018年05月 
    症例2は22歳男性で、Alagille症候群(AGS)の診断で内科的治療を開始した。13歳時に肝硬変の進行を認め、14歳時に母親をドナーとする生体肝移植を施行した。21歳時の定期腹部造影CTで下膵十二指腸動脈(IPDA)、脾動脈(SPA)に動脈瘤を指摘された。IPDA瘤は嚢状で進行性であったことから、経大腿動脈的コイル塞栓術(IVR)を施行した。術後経過に問題はなかった。SPA動脈瘤に関しては進行性ではないため経過観察とした。症例2は17歳女性で、出生直後にAGSと診断され、以降内科的治療を開始した肝硬変の進行を認めたため、1歳時に母親をドナーとする生体肝移植を施行したが、難治性肝静脈狭窄によるグラフト不全を合併した。2歳時に祖母をドナーとする生体再肝移植を施行した。16歳時の定期CTにてSMAに動脈瘤を指摘された。SMA動脈瘤は緩徐に進行性であるが、SMA動脈の本幹かつ紡錘状であるため、経過観察とした。
  • Sanada Y, Yano T, Urahashi T, Ihara Y, Okada N, Yamada N, Hirata Y, Katano T, Yamamoto H, Mizuta K
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 24 3 436 - 439 2018年03月 [査読有り][通常論文]
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    外科 80 2 131 - 137 (株)南江堂 2018年02月 
    胆道閉鎖症への治療として開始された本邦の小児生体肝移植は,開始から28年,症例数は2,900例を超え標準的治療として定着した.胆道閉鎖症では思春期症例の移植後長期フォローアップが,肝芽腫ではアジュバンド化学療法の確立が治療成績に向上には重要である.小児における脳死肝移植が不十分なわが国においては,メープルシロップ尿症の摘出肝を用いた生体ドミノ肝移植や,オルニチントランスカルバミラーゼ(OTC)欠損症保因者ドナーによる生体肝移植は考慮する価値のある選択肢の一つである.(著者抄録)
  • 眞田 幸弘, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 浦橋 泰然, 水田 耕一
    小児外科 50 1 91 - 95 (株)東京医学社 2018年01月
  • 眞田 幸弘, 納屋 樹, 片野 匠, 平田 雄大, 岡田 憲樹, 山田 直也, 井原 欣幸, 浦橋 泰然, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 31 2 99 - 99 (一社)日本小児栄養消化器肝臓学会 2017年12月
  • 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 水田 耕一
    移植 52 4-5 426 - 427 (一社)日本移植学会 2017年11月
  • 吉田 幸世, 尾沼 恵梨香, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    移植 52 4-5 464 - 465 (一社)日本移植学会 2017年11月
  • 尾沼 恵梨香, 眞田 幸弘, 吉田 幸世, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    移植 52 4-5 465 - 465 (一社)日本移植学会 2017年11月
  • ここを工夫した私の手術手技(肝胆)[小児] 小児肝移植における胆道再建
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    日本臨床外科学会雑誌 78 増刊 440 - 440 日本臨床外科学会 2017年10月
  • Noriki Okada, Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Naoya Yamada, Yuta Hirata, Takumi Katano, Kentaro Ushijima, Shinya Otomo, Shujiro Fujita, Koichi Mizuta
    WORLD JOURNAL OF GASTROENTEROLOGY 23 40 7337 - 7342 2017年10月 [査読有り][通常論文]
     
    We report a case involving a rescued low birth weight infant (LBWI) with acute liver failure. Case: The patient was 1594 g and 323/7 gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation (LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.
  • 眞田 幸弘, 片野 匠, 岡田 憲樹, 山田 直也, 井原 欣幸, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 31 Suppl. 113 - 113 (一社)日本小児栄養消化器肝臓学会 2017年09月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 31 Suppl. 114 - 114 (一社)日本小児栄養消化器肝臓学会 2017年09月
  • OTC欠損症肝移植例における血漿アミノ酸分析
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    日本先天代謝異常学会雑誌 33 170 - 170 日本先天代謝異常学会 2017年09月
  • 移植後における免疫寛容の誘導 小児肝移植における臨床的免疫寛容の検討
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    移植 52 総会臨時 254 - 254 (一社)日本移植学会 2017年08月
  • 脳死分割肝移植における臓器分配システムへの提言 J-SPLIT(Japanese Split Liver Transport)Scoreによる分配基準の導入
    浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 水田 耕一
    移植 52 総会臨時 374 - 374 (一社)日本移植学会 2017年08月
  • 生体肝移植後に腹部内臓動脈瘤が判明したAlagille症候群の2例
    納屋 樹, 眞田 幸弘, 片野 匠, 平田 雄大, 岡田 憲樹, 山田 直也, 井原 欣幸, 浦橋 泰然, 中村 仁康, 杉本 英治, 水田 耕一
    移植 52 総会臨時 379 - 379 (一社)日本移植学会 2017年08月
  • 小児肝移植におけるきょうだいへの支援 絵本によるきょうだいへの説明に向けて
    吉田 幸世, 尾沼 恵梨香, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 水田 耕一
    移植 52 総会臨時 386 - 386 (一社)日本移植学会 2017年08月
  • 生体肝移植における皮下注用人免疫グロブリン製剤の使用経験
    平田 雄大, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    移植 52 総会臨時 394 - 394 (一社)日本移植学会 2017年08月
  • 生体肝移植ドナーの左外側区域切除後にS4肝膿瘍を合併した一例
    大豆生田 尚彦, 眞田 幸弘, 佐久間 康成, 片野 匠, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 浦橋 泰然, 佐田 尚宏, 水田 耕一
    移植 52 総会臨時 466 - 466 (一社)日本移植学会 2017年08月
  • 小児生体肝移植後早期再開腹症例の検討
    岡田 憲樹, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 平田 雄大, 片野 匠, 牛島 健太郎, 大友 慎也, 水田 耕一
    日本消化器外科学会総会 72回 PN15 - 2 (一社)日本消化器外科学会 2017年07月
  • 小児生体肝移植後肝静脈・門脈狭窄に対する血管内ステント治療の成績とその適応
    片野 匠, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 牛島 健太郎, 大友 慎也, 水田 耕一
    日本消化器外科学会総会 72回 PN15 - 5 (一社)日本消化器外科学会 2017年07月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    日本小児外科学会雑誌 53 3 575 - 575 (一社)日本小児外科学会 2017年05月
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    日本小児外科学会雑誌 53 2 343 - 343 (一社)日本小児外科学会 2017年04月
  • 肝移植後のMac-2 Binding Protein Glycosylation isomer測定意義と上昇メカニズムの検討
    山田 直也, 眞田 幸弘, 岡田 憲樹, 浦橋 泰然, 水田 耕一
    肝臓 58 Suppl.1 A358 - A358 (一社)日本肝臓学会 2017年04月
  • 山田 直也, 眞田 幸弘, 浦橋 泰然, 井原 欣志, 岡田 憲樹, 平田 雄大, 田代 昌久, 水田 耕一
    日本小児外科学会雑誌 53 1 161 - 161 (一社)日本小児外科学会 2017年02月
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 片野 匠, 水田 耕一
    日本小児外科学会雑誌 53 1 162 - 162 (一社)日本小児外科学会 2017年02月
  • 片野 匠, 山田 直也, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 田代 昌久, 佐久間 康成, 笹沼 英紀, 安田 是和, 水田 耕一
    日本小児外科学会雑誌 53 1 163 - 163 (一社)日本小児外科学会 2017年02月
  • Yukihiro Sanada, Shuji Hishikawa, Noriki Okada, Naoya Yamada, Takumi Katano, Yuta Hirata, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta
    LANGENBECKS ARCHIVES OF SURGERY 402 1 123 - 133 2017年02月 [査読有り][通常論文]
     
    When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT. Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion. Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 +/- 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 +/- 0.4 and 1.9 +/- 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001). Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
  • Naoya Yamada, Yukihiro Sanada, Masahisa Tashiro, Yuta Hirata, Noriki Okada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta
    JOURNAL OF GASTROENTEROLOGY 52 2 245 - 252 2017年02月 [査読有り][通常論文]
     
    Background and Aim Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) is a novel fibrosis marker. We examined the ability of M2BPGi to predict liver fibrosis in patients with biliary atresia. Methods Sixty-four patients who underwent living donor liver transplantation (LDLT) were included [ median age, 1.1 years (range 0.4-16.0), male 16 patients (25.0 %)]. We examined M2BPGi levels in serum obtained the day before LDLT, and we compared the value of the preoperative M2BPGi levels with the histological evaluation of fibrosis using the METAVIR fibrosis score. Subsequently, we assessed the ability of M2BPGi levels to predict fibrosis. Results The median M2BPGi level in patients with BA was 6.02 (range, 0.36-20.0), and 0, 1, 1, 11, and 51 patients had METAVIR fibrosis scores of F0, F1, F2, F3, and F4, respectively. In patients with F4 fibrosis, the median M2BPGi level was 6.88 (quartile; 5.235, 12.10), significantly higher than that in patients with F3 fibrosis who had a median level of 2.42 (quartile; 1.93, 2.895, p < 0.01). Area under the curve analysis for the ability of M2BPGi level to predict grade fibrosis was 0.917, with a specificity and sensitivity of 0.923 and 0.941, respectively. In comparison with other fibrosis markers such as hyaluronic acid, procollagen-III-peptide, type IV collagen 7 s, and aspartate aminotransferase platelet ratio index, M2BPGi showed the strongest ability to predict grade F4 fibrosis. Conclusion M2BPGi is a novel fibrosis marker for evaluating the status of the liver in patients with BA, especially when predicting grade F4 fibrosis.
  • 岡田 憲樹, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 平田 雄大, 片野 匠, 牛島 健太郎, 大友 慎也, 藤田 秀次郎, 小浦 詩, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 30 2 94 - 95 (一社)日本小児栄養消化器肝臓学会 2016年12月
  • Yamada N, Sanada Y, Katano T, Tashiro M, Hirata Y, Okada N, Ihara Y, Miki A, Sasanuma H, Urahashi T, Sakuma Y, Mizuta K
    World journal of gastroenterology 22 44 9865 - 9870 2016年11月 [査読有り][通常論文]
     
    This is the first report of living donor liver transplantation (LDLT) for congenital hepatic fibrosis (CHF) using a mother's graft with von Meyenburg complex. A 6-year-old girl with CHF, who suffered from recurrent gastrointestinal bleeding, was referred to our hospital for liver transplantation. Her 38-year-old mother was investigated as a living donor and multiple biliary hamartoma were seen on her computed tomography and magnetic resonance imaging scan. The mother's liver function tests were normal and she did not have any organ abnormality, including polycystic kidney disease. LDLT using the left lateral segment (LLS) graft from the donor was performed. The donor LLS graft weighed 250 g; the graft recipient weight ratio was 1.19%. The operation and post-operative course of the donor were uneventful and she was discharged on post-operative day (POD) 8. The graft liver function was good, and the recipient was discharged on POD 31. LDLT using a graft with von Meyenburg complex is safe and useful. Long-term follow-up is needed with respect to graft liver function and screening malignant tumors.
  • Urahashi T, Ihara Y, Sanada Y, Okada N, Yamada N, Hirata Y, Katano T, Mizuta K
    Clinical transplantation 30 11 1425 - 1432 2016年11月 [査読有り][通常論文]
     
    A temporary portocaval shunt (TPCS) associated with retrohepatic vena cava preservation prevents the edema caused by splanchnic congestion during liver transplantation (LT), especially for non-cirrhotic cases. We herein report a modified TPCS technique using the recanalized umbilical vein and an end-to-side recanalized umbilico-caval anastomosis for use during pediatric living donor liver transplantation (LDLT). This work evaluated a group of pediatric patients who underwent LDLT between 2001 and 2014 with the conventional TPCS (n=16) vs the recanalized umbilico-caval shunt (the crossed fingers method, n=10). The crossed fingers method was performed by suturing an end-to-side anastomosis of the patent or recanalized umbilical vein to the vena cava using a continuous monofilament suture like "crossing the fingers," that is, placing the left portal vein across the portal vein trunk next to it. The preoperative, surgical, and postoperative characteristics were similar in both groups except for the significantly shorter portal vein clamping time for the crossed fingers method. This method can allow the portal circulation to be totally decompressed before and after implanting the graft and while maintaining the hemodynamic stability throughout all stages of pediatric LDLT.
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    小児内科 48 10 1496 - 1501 (株)東京医学社 2016年10月
  • 平田 雄大, 井原 欣幸, 岡田 憲樹, 眞田 幸弘, 水田 耕一
    日本小児外科学会雑誌 52 6 1236 - 1240 (一社)日本小児外科学会 2016年10月 
    肺転移に代表される肝外病変を認める切除不能型肝芽腫に対する移植の適応や時期は、未だ確立していない。肺転移を認めた切除不能型肝芽腫に対する生体肝移植の2例を経験したので報告する。症例1は4歳時に肺腫瘤影を指摘され、肝芽腫(PRETEXT IV、肺転移あり)と診断された。肺病変切除と化学療法後、5歳時に生体肝移植を施行した。症例2は発熱、腹部膨満、肝脾腫を指摘され、肝芽腫(PRETEXT IV、肺転移あり)と診断された。化学療法後に右肺病変を切除し、化学療法再開後に左肺病変を消失し、2歳時に生体肝移植を施行した。2症例で術後AFPは正常化を認めた。症例1は術後2年間再発所見なく外来通院中である。症例2は術後経過良好であったが、術後17日目に突然死した。診断時に肺転移を認める症例でも外科的切除と化学療法により腫瘍のviabilityをコントロールできれば肝移植で救命できる可能性はあると考えられた。(著者抄録)
  • 尾沼 恵梨香, 眞田 幸弘, 吉田 幸世, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    移植 51 4-5 405 - 410 (一社)日本移植学会 2016年10月 
    生体肝移植を施行した新生児劇症肝不全8例(男児3名、女児5名、9〜59日)と、それ以外の128例(男児55名、女児73名、1〜26歳)を対象とした。新生児劇症肝炎8例の原疾患は、新生児ヘモクロマトーシス(NH)6例、原因不明1例、Niemann-Pick病C型1例であった。新生児劇症肝不全症例以外の128例の原疾患は、胆道閉鎖症91例、オルニチントランスカルバミラーゼ9例、アラジール症候群5例、グラフト不全4例、肝芽腫3例、門脈還流異常症3例、メープルシロップ尿症3例、ウィルソン病2例、シトルリン血症2例、原発性硬化性胆管炎2例、先天性肝線維症1例、肝graft-versus-host-disease 1例、メチルマロン酸血症1例、肝硬変1例であった。新生児劇症肝炎症例はそれ以外の症例に比べ入院期間が有意に長く、神経学的後遺症の頻度も多かった。
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 牛島 健太郎, 大友 慎也, 水田 耕一
    日本外科感染症学会雑誌 13 5 551 - 551 (一社)日本外科感染症学会 2016年10月
  • Okada N, Ihara Y, Urahashi T, Sanada Y, Yamada N, Hirata Y, Tashiro M, Katano T, Ushijima K, Otomo S, Takahashi H, Matsubara S, Mizuta K
    Pediatrics international : official journal of the Japan Pediatric Society 58 10 1059 - 1061 2016年10月 [査読有り][通常論文]
     
    Neonatal hemochromatosis (NH) is a rare disease with a poor prognosis, particularly prior to 2008. Antenatal maternal high-dose immunoglobulin (Ig) is effective in preventing NH recurrence, but the adverse effects of this treatment have not been documented as yet. Here, we report on a patient who underwent high-dose Ig treatment to prevent NH recurrence. The patient was a 31-year-old pregnant Japanese woman. Her first child died of NH after receiving living donor liver transplantation. The patient received high-dose Ig treatment to prevent recurrence of NH from gestational weeks 16 to 35. During the treatment, platelet count gradually decreased, and cesarean section was required at 35 gestational weeks. The child did not develop liver failure. High-dose Ig prevented the recurrence of NH. Caution should be exercised due to possible adverse effects of this treatment.
  • Sanada Y, Sakuma Y, Sasanuma H, Miki A, Katano T, Hirata Y, Okada N, Yamada N, Ihara Y, Urahashi T, Sata N, Yasuda Y, Mizuta K
    World journal of gastroenterology 22 34 7851 - 6 2016年09月 [査読有り][通常論文]
     
    Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor's opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient's HV and the donor's opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.
  • 小児生体肝移植における術中一時的門脈大循環シャント術の変遷
    浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠, 水田 耕一
    移植 51 総会臨時 258 - 258 (一社)日本移植学会 2016年09月
  • 肝移植後予定観血的手技時における経口TPO受容体アゴニストの使用経験
    片野 匠, 眞田 幸弘, 大友 慎也, 牛島 健太郎, 平田 雄大, 岡田 憲樹, 山田 直也, 井原 欣幸, 浦橋 泰然, 水田 耕一
    移植 51 総会臨時 265 - 265 (一社)日本移植学会 2016年09月
  • 小児肝移植後患者における服薬自己管理への移行期支援
    尾沼 恵梨香, 眞田 幸弘, 大友 慎也, 吉田 幸世, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 牛島 健太郎, 水田 耕一
    移植 51 総会臨時 339 - 339 (一社)日本移植学会 2016年09月
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 30 Suppl. 104 - 104 (一社)日本小児栄養消化器肝臓学会 2016年08月
  • 当施設における生体肝移植後重症敗血症の危険因子の解析
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 大友 慎也, 牛島 健太郎, 水田 耕一
    日本消化器外科学会総会 71回 P3 - 5 (一社)日本消化器外科学会 2016年07月
  • 非黄疸胆道閉鎖症における肝移植適応
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 三木 厚, 笹沼 英紀, 佐久間 康成, 佐田 尚宏, 水田 耕一
    日本肝胆膵外科学会・学術集会プログラム・抄録集 28回 473 - 473 (一社)日本肝胆膵外科学会 2016年06月
  • 小児生体肝移植後20年目に特発性腸管気腫症を来たした1例
    片野 匠, 山田 直也, 岡田 憲樹, 眞田 幸弘, 浦橋 泰然, 水田 耕一
    日本肝胆膵外科学会・学術集会プログラム・抄録集 28回 663 - 663 (一社)日本肝胆膵外科学会 2016年06月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 片野 匠
    日本小児外科学会雑誌 52 3 481 - 481 (一社)日本小児外科学会 2016年05月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 水田 耕一
    日本小児外科学会雑誌 52 3 534 - 534 (一社)日本小児外科学会 2016年05月
  • 大友 慎也, 牛島 健太郎, 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 山田 直也, 岡田 憲樹, 平田 雄大, 吉田 幸世, 尾沼 恵梨香, 須藤 俊明
    TDM研究 33 2 80 - 80 (一社)日本TDM学会 2016年05月
  • 坂井 亮太, 大友 慎也, 牛島 健太郎, 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 山田 直也, 岡田 憲樹, 平田 雄大, 須藤 俊明, 木村 利美
    TDM研究 33 2 189 - 189 (一社)日本TDM学会 2016年05月
  • Y. Sakuma, H. Sasanuma, A. Miki, A. Shimizu, N. Sata, Y. Yasuda, A. K. Lefor, Y. Hirata, N. Yamada, N. Okada, Y. Sanada, Y. Ihara, T. Urahashi, K. Mizuta
    Transplantation Proceedings 48 4 1110 - 1114 2016年05月 [査読有り][通常論文]
     
    Background In small infants, left lateral segment grafts are sometimes too large to overcome the problems of large-for-size grafts in the abdominal compartment. To address this problem, we have developed a safe living donor graftectomy for neonates, a so-called "S2 monosegment graft" to minimize graft thickness. We reviewed our single-center experience to evaluate the feasibility of this technique for reducing graft size. Methods Eleven living-donor liver transplants using S2 monosegment grafts were performed between October 2008 and September 2014 at our institution. Medical records of both donors and recipients were reviewed and data collected retrospectively. Results The mean age of recipients at the time of transplantation was 125.3 days, including 3 neonates. The average S2 monosegment graft weight was 127.4 g, and the graft-to-recipient body weight ratio was successfully reduced to 3.5%. The graft livers were reduced to 4.1 cm in thickness. Two recipients with grafts larger than 5 cm could not undergo primary abdominal closure. Portal vein stenosis and biliary stenosis was observed in 1 recipient, and hepatic artery complications were seen in 2 recipients the clinical course for all donors were uneventful. Liver regeneration was seen in every patient. The graft and patient 1-year survival rate was 100%. Conclusions Living-donor liver transplantation using S2 monosegment grafts offers a safe and useful option for treating smaller infants. Here, we introduce our method of S2 monosegment graft emphasizing the donor harvest and graft thickness.
  • Hirata Y, Sanada Y, Urahashi T, Ihara Y, Yamada N, Okada N, Tashiro M, Katano T, Otomo S, Ushijima K, Mizuta K
    Transplantation proceedings 48 4 1105 - 1109 2016年05月 [査読有り][通常論文]
  • Kawano Y, Mizuta K, Sanada Y, Urahashi T, Ihara Y, Okada N, Yamada N, Sasanuma H, Sakuma Y, Taniai N, Yoshida H, Kawarasaki H, Yasuda Y, Uchida E
    Transplantation Proceedings 48 4 1156 - 1161 2016年05月 [査読有り][通常論文]
     
    INTRODUCTION: Although hepatic vein stenosis after liver transplantation is a rare complication, the complication rate of 1% to 6% is higher in pediatric living-donor liver transplantation than that in other liver transplantation cases. Diagnosis is very important because this complication can cause hepatic congestion that develops to liver cirrhosis, graft loss, and patient loss. However, this is unlikely in cases where there are no ascites or hypoalbuminemia. OBJECTIVES: Eleven of 167 patients who had undergone pediatric living-donor liver transplantation were identified in the outpatient clinic at Jichi Medical University as having suffered from hepatic vein stenosis, and were enrolled in the study. METHODS: We conducted a retrospective study in which we reviewed historical patient records to investigate the parameters for diagnosis and examine treatment methods and outcomes. RESULTS: The 11 patients were treated with 16 episodes of balloon dilatation. Three among these received retransplantation and another 2 cases required the placement of a metallic stent at the stenosis. Histological examination revealed severe fibrosis in four of nine patients who had a liver biopsy, with mild fibrosis revealed in the other five grafts. Furthermore, hepatomegaly and splenomegaly diagnosed by computed tomography, elevated levels of hyarulonic acid, and/or a decrease in calcineurin inhibitor clearance were found to be pathognomonic at diagnosis, and tended to improve after treatment. CONCLUSIONS: Diagnosis of hepatic vein stenosis after liver transplantation can be difficult, so careful observation is crucial to avoid the risk of acute liver dysfunction. Comprehensive assessment using volumetry of the liver and spleen and monitoring of hyarulonic acid levels and/or calcineurin inhibitor clearance, in addition to some form of imaging examination, is important for diagnosis and evaluation of the effectiveness of therapy.
  • 小児発症の原発性硬化性胆管炎に対する生体肝移植症例の検討
    山田 直也, 眞田 幸弘, 浦橋 泰然, 岡田 憲樹, 水田 耕一
    肝臓 57 Suppl.1 A428 - A428 (一社)日本肝臓学会 2016年04月
  • 胆道閉鎖症における肝線維化マーカーWFA結合性Mac-2 binding protein(M2BPGi)の測定意義
    山田 直也, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 平田 雄大, 田代 昌久, 水田 耕一
    日本外科学会定期学術集会抄録集 116回 YT - 3 (一社)日本外科学会 2016年04月
  • 長期自己肝温存胆道閉鎖症(BA)における肝不全の予測マーカーの検討
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 水田 耕一
    日本外科学会定期学術集会抄録集 116回 OP - 2 (一社)日本外科学会 2016年04月
  • Yamada N, Sanada Y, Hirata Y, Okada N, Ihara Y, Sasanuma H, Urahashi T, Sakuma Y, Yasuda Y, Mizuta K
    Pediatric surgery international 32 4 363 - 8 2016年04月 [査読有り][通常論文]
     
    PURPOSE: We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy. METHODS: The data was collected retrospectively. SFSG was used in 14LDLTs (5.7%) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient. RESULTS: The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1%, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14-88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively). CONCLUSIONS: Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 片野 匠, 水田 耕一
    肝・胆・膵 72 3 547 - 564 (株)アークメディア 2016年03月
  • 倉科 憲太郎, 細谷 好則, 齋藤 心, 松本 志郎, 小暮 亜弥子, 佐藤 敏子, 村越 美穂, 荒川 由起子, 岡田 憲樹, 春田 英律, 宇井 崇, 三木 厚, 堀江 久永, 佐久間 康成, 佐田 尚宏
    日本胃癌学会総会記事 88回 344  (一社)日本胃癌学会 2016年03月 [査読無し][通常論文]
  • 山田 直也, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 平田 雄大, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 29 2 134 - 134 (一社)日本小児栄養消化器肝臓学会 2015年12月
  • 眞田 幸弘, 水田 耕一, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 近藤 福雄
    日本小児栄養消化器肝臓学会雑誌 29 2 137 - 138 (一社)日本小児栄養消化器肝臓学会 2015年12月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 田代 昌久
    ICUとCCU 39 11 677 - 682 医学図書出版(株) 2015年11月 
    小児肝移植患者は、成人に比べ、グラフト不全や患者予後に直結する血管合併症や重症感染症のリスクが高い。小児肝移植患者の呼吸管理では、術前からの呼吸器合併症、過大グラフト、術中のover volumeなどの影響で抜管は遅れる傾向にある。また抜管可能であっても、術後に肝血流障害を認める症例では、肝血流が安定するまで抜管を遅らせるのが望ましい。循環管理では血管内脱水による肝機能障害や血栓症を防ぐため、心肺機能が許す範囲でハイドレーションをかける。大量腹水をもたらす重症急性拒絶反応の出現に注意する。肝移植周術期の敗血症は重篤であるため、発熱時の速やかな起炎菌・感染源の同定と抗菌薬治療、術後早期経腸栄養による感染症の予防が重要である。低体重の新生児や乳児における肝移植の成否には、肝移植のあらゆる術後合併症を理解し、新生児への血液浄化療法に精通したICU、PICUのスタッフの存在が不可欠である。(著者抄録)
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 鯉沼 俊貴, 小山 寛介, 和田 政彦, 布宮 伸, 水田 耕一
    日本外科感染症学会雑誌 12 5 582 - 582 (一社)日本外科感染症学会 2015年11月
  • Wakiya T, Sanada Y, Urahashi T, Ihara Y, Yamada N, Okada N, Hirata Y, Hakamada K, Yasuda Y, Mizuta K
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 21 11 1419 - 1427 2015年11月 [査読有り][通常論文]
     
    The serum ferritin (SF) concentration is a widely available and objective laboratory parameter. SF is also widely recognized as an acute-phase reactant. The purpose of the present study was to identify the chronological changes in the recipient's SF concentration during liver transplantation (LT) and to clarify factors having an effect on the recipient's intraoperative SF level. In addition, the study retrospectively evaluated the usefulness of measuring SF during LT. Ninety-eight pediatric recipients were retrospectively analyzed. The data were analyzed and compared according to the SF level in the recipient. Patients were classified into 2 groups based on the intraoperative peak SF levels of ≤ 1000 ng/mL (low-SF group) or >1000 ng/mL (high-SF group). The SF value increased dramatically after reperfusion and fell to normal levels within the early postoperative period. The warm ischemia time (WIT) was significantly longer in the high-SF group (47.0 versus 58.5 minutes; P = 0.003). In addition, a significant positive correlation was observed between the peak SF value and WIT (r = 0.35; P < 0.001). There were significant positive correlations between the peak SF value and the donors' preoperative laboratory data, including transaminases, cholinesterase, hemoglobin, transferrin saturation, and SF, of which SF showed the strongest positive correlation (r = 0.74; P < 0.001). The multivariate analysis revealed that WIT and donor's SF level were a significant risk factor for high SF level in the recipient (P = 0.007 and 0.02, respectively). In conclusion, the SF measurement can suggest the degree of ischemia/reperfusion injury (IRI). A high SF level in the donor is associated with the risk of further acute reactions, such as IRI, in the recipient.
  • 尾沼 恵梨香, 眞田 幸弘, 牛島 健太郎, 吉田 幸世, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 大友 慎也, 水田 耕一
    移植 50 4-5 411 - 416 (一社)日本移植学会 2015年10月 
    小児肝移植における服薬アドヒアランスの現状と課題について検討した。肝移植を施行した中学生以上で移植後1年以上経過した125例(男性48名、女性77名、現年齢13〜37歳、移植時0.8〜22.6歳)を対象とした。電子カルテに記載された内容をもとに後方視的に収集した。服薬アドヒアランス良好群は83例、服薬ノンアドヒアランス群は42例であった。服薬ノンアドヒアランス群において、移植時年齢と現年齢は有意に高く、服薬数に関しては、免疫抑制薬服薬数と全服薬数が有意に多かった。服薬ノンアドヒアランス群において有意に肝機能障害を認め、グラフト不全症例が多い傾向にあった。免疫抑制薬3剤内服開始時年齢は服薬ノンアドヒアランス群で高い傾向にあり、服薬ノンアドヒアランス群20例の全例に肝機能障害を認めた。社会的背景に関しては、服薬ノンアドヒアランス群において不定期通院、内服自己管理、家庭環境・家族形態の変化、不快な服薬体験を有意に多く認めた。現年齢19歳以上、移植時年齢中学生以上において服薬ノンアドヒアランス率は有意に高かった。
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 50 4-5 463 - 463 (一社)日本移植学会 2015年10月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 50 4-5 481 - 482 (一社)日本移植学会 2015年10月
  • 平田 雄大, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 田代 昌久, 水田 耕一
    移植 50 4-5 509 - 510 (一社)日本移植学会 2015年10月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 50 4-5 511 - 511 (一社)日本移植学会 2015年10月
  • 田代 昌久, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    移植 50 4-5 528 - 528 (一社)日本移植学会 2015年10月
  • 尾沼 恵梨香, 眞田 幸弘, 吉田 幸世, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    移植 50 4-5 535 - 536 (一社)日本移植学会 2015年10月
  • Yukihiro Sanada, Koichi Mizuta, Toshiro Niki, Masahisa Tashiro, Yuta Hirata, Noriki Okada, Naoya Yamada, Yoshiyuki Ihara, Taizen Urahashi, Yurie Soejima, Toshio Fukusato, Fukuo Kondo
    Journal of Hepato-Biliary-Pancreatic Sciences 22 10 746 - 756 2015年10月 [査読有り][通常論文]
     
    Hepatocellular nodules caused by congenital extrahepatic portosystemic shunts (CEPS) occur as a result of abnormal portal blood flow, and are mostly cases of benign focal nodular hyperplasia (FNH). However, hepatocellular adenomas (HCA) and hepatocellular carcinomas have been documented in the CEPS patients. HCA can now be immunohistochemically diagnosed; therefore, the concept of hepatocellular nodules resulting from CEPS should be revisited. In this study, we performed a retrospective immunohistochemical investigation of hepatocellular nodules from livers isolated from the CEPS patients undergoing living donor liver transplantation (LDLT).
    Hepatocellular nodules from livers of five patients with CEPS who underwent LDLT between June 2004 and October 2012 at our institution were immunohistochemically investigated. HCA were classified into four subtypes (HNF1α-inactivated HCA (H-HCA); inflammatory HCA; β-catenin-activated HCA (b-HCA); unclassified HCA).
    Sixteen hepatocellular nodules were collected from livers of five patients with CEPS who underwent LDLT. Ten hepatocellular nodules were categorized as FNH (62.5%), five were categorized as b-HCA (31.3%), and one was categorized as
  • Sanada Y, Mizuta K, Niki T, Tashiro M, Hirata Y, Okada N, Yamada N, Ihara Y, Urahashi T, Soejima Y, Fukusato T, Kondo F
    Journal of hepato-biliary-pancreatic sciences 22 10 746 - 756 2015年10月 [査読有り][通常論文]
     
    BACKGROUND: Hepatocellular nodules caused by congenital extrahepatic portosystemic shunts (CEPS) occur as a result of abnormal portal blood flow, and are mostly cases of benign focal nodular hyperplasia (FNH). However, hepatocellular adenomas (HCA) and hepatocellular carcinomas have been documented in the CEPS patients. HCA can now be immunohistochemically diagnosed; therefore, the concept of hepatocellular nodules resulting from CEPS should be revisited. In this study, we performed a retrospective immunohistochemical investigation of hepatocellular nodules from livers isolated from the CEPS patients undergoing living donor liver transplantation (LDLT). METHODS: Hepatocellular nodules from livers of five patients with CEPS who underwent LDLT between June 2004 and October 2012 at our institution were immunohistochemically investigated. HCA were classified into four subtypes (HNF1α-inactivated HCA (H-HCA); inflammatory HCA; β-catenin-activated HCA (b-HCA); unclassified HCA). RESULTS: Sixteen hepatocellular nodules were collected from livers of five patients with CEPS who underwent LDLT. Ten hepatocellular nodules were categorized as FNH (62.5%), five were categorized as b-HCA (31.3%), and one was categorized as H-HCA (6.2%). CONCLUSIONS: Some of the hepatocellular nodules resulting from CEPS were indicative of HCAs, especially the b-HCA subtype which has the potential for malignant transformation. Surgical or interventional treatments might have to be performed when hepatocellular nodules appear in the CEPS patients.
  • 倉根 超, 山田 直也, 眞田 幸弘, 井原 欣幸, 岡田 憲樹, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 29 Suppl. 83 - 83 (一社)日本小児栄養消化器肝臓学会 2015年09月
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 29 Suppl. 84 - 84 (一社)日本小児栄養消化器肝臓学会 2015年09月
  • 山田 直也, 眞田 幸弘, 井原 欣幸, 岡田 憲樹, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 29 Suppl. 87 - 87 (一社)日本小児栄養消化器肝臓学会 2015年09月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 田代 昌久
    移植 50 総会臨時 244 - 244 (一社)日本移植学会 2015年09月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 田代 昌久
    移植 50 総会臨時 288 - 288 (一社)日本移植学会 2015年09月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 田代 昌久
    移植 50 総会臨時 291 - 291 (一社)日本移植学会 2015年09月
  • 山田 直也, 眞田 幸弘, 尾沼 恵梨香, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 平田 雄大, 田代 昌久, 水田 耕一
    移植 50 総会臨時 313 - 313 (一社)日本移植学会 2015年09月
  • 尾沼 恵梨香, 眞田 幸弘, 大友 慎也, 吉田 幸世, 浦橋 泰然, 山田 直也, 岡田 憲樹, 水田 耕一
    移植 50 総会臨時 378 - 378 (一社)日本移植学会 2015年09月
  • Sanada Y, Kawano Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Hirata Y, Tashiro M, Mizuta K
    Pediatric transplantation 19 6 595 - 604 2015年09月 [査読有り][通常論文]
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    日本小児外科学会雑誌 51 5 951 - 951 (一社)日本小児外科学会 2015年08月
  • 肝移植と門脈圧亢進症 肝移植後門脈体循環シャントの臨床的意義と治療適応
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 中村 仁康, 木島 茂喜, 杉本 英治, 水田 耕一
    日本門脈圧亢進症学会雑誌 21 3 107 - 107 (一社)日本門脈圧亢進症学会 2015年08月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 安田 是和, 水田 耕一
    移植 50 2-3 243 - 243 (一社)日本移植学会 2015年08月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 50 2-3 251 - 251 (一社)日本移植学会 2015年08月
  • 眞田 幸弘, 岡田 憲樹, 菱川 修司, 浦橋 泰然, 井原 欣幸, 山田 直也, 平田 雄大, 水田 耕一, 小林 英司
    移植 50 2-3 269 - 270 (一社)日本移植学会 2015年08月
  • 藤倉 佐和子, 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    移植 50 2-3 310 - 310 (一社)日本移植学会 2015年08月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 平田 雄大
    移植 50 2-3 310 - 311 (一社)日本移植学会 2015年08月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 50 2-3 312 - 312 (一社)日本移植学会 2015年08月
  • Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Noriki Okada, Naoya Yamada, Yuta Hirata, Koichi Mizuta
    EUROPEAN JOURNAL OF PEDIATRIC SURGERY 25 3 236 - 241 2015年06月 [査読有り][通常論文]
     
    BackgroundAlthough endotoxin (Et) has been used as a biological index of bacterial infections, Et can also be used to evaluate liver functions because Et present in the portal vein blood is processed by the hepatic reticuloendothelial system. In the field of posttransplant management, it is important for liver transplant recipients to monitor the presence of posttransplant bacterial infections and graft liver functions because these results are directly correlated with a graft prognosis. Therefore, the measurement of Et during liver transplantation (LT) may be the detection of posttransplant infections and graft liver functions. This retrospective study investigated whether Et measured by the Et activity assay (EAA) in the peripheral venous blood during living donor LT (LDLT) can predict the incidence of posttransplant bacterial infections and graft liver functions. Materials and MethodsThe study subjects consisted of 21 patients who underwent LDLT between April 2010 and February 2011. Et activity (EA) was measured using the EAA in peripheral venous blood samples collected 1 or 2 days before LDLT, and on postoperative days (PODs) 1, 5, 7, and 14. We included LDLT recipients with intra-abdominal infections, respiratory infections, and bacteremia in the group with posttransplant bacterial infections. ResultsThe incidence rates of posttransplant bacterial infections or hyperbilirubinemia after LDLT were 57.1%. The LDLT recipients with posttransplant bacterial infections or hyperbilirubinemia had significantly higher levels of EA in comparison with patients without complications before LDLT (0.220.10 vs. 0.07 +/- 0.05, p<0.001), but they had no statistically significant increase of EA between PODs 1 and 14. Based on a receiver operating characteristic curve analysis of pretransplant levels of EA in patients with posttransplant bacterial infections or hyperbilirubinemia, the recommended cutoff value to diagnose posttransplant bacterial infections or hyperbilirubinemia was set at 0.16 (sensitivity 83.3%, specificity 88.9%, and area under the curve 0.940). ConclusionAt a pretransplant level of EA greater than 0.16, patients had an augmented risk for developing posttransplant bacterial infections or hyperbilirubinemia.
  • Yamada N, Sanada Y, Okada N, Wakiya T, Ihara Y, Urahashi T, Mizuta K
    Virology journal 12 91 - 91 2015年06月 [査読有り][通常論文]
     
    A 12-year-old female patient with biliary atresia underwent living donor liver transplantation (LDLT). Twelve months after the LDLT, she developed acute hepatitis (alanine aminotransferase 584 IU/L) and was diagnosed with disseminated varicella-zoster virus (VZV) infection with high level of serum VZV-DNA (1.5 × 10(5) copies/mL) and generalized vesicular rash. She had received the VZV vaccination when she was 5-years-old and had not been exposed to chicken pox before the LDLT, and her serum was positive for VZV immunoglobulin G at the time of the LDLT. Although she underwent treatment with intravenous acyclovir, intravenous immunoglobulin, and withdrawal of immunosuppressants, her symptoms worsened and were accompanied by disseminated intravascular coagulation, pneumonia, and encephalitis. These complications required treatment in the intensive care unit for 16 days. Five weeks later, her clinical findings improved, although her VZV-DNA levels remained high (8.5 × 10(3)copies/mL). Oral acyclovir was added for 2 weeks, and she was eventually discharged from our hospital on day 86 after admission; she has not experienced a recurrence. In conclusion, although disseminated VZV infection with multiple organ failure after pediatric LDLT is a life-threatening disease, it can be cured via an early diagnosis and intensive treatment.
  • 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 平田 雄大, 田代 昌久, 牛島 健太郎, 大友 慎也, 水田 耕一
    肝・胆・膵 70 5 693 - 699 (株)アークメディア 2015年05月
  • Okada N, Sanada Y, Hirata Y, Yamada N, Wakiya T, Ihara Y, Urahashi T, Miki A, Kaneda Y, Sasanuma H, Fujiwara T, Sakuma Y, Shimizu A, Hyodo M, Yasuda Y, Mizuta K
    Pediatric transplantation 19 3 279 - 86 2015年05月 [査読有り][通常論文]
     
    Previous studies have demonstrated the safety of ABO-incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO-incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO-incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m(2) in two cases; second period: 50 mg/m(2) in two cases; and 200 mg/m(2) in eight cases). Two patients who received 375 mg/m(2) rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m(2) rituximab required retransplantation as a consequence of antibody-mediated complications. All eight patients administered 200 mg/m(2) survived, and the mean CD20(+) lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO-incompatible LDLT, the administration of 200 mg/m(2) rituximab three wk prior to LDLT was safe and effective.
  • 肝胆膵 小児生体ドミノ肝移植における一次レシピエント手術の工夫
    岡田 憲樹, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 山田 直也, 平田 雄大, 佐久間 康成, 笹沼 英紀, 森嶋 計, 安田 是和, 水田 耕一
    日本外科学会定期学術集会抄録集 115回 OP - 4 (一社)日本外科学会 2015年04月
  • 胆道閉鎖症の診断・治療の標準化に向けて 小児 胆道閉鎖症における標準的外来フォローアップ
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    日本外科学会定期学術集会抄録集 115回 SY - 5 (一社)日本外科学会 2015年04月
  • 肝胆膵 胆道閉鎖症における生体肝移植後拒絶反応の危険因子の解析 マイクロキメリズムの免疫寛容に対する影響
    眞田 幸弘, 川野 陽一, 三木 厚, 相田 順子, 仲村 賢一, 下村 七生貴, 石川 直, 新井 冨生, 平田 雄大, 山田 直也, 岡田 憲樹, 井原 欣幸, 浦橋 泰然, 安田 是和, 田久保 海誉, 水田 耕一
    日本外科学会定期学術集会抄録集 115回 OP - 5 (一社)日本外科学会 2015年04月
  • 平田 雄大, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 水田 耕一
    小児外科 47 3 319 - 322 (株)東京医学社 2015年03月
  • Sanada Y, Kawano Y, Ishikawa N, Aida J, Nakamura K, Izumiyama-Shimomura N, Urahashi T, Ihara Y, Okada N, Yamada N, Hirata Y, Takubo K, Mizuta K
    Pediatric transplantation 19 2 244 - 245 2015年03月 [査読有り][通常論文]
  • Yamada N, Sanada Y, Hirata Y, Okada N, Wakiya T, Ihara Y, Miki A, Kaneda Y, Sasanuma H, Urahashi T, Sakuma Y, Yasuda Y, Mizuta K
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 21 2 233 - 8 2015年02月 [査読有り][通常論文]
     
    In the field of pediatric living donor liver transplantation (LDLT), physicians sometimes must reduce the volume of left lateral segment (LLS) grafts to prevent large-for-size syndrome. There are 2 established methods for decreasing the size of an LLS graft: the use of a segment 2 (S2) monosegment graft and the use of a reduced LLS graft. However, no procedure for selecting the proper graft type has been established. In this study, we conducted a retrospective investigation of LDLT and examined the strategy of graft selection for patients weighing ≤6 kg. LDLT was conducted 225 times between May 2001 and December 2012, and 15 of the procedures were performed in patients weighing ≤6 kg. We selected S2 monosegment grafts and reduced LLS grafts if the preoperative computed tomography (CT)-volumetry value of the LLS graft was >5% and 4% to 5% of the graft/recipient weight ratio, respectively. We used LLS grafts in 7 recipients, S2 monosegment grafts in 4 recipients, reduced S2 monosegment grafts in 3 recipients, and a reduced LLS graft in 1 recipient. The reduction rate of S2 monosegment grafts for use as LLS grafts was 48.3%. The overall recipient and graft survival rates were both 93.3%, and 1 patient died of a brain hemorrhage. Major surgical complications included hepatic artery thrombosis in 2 recipients, bilioenteric anastomotic strictures in 2 recipients, and portal vein thrombosis in 1 recipient. In conclusion, our graft selection strategy based on preoperative CT-volumetry is highly useful in patients weighing ≤6 kg. S2 monosegment grafts are effective and safe in very small infants particularly neonates.
  • Yukihiro Sanada, Hideki Sasanuma, Yasunaru Sakuma, Kazue Morishima, Naoya Kasahara, Yuji Kaneda, Atsushi Miki, Takehito Fujiwara, Atsushi Shimizu, Masanobu Hyodo, Yuta Hirata, Naoya Yamada, Noriki Okada, Yoshiyuki Ihara, Taizen Urahashi, Seiji Madoiwa, Jun Mimuro, Koichi Mizuta, Yoshikazu Yasuda
    Pediatric transplantation 18 8 E270-3 - 3 2014年12月 [査読有り][通常論文]
     
    The use of donors with coagulation FIX deficiency is controversial, and there are no current protocols for peri-transplant management. We herein describe the first reported case of a pediatric LDLT from an asymptomatic donor with mild coagulation FIX deficiency. A 32-yr-old female was evaluated as a donor for her 12-month-old daughter with biliary atresia. The donor's pretransplant coagulation tests revealed asymptomatic mild coagulation FIX deficiency (FIX activity 60.8%). Freeze-dried human blood coagulation FIX concentrate was administered before the dissection of the liver and 12 h afterwards by bolus infusion (40 U/kg) and was continued on POD 1. The bleeding volume at LDLT was 590 mL. On POD 1, 3, 5, and 13, the coagulation FIX activity of the donor was 121.3%, 130.6%, 114.6%, and 50.2%, respectively. The donor's post-transplant course was uneventful, and the recipient is currently doing well at 18 months after LDLT. The FIX activity of the donor and recipient at nine months after LDLT was 39.2% and 58.0%, respectively. LDLT from donors with mild coagulation FIX deficiency could be performed effectively and safely using peri-transplant short-term coagulation FIX replacement and long-term monitoring of the plasma FIX level in the donor.
  • 平田 雄大, 井原 欣幸, 岡田 憲樹, 山田 直也, 眞田 幸弘, 浦橋 泰然, 水田 耕一
    日本小児外科学会雑誌 50 6 1070 - 1070 (一社)日本小児外科学会 2014年10月
  • 岡田 憲樹, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 山田 直也, 平田 雄大, 水田 耕一
    周産期医学 44 10 1379 - 1382 (株)東京医学社 2014年10月
  • 経皮的針肝生検後の肝損傷に対する止血に難渋した1例
    岡田 憲樹, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 山田 直也, 平田 雄大, 河合 陽, 中田 学, 仲澤 聖則, 安田 是和, 水田 耕一
    Japanese Journal of Acute Care Surgery 4 2 238 - 238 日本Acute Care Surgery学会 2014年09月
  • 眞田 幸弘, 相田 順子, 川野 陽一, 仲村 賢一, 泉山 七生貴, 石川 直, 新井 冨生, 平田 雄大, 山田 直也, 岡田 憲樹, 脇屋 太一, 井原 欣幸, 浦橋 泰然, 水田 耕一, 田久保 海誉
    日本小児外科学会雑誌 50 5 962 - 962 (一社)日本小児外科学会 2014年08月
  • 山田 直也, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 平田 雄大, 吉田 幸世, 水田 耕一
    日本小児外科学会雑誌 50 5 962 - 962 (一社)日本小児外科学会 2014年08月
  • 移植および小児・妊婦・高齢者と門脈圧亢進症 非黄疸胆道閉鎖症の肝移植適応における肝生検の重要性
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    日本門脈圧亢進症学会雑誌 20 3 42 - 42 (一社)日本門脈圧亢進症学会 2014年08月
  • CMV感染の予防的投与法とその適応 小児肝移植後CMV感染症の治療戦略
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    日本移植学会総会プログラム抄録集 50回 237 - 237 (一社)日本移植学会 2014年08月
  • 小児生体肝移植における経臍静脈的門脈カテーテルの応用
    浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    日本移植学会総会プログラム抄録集 50回 403 - 403 (一社)日本移植学会 2014年08月
  • Yukihiro Sanada, Taiichi Wakiya, Shuji Hishikawa, Yuta Hirata, Naoya Yamada, Noriki Okada, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Eiji Kobayashi
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 21 7 463 - 472 2014年07月 [査読有り][通常論文]
     
    Background Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC. Methods Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. Results The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively). Conclusions It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
  • 胆道閉鎖症キャリーオーバー症例に対する消化器外科医の役割について
    浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 平田 雄大
    日本消化器外科学会総会 69回 RS - 2 (一社)日本消化器外科学会 2014年07月
  • Sanada Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Hirata Y, Mizuta K
    Hepato-gastroenterology 61 133 1368 - 1373 2014年07月 [査読有り][通常論文]
  • Sanada Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Hirata Y, Mizuta K
    Hepato-gastroenterology 61 133 1368 - 1373 2014年07月 [査読有り][通常論文]
  • Yukihiro Sanada, Koshi Matsumoto, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Yuta Hirata, Koichi Mizuta
    WORLD JOURNAL OF GASTROENTEROLOGY 20 21 6638 - 6650 2014年06月 [査読有り][通常論文]
     
    AIM: To assessed the clinical significance of protocol liver biopsy (PLB) in pediatric liver transplantation (LT). METHODS: Between July 2008 and August 2012, 89 and 55 PLBs were performed in pediatric patients at two and five years after LT, respectively. We assessed the histopathological findings using the Metavir scoring system, including activity (A) and fibrosis (F), and we identified factors associated with scores of >= A1 and >= F1. Our results clarified the timing and effectiveness of PLB. RESULTS: The incidences of scores of >= A1 and >= F1 were 24.7% and 24.7%, respectively, at two years after LT and 42.3% and 34.5%, respectively, at five years. Independent risk factors in a multivariate analysis of a score of >= A1 at two years included >= 2 h of cold ischemic time, no acute cellular rejection and an alanine amino transaminase (ALT) level of >= 20 IU/L (P = 0.028, P = 0.033 and P = 0.012, respectively); however, no risk factors were identified for a score of >= F1. Furthermore, no independent risk factors associated with scores of >= A1 and >= F1 at five years were identified using multivariate analysis. A ROC curve analysis of ALT at two years for a score of >= A1 demonstrated the recommended cutoff value for diagnosing >= A1 histology to be 20 IU/L. The incidence of scores of >= A2 or >= F2 at two years after LT was 3.4% (three cases), and all patients had an absolute score of >= A2. In contrast to that observed for PLBs at five years after LT, the incidence of scores of >= A2 or >= F2 was 20.0% (11 cases), and all patients had an absolute score of >= F2. In all cases, the dose of immunosuppressants was increased after the PLB, and all ten patients who underwent a follow-up liver biopsy improved to scores of <= A1 or F1. CONCLUSION: PLB at two years after LT is an unnecessary examination, because the serum ALT level reflects portal inflammation. In addition, immunosuppressive therapy should be modulated to maintain the ALT concentration at a level less than 20 IU/L. PLB at five years is an excellent examination for the detection of early reversible graft fibrosis because no serum markers reflect this finding. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
  • 右肝動脈血行再建を行った固有肝動脈瘤破裂の一例
    本間 祐子, 佐久間 康成, 安部 望, 森本 光昭, 森嶋 計, 黒河内 顕, 岡田 憲樹, 菱川 修司, 佐田 尚宏, 安田 是和
    日本肝胆膵外科学会・学術集会プログラム・抄録集 26回 496 - 496 (一社)日本肝胆膵外科学会 2014年06月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    移植 49 1 86 - 86 (一社)日本移植学会 2014年05月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    移植 49 1 129 - 130 (一社)日本移植学会 2014年05月
  • 小池 輪太郎, 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    移植 49 1 131 - 132 (一社)日本移植学会 2014年05月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    移植 49 1 152 - 153 (一社)日本移植学会 2014年05月
  • 脇屋 太一, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 豊木 嘉一, 袴田 健一, 水田 耕一
    移植 49 1 158 - 159 (一社)日本移植学会 2014年05月
  • Yukihiro Sanada, Youichi Kawano, Atsushi Miki, Junko Aida, Ken-ichi Nakamura, Naotaka Shimomura, Naoshi Ishikawa, Tomio Arai, Yuta Hirata, Naoya Yamada, Noriki Okada, Taiichi Wakiya, Yoshiyuki Ihara, Taizen Urahashi, Yoshikazu Yasuda, Kaiyo Takubo, Koichi Mizuta
    TRANSPLANT INTERNATIONAL 27 4 383 - 390 2014年04月 [査読有り][通常論文]
     
    Some studies have found that gender mismatch between donors and recipients are related to poor graft prognosis after liver transplantation. However, few studies have investigated the impact of gender mismatch on acute cellular rejection (ACR) in pediatric living donor liver transplantation (LDLT). This retrospective study investigated the clinical significance of these factors in ACR after pediatric LDLT. Between November 2001 and February 2012, 114 LDLTs were performed for recipients with biliary atresia (BA) using parental grafts. We performed univariate and multivariate analyses to identify the factors associated with ACR. The donor-recipient classifications included mother donor to daughter recipient (MD; n=43), mother to son (n=18), father to daughter (FD; n=33), and father to son (n=20) groups. The overall incidence rate of ACR in the recipients was 36.8%. Multivariate analysis showed that gender mismatch alone was an independent risk factor for ACR (P=0.012). The FD group had a higher incidence of ACR than the MD group (P=0.002). In LDLT, paternal grafts with gender mismatch were associated with a higher increased incidence of ACR than maternal grafts with gender match. Our findings support the possibility that maternal antigens may have an important clinical impact on graft tolerance in LDLT for patients with BA.
  • 平田 雄大, 井原 欣幸, 山田 直也, 岡田 憲樹, 眞田 幸弘, 浦橋 泰然, 坂井 亮太, 大友 慎也, 牛島 健太郎, 水田 耕一
    日本小児外科学会雑誌 50 2 286 - 286 (一社)日本小児外科学会 2014年04月
  • 生体部分肝移植後限局性腹水の臨床的意義
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    超音波医学 41 Suppl. S607 - S607 (公社)日本超音波医学会 2014年04月
  • 肝移植周術期におけるbeta-D glucanの測定意義
    眞田 幸弘, 浦橋 泰然, 岡田 憲樹, 水田 耕一
    肝臓 55 Suppl.1 A460 - A460 (一社)日本肝臓学会 2014年04月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    日本小児外科学会雑誌 50 3 686 - 686 (一社)日本小児外科学会 2014年04月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    日本小児外科学会雑誌 50 3 713 - 713 (一社)日本小児外科学会 2014年04月
  • Taizen Urahashi, Koichi Mizuta, Yoshiyuki Ihara, Yukihiro Sanada, Taiichi Wakiya, Naoya Yamada, Noriki Okada
    TRANSPLANT INTERNATIONAL 27 3 322 - 329 2014年03月 [査読有り][通常論文]
     
    The development of late-onset hepatic venous outflow obstruction (LOHVOO) following pediatric living donor liver transplantation (LDLT) can lead to uncontrollable fibrotic damage in liver grafts, even long-term patency of the graft outflow is achieved with appropriate therapeutic modalities. The aim of this study was to verify our hypothesis that some immunological responses, particularly cellular and/or antibody-mediated rejection (AMR), are associated with LOHVOO, which occurs following damage to liver sinusoidal endothelial cells in zone 3 of liver grafts. One hundred and eighty-nine patients underwent LDLT between May 2001 and December 2010 at our institute. Nine patients (4.8%) were identified as having LOHVOO. The preoperative factors, operative factors, and mortality, morbidity, and survival rates were examined and compared between the groups with and without LOHVOO. No statistical differences were observed between the groups with regard to preoperative factors, technical factors, or postoperative complications. However, FlowPRA reactivity was found to be a statistically significant risk factor for LOHVOO (P=0.006). The patients with both class I- and class II-reactive antibodies also had a significant risk of developing LOHVOO (P=0.03) and exhibited significantly higher retransplant rates. In conclusion, although further studies are needed to clarify this phenomenon, the pathophysiological mechanism underlying the development of LOHVOO after LDLT may be explained by immune-mediated responses that facilitate damage in zone 3 of liver grafts.
  • 眞田 幸弘, 松本 光司, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 平田 雄大, 水田 耕一
    日本外科学会雑誌 115 臨増2 319 - 319 (一社)日本外科学会 2014年03月
  • Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Koichi Mizuta
    SURGERY TODAY 44 1 180 - 184 2014年01月 [査読有り][通常論文]
     
    Fluid collection is common after living donor liver transplantation (LDLT), and can include hematomas, bilomas, abscesses, and seromas. Although accumulated fluid rarely becomes infected and usually remains localized, localized ascites can sometimes be sufficiently extensive to induce vascular complications. This report presents three such cases in pediatric patients that underwent LDLT. A 33-month-old patient showed an increase in the volume of localized ascites around the hepatic vein anastomoses together with low hepatic vein flow on postoperative day (POD) 47. An 82-month-old patient showed an increase in the volume of localized ascites around the portal vein anastomoses together with low portal vein flow on POD 71. A 63-month-old patient showed an increase in the size of a localized abscess around the hepaticojejunostomy with dilatation of all of the intrahepatic bile ducts on POD 20. These cases illustrate the need for awareness of possible vascular or biliary complications due to compressive localized ascites after LDLT.
  • Kawano Y, Mizuta K, Sanada Y, Urahashi T, Ihara Y, Okada N, Yamada N, Sasanuma H, Sakuma Y, Taniai N, Yoshida H, Kawarasaki H, Yasuda Y, Uchida E
    Transplantation Proceeding 46 10 3543 - 3547 2014年 [査読有り][通常論文]
     
    PURPOSE: Cytomegalovirus (CMV) infection is known to be the most frequently viral infection among patients after liver transplantation. This is especially true in pediatric living-donor liver transplantation because the recipients have often not been infected with CMV and postoperative primary infection with CMV frequently occurs. PATIENTS AND METHODS: Of 93 patients who underwent pediatric liver transplantation at our department, 33 patients (36.3%) were diagnosed with CMV infection using the antigenemia method (C7-HRP). Retrospective review and statistical analysis were conducted to confirm risk factors of post-transplantation CMV infection. RESULT: Positive lymphocytes were diagnosed between postoperative days 8 and 111 after transplantation. Ganciclovir or foscavir were administrated to 21 patients. The other 10 patients who had one positive lymphocyte were observed and the cell disappeared on follow-up examination. We did not observe any cases of positive lymphocytes with C7-HRP in patients who received a graft from a CMV antibody-negative donor. Independent predictors associated with CMV infection in the multivariable analysis were administration of OKT3 and grafts from CMV antibody-positive donors. CONCLUSION: In CMV infection after pediatric liver transplantation, cases with CMV antibody-positive donors and with OKT3 administration for acute rejection are considered high risk, and cases with CMV antibody-negative donors are considered low risk.
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也, 平田 雄大
    小児外科 45 11 1229 - 1234 (株)東京医学社 2013年11月
  • Taiichi Wakiya, Taizen Urahashi, Yoshiyuki Ihara, Yukihiro Sanada, Naoya Yamada, Noriki Okada, Kenichi Hakamada, Koichi Mizuta
    PEDIATRICS INTERNATIONAL 55 5 E119 - E122 2013年10月 [査読有り][通常論文]
     
    Abnormalities of liver function tests are frequently documented in patients with Kawasaki disease, but the mechanism responsible for this has not yet been established. Described herein is the case of a 1-year-10-month-old girl who underwent liver transplantation at 11 months of age. Eleven months after transplantation the patient was diagnosed with Kawasaki disease, which was associated with some portal flow reduction, and received i.v. immunoglobulin, after which fever abated with improvement of portal flow to its pre-fever level. Abnormalities of liver function tests in Kawasaki disease patients may occur as a result of inflammation of both the biliary and portal systems. There are no reports on the potential relationship between Kawasaki disease and the portal vein, and accumulation of further data is necessary to better examine this relationship.
  • 肝移植周術期管理におけるエンドトキシンの測定意義
    眞田 幸弘, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也, 兼田 裕司, 笹沼 英紀, 佐久間 康成, 安田 是和, 水田 耕一
    日本消化器外科学会雑誌 46 Suppl.2 160 - 160 (一社)日本消化器外科学会 2013年10月
  • 岡田 憲樹, 山田 直也, 眞田 幸弘, 井原 欣幸, 浦橋 泰然, 水田 耕一
    日本小児外科学会雑誌 49 6 1180 - 1181 (一社)日本小児外科学会 2013年10月
  • 浦橋 泰然, 寺谷 工, 岡田 憲樹, 水田 耕一, 小林 英司
    移植 48 総会臨時 374 - 374 (一社)日本移植学会 2013年08月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    移植 48 総会臨時 269 - 269 (一社)日本移植学会 2013年08月
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    移植 48 総会臨時 304 - 304 (一社)日本移植学会 2013年08月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 岡田 憲樹, 平田 雄大, 水田 耕一
    移植 48 総会臨時 356 - 356 (一社)日本移植学会 2013年08月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    小児外科 45 7 753 - 757 (株)東京医学社 2013年07月
  • Taizen Urahashi, Yoshiyuki Mara, Yukihiro Sanada, Taiichi Wakiya, Naoya Yamada, Noriki Okada, Koichi Mizuta
    EXPERIMENTAL AND CLINICAL TRANSPLANTATION 11 3 259 - 263 2013年06月 [査読有り][通常論文]
     
    Objectives: Treatment for patients with biliary atresia is a Kasai hepatic portoenterostomy; however, the efficacy of repeat Kasai hepatic portoenterostomy is unclear. This study sought to examine the effect of a prior Kasai hepatic portoenterostomy, especially a repeat Kasai hepatic portoenterostomy, on the outcomes of living-donor liver transplant. Materials and Methods: One hundred twenty-six of 170 children that underwent a living-donor liver transplant between May 2001, and March 2010, received a living-donor liver transplant for biliary atresia. These patients were divided into 2 groups according to the number of previous portoenterostomies: 1 (group A, n=100) or 2 or more Kasai hepatic portoenterostomies (group B, n=26). Portoenterostomy was performed twice in 24 patients in group B, 3 times in 1, and 4 times in I. Preoperative, operative factors, mortality, morbidity, and survival rates were examined and compared between groups. Results: The surgical factors such as operative time, blood loss per weight, cold ischemia time, and weight of the native liver were significantly greater in group B than they were in group A. The patient survival rates were comparable in the 2 groups (94.5% in group A and 93.3% in group B), and the difference was not statistically significant. No statistically significant difference was observed between the groups with regard to vascular complications, biliary complications, and other factors including postoperative variables. Bowel perforation requiring surgical repair was more frequent in group B than it was in group A. Conclusions: Repeat Kasai hepatic portoenterostomy might have a negative effect on patients who undergo living-donor liver transplant for biliary atresia patients with potential lethal complications such as bowel perforation. More biliary atresia patients could have a liver transplant, with improved survival and better life expectancy, if they have inadequate biliary drainage after the initial Kasai hepatic portoenterostomy.
  • 【最新 肝胆膵脾手術アトラス】肝臓 小児生体肝移植
    水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    手術 67 6 761 - 767 金原出版(株) 2013年05月
  • 井原 欣幸, 水田 耕一, 浦橋 泰然, 眞田 幸弘, 岡田 憲樹, 山田 直也
    日本小児外科学会雑誌 49 3 549 - 549 (一社)日本小児外科学会 2013年05月
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Yoshikazu Yasuda, Hideo Kawarasaki
    JOURNAL OF SURGICAL RESEARCH 180 2 349 - 355 2013年04月 [査読有り][通常論文]
     
    Background: Endotoxin (Et) in the portal vein blood is processed by the hepatic reticuloendothelial system. Thus, it is possible that the Et kinetics of the peripheral venous blood may be useful as a biological index that can be used to evaluate liver function. In this study, we measured Et using the endotoxin activity assay in peripheral venous blood during living donor liver transplantation (LDLT), to study its clinical significance. Methods: Subjects were 17 patients who underwent LDLT. In the perioperative peripheral venous blood, was measured Et activity (EA) using the endotoxin activity assay at 1 or 2 d before LT, and then on 1, 5, 7, 14, and 21 postoperative days. Results: Patients with infections had significantly higher EA levels compared with those without complications before LDLT and 14 postoperative days (P = 0.038 and 0.027, respectively). The average EA level of patients with infections and without complications before LT was 0.22 and 0.08, respectively (P = 0.038). Patients with an EA level higher than 0.20 before LDLT had a significantly longer period of hospitalization compared with those without complications (P = 0.038). Conclusions: A preoperative EA level more than 0.20 is a high risk factor for post-transplant infection and a prolonged period of hospitalization. Crown Copyright (c) 2013 Published by Elsevier Inc. All rights reserved.
  • 浦橋 泰然, 水田 耕一, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 山田 直也
    日本小児外科学会雑誌 49 2 318 - 318 (一社)日本小児外科学会 2013年04月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    小児外科 45 3 328 - 332 (株)東京医学社 2013年03月
  • MSSAによるBSIに対してde-escalationを行えずにVCM投与を継続した乳児の一例
    大友 慎也, 藤谷 好弘, 笹原 鉄平, 小林 亮, 森澤 雄司, 須藤 俊明, 坂井 亮太, 水田 耕一, 浦橋 泰然, 井原 欣幸, 岡田 憲樹, 山田 直也
    日本化学療法学会雑誌 61 1 112 - 112 (公社)日本化学療法学会 2013年01月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 岡田 憲樹, 山田 直也
    小児外科 44 12 1211 - 1215 (株)東京医学社 2012年12月
  • 岡田 憲樹, 眞田 幸弘, 脇屋 太一, 山田 直也, 井原 欣幸, 浦橋 泰然, 水田 耕一
    移植 47 6 476 - 480 (一社)日本移植学会 2012年12月 
    症例は2歳9ヵ月男児で、胆道閉鎖症に対し1歳1ヵ月時に母親をドナーとする生体肝移植を施行し、免疫抑制療法をtacrolimus(Tac)とmethylprednisolone(MP)で開始した。7ヵ月目に血清ヒアルロン酸、AST、ALTの上昇を認め、免疫性肝障害と判断してmycophenolate mofetilを追加し、MPは中止した。19ヵ月時にうどんを摂取した際に顔面の紅潮を認め、その後蕁麻疹などのアレルギー症状が頻繁に出現するようになった。アーモンドがのったドーナッツの摂食で喘鳴、チアノーゼが出現し、近医でアナフィラキシーショックと診断された。直前の外来血液検査では好酸球数、IgE、Th2ケモカインレセプターが上昇し、移植前陰性であった特異的IgE抗体価がミルク、小麦、大豆などで強い上昇が認められた。Tac中に合併する食物アレルギーを疑い、Tacからciclosporinへ変更した。その結果、上昇していた検査値は低下してアレルギー症状も消失し、3年経過して食物アレルギーはない。
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Yoshikazu Yasuda
    HEPATOLOGY INTERNATIONAL 6 4 778 - 782 2012年10月 [査読有り][通常論文]
     
    Endotoxin (Et) in the portal vein blood is processed by the hepatic reticuloendothelial system, and therefore, it is possible that the hepatic clearance of Et may become a biological index for liver function. In this study, Et levels of preoperative peripheral and portal vein blood at the time of liver transplantation (LT) were measured in order to study the meaning. The study population comprised 19 patients in whom pediatric living donor LT was performed. In the preoperative peripheral and the portal vein blood at the time of LT, we measured Et activity (EA) by the Et activity assay (EAA) and the Limulus amebocyte lysate (LAL) method. The preoperative peripheral vein blood showed a low EA in all cases. In the EA of the peripheral and the portal vein blood, the latter showed a significantly high level (p = 0.049). With the LAL method, 5.3% (2/38) of patients were positive for Et. The EAA is considered to be superior to the LAL method for the detection of Et, even in low endotoxinemia, and is also capable of elucidating the Et kinetics by accurately reflecting hepatic clearance.
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Taiichi Wakiya, Yoshiyuki Ihara, Noriki Okada, Naoya Yamada, Manabu Nakata, Yoshikazu Yasuda
    WORLD JOURNAL OF SURGERY 36 10 2449 - 2454 2012年10月 [査読有り][通常論文]
     
    Background Posttransplant portosystemic shunts may result in severe fatty changes, portal vein complications, or graft liver failure because they reduce the effectiveness of portal perfusion through a portal steal phenomenon. However, the indications and timing of surgical and interventional treatments for posttransplant portosystemic shunts are still a matter of debate. We performed a retrospective investigation of the present state of long-term outpatients with posttransplant portosystemic shunts. Methods This study comprised 150 outpatients who underwent liver transplantation between October 1988 and August 2006 in our department and other facilities. The diagnosis was based on the presence of any portosystemic shunts with the diameter of more than 5 mm indicated by computed tomography. Results A total of 16 patients (16/150, 10.7 %) were diagnosed as having posttransplant portosystemic shunt. Among them, eight patients (8/16, 50.0 %) developed portal vein complications, and 1 (1/16, 6.3 %) developed graft liver failure. Conclusions The persistence of posttransplant portosystemic shunts results in portal vein complications or graft liver failure. Therefore, surgical and interventional treatment for patients with posttransplant portosystemic shunts should be performed based on the clinical and radiologic findings.
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Yoshikazu Yasuda, Hideo Kawarasaki
    PEDIATRIC SURGERY INTERNATIONAL 28 10 993 - 996 2012年10月 [査読有り][通常論文]
     
    The pediatric end-stage liver disease (PELD) score is not a direct index that reflects the degree of hepatocellular injury. Beta-d glucan (BDG) in the portal vein blood is processed by the hepatic reticuloendothelial system. It is possible that the hepatic clearance of BDG may be used as a biological index to assess the liver function. In this study, the relationship between PELD score and hepatic clearance of BDG was made clear in order to study the efficacy of measurement of the serum BDG. This study including 21 patients with biliary atresia (BA) who underwent liver transplantation (LT) was performed. The BDG was measured in the preoperative peripheral vein blood and the portal vein blood at the time of LT. The portal vein blood showed a significantly high level of BDG than the peripheral vein blood (p < 0.01). There was a significant negative correlation between the PELD score and the hepatic clearance of BDG in the 10 patients who were indicated for LT due to liver failure (p < 0.01). The serum BDG can be used as a biological index in place of liver metabolism and should be measured in BA patients as a non-invasive indicator of the degree of progression of liver failure.
  • Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Koichi Mizuta
    PEDIATRIC TRANSPLANTATION 16 6 E193 - E195 2012年09月 [査読有り][通常論文]
     
    Sanada Y, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Mizuta K. Liver transplantation for a pediatric patient with hemophilia B. ?Pediatr Transplantation 2012: 00: 000000. (c) 2012 John Wiley & Sons A/S. Abstract: Hemophilia exposes patients to greater risks of bleeding complications during the perioperative period. However, there are no current protocols for factor replacement during LT. We herein describe a case of pediatric living donor LDLT performed for a patient with hemophilia B using perioperative short-term factor replacement. A 4-yr-old female patient with an extrahepatic portosystemic shunt and asymptomatic hemophilia B (factor IX activity 18.7%) underwent an ABO-compatible LDLT using a left lobe graft. The bleeding volume was 2980 mL. Freeze-dried human blood coagulation factor IX concentrate (Novact M, Kaketsuken, Japan) was administered at the induction of anesthesia and at the end of LDLT by bolus infusion (80 U/kg) and was continued by bolus infusion (40 U/kg) on POD 1, 2, 3, and 4. On POD 1, 5, 8, and 12, the factor IX plasma levels were 34.5%, 64.9%, 43.5%, and 53.1%, respectively. The postoperative course was uneventful, and the patient is currently doing well at 2.5 yr after LDLT. Factor concentrate should be administered at the induction of anesthesia and at the end of LT by bolus infusion, and thereafter be continued for a few days after LT by bolus infusion.
  • 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 水田 耕一
    移植 47 総会臨時 179 - 179 (一社)日本移植学会 2012年09月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 山田 直也, 矢野 智則, 水田 耕一
    移植 47 総会臨時 181 - 181 (一社)日本移植学会 2012年09月
  • 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 水田 耕一
    移植 47 総会臨時 260 - 260 (一社)日本移植学会 2012年09月
  • 眞田 幸弘, 浦橋 泰然, 脇屋 太一, 梅原 実, 井原 欣幸, 岡田 憲樹, 山田 直也, 水田 耕一, 菱川 修司, 小林 英司
    移植 47 4-5 326 - 334 (一社)日本移植学会 2012年09月 
    実験用ブタを用いた多内臓移植と小腸移植の手術経験について報告した。実験用ブタを用いて異所性自己小腸移植9回と多内臓移植2回を施行した。異所性自己小腸移植と多内臓移植の手術時間は、それぞれ平均300分、334分であった。また、冷阻血時間は、平均53分、116分で、温阻血時間は平均38分、40分であり、バックテーブル時間は、平均29分、17分であった。異所性自己小腸移植におけるグラフト小腸摘出時間は平均90分であった。また、グラフト血管の動脈径、静脈径は平均4.2mm、9.8mmで、吻合時間は平均動脈16分、静脈13分であった。また、多内臓移植におけるグラフト多内臓摘出時間は平均129分であった。吻合時間は平均動脈12分、静脈7分であった。全例で再灌流後30分間、良好な臓器血流が得られた。
  • 小松原 利英, 眞田 幸弘, 浦橋 泰然, 脇屋 太一, 岡田 憲樹, 安田 是和, 水田 耕一
    移植 47 4-5 320 - 325 (一社)日本移植学会 2012年09月 
    9歳男児。日齢76に胆道閉塞症に対し葛西手術を施行した。今回、黄疸の進行で生体肝移植目的に入院となった。45歳の父親をドナーとした拡大左葉グラフトによる生体肝移植を行った。術後早期より肝機能障害を伴わない5000〜10000ml/dayの大量腹水が出現し、肝生検で急性拒絶反応(P3B3V3)を認め、類洞および中心静脈周囲の線維化を伴い、ステロイドパルス療法および腹水濃縮還流を開始した。腹水は改善せず、急性拒絶反応(P1B1V3)は改善したが、中心静脈内皮炎と周囲の線維化が高度で、拒絶反応は遷延していると判断した。肝静脈狭窄を疑い、腹部造影CTおよび経内頸静脈的肝静脈造影を行ったが、肝静脈吻合部の狭窄は認めなかった。3回のステロイド療法でも腹水は減少せず、ステロイド抵抗性拒絶反応と診断し、第62病日よりOKT3の10日間使用により徐々に腹水は減少した。第75病日に急性拒絶反応(P0B0V0)の改善、中心静脈周囲および類洞線維化の改善を確認し、第94病日に腹腔ドレーン抜去となり第108病日に退院した。肝移植後2年を経て経過は良好である。
  • Wakiya T, Sanada Y, Urahashi T, Ihara Y, Yamada N, Okada N, Egami S, Sakamoto K, Murayama K, Hakamada K, Yasuda Y, Mizuta K
    Pediatric transplantation 16 6 E196 - 200 2012年09月 [査読有り][通常論文]
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Toshitaka Koinuma, Kansuke Koyama, Shinichiro Tanaka, Kazuhide Misawa, Masahiko Wada, Shin Nunomiya, Yoshikazu Yasuda, Hideo Kawarasaki
    THERAPEUTIC APHERESIS AND DIALYSIS 16 4 368 - 375 2012年08月 [査読有り][通常論文]
     
    In the field of pediatric living donor liver transplantation, the indications for apheresis and dialysis, and its efficacy and safety are still a matter of debate. In this study, we performed a retrospective investigation of these aspects, and considered its roles. Between January 2008 and December 2010, 73 living donor liver transplantations were performed in our department. Twenty seven courses of apheresis and dialysis were performed for 19 of those patients (19/73; 26.0%). The indications were ABO incompatible-liver transplantation in 11 courses, fluid management in seven, acute liver failure in three, renal replacement therapy in two, endotoxin removal in two, cytokine removal in one, and liver allograft dysfunction in one. Sixteen courses of apheresis and dialysis were performed prior to liver transplantation for 14 patients. The median IgM antibody titers before and after apheresis for ABO blood type-incompatible liver transplantation was 128 and eight, respectively (P < 0.05). Eleven courses of apheresis and dialysis were performed post liver transplantation for 10 patients. The median PaO2/FiO2 ratio before and after dialysis for fluid overload was 159 and 339, respectively (P < 0.05). No bleeding or technical complications attributable to apheresis and dialysis occurred. The 1-year survival rate of the patients was 100%. Apheresis and dialysis in pediatric living donor liver transplantation are effective for antibody removal in ABO-incompatible liver transplantation, and fluid management for acute respiratory failure.
  • 肝内結節性病変と門脈圧亢進症 先天性門脈体循環シャントに伴う肝結節性病変の解析
    眞田 幸弘, 水田 耕一, 浦橋 泰然, 井原 欣幸, 脇屋 太一, 岡田 憲樹, 山田 直也, 仁木 利郎, 近藤 福雄
    日本門脈圧亢進症学会雑誌 18 3 67 - 67 (一社)日本門脈圧亢進症学会 2012年08月
  • 岡田 憲樹, 眞田 幸弘, 山田 直也, 脇屋 太一, 梅原 実, 井原 欣幸, 浦橋 泰然, 水田 耕一, 藤原 岳人, 俵藤 正信, 安田 是和
    移植 47 2-3 224 - 228 (一社)日本移植学会 2012年06月 
    症例は9歳男児で、生後3ヵ月に先天性門脈欠損症と診断され、治療抵抗性の抗アンモニア血症、多発肝腫瘍のため8歳時に父親をドナーとするABO血液型適合生体肝移植を施行した。術前cytomegalovirus(CMV)抗体検査ではドナー既感染/レシピエント未感染であった。術後30日目に急性胃腸炎で入院し、いったん改善後に貧血、大量下血を認め、hypovolemic shockの状態となった。更に40℃台の発熱を認め、CMV腸炎による消化管出血の可能性を考え、免疫抑制剤を中止し、γ-globulin、ganciclovirの点滴治療を開始した。下部消化管内視鏡で回盲弁から10cm口側の回腸に出血源と考えられる多発潰瘍を認め、術後41日目のCMV抗原が陽性であり、CMV腸炎を疑った。その後CMV抗原値は減少し、解熱傾向となって免疫抑制剤を再開し、valganciclovir hydrochloride経口投与に変更し退院となった。以後CMV感染症の再燃はなく、術後2年6ヵ月で経過良好である。
  • Sanada Y, Ushijima K, Mizuta K, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Egami S, Hishikawa S, Otomo S, Sakamoto K, Yasuda Y, Kawarasaki H
    Transplantation proceedings 44 1341 - 1345 5 2012年06月 [査読有り][通常論文]
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 山田 直也
    今日の移植 25 3 193 - 195 (株)日本医学館 2012年05月 
    当院では2009年1月からグラセプターの使用を開始し、その使用基準は「移植後3年以上経過した5歳以上の症例」としている。今回、具体的な使用方法を紹介し、これまでに使用した28例について報告した。28例の内訳は男性7例、女性21例、年齢5〜19歳(中央値12歳)、移植後年数は4〜18年(中央値9年)であった。グラセプターを導入した理由は「家族や患者の希望」が最も多く13例(46%)、次いで「免疫抑制剤を増量・再開時」11例(39%)、「服薬コンプライアンス不良」4例(14%)であった。グラセプターへの切り替え・導入パターンの内訳は、プログラフ顆粒剤からの切り替え10例(36%)、プログラフカプセル剤からの切り替え10例(36%)、シクロスポリンからの切り替え1例(4%)、カルシニューリン阻害剤(CNI)を中止してからの再開7例(25%)であった。グラセプターの継続使用が可能であった症例の割合は89%であり、CNI中止から再開した症例ではグラセプター導入後に肝機能や病理所見の改善が認められ、服薬コンプライアンス不良に対してグラセプターを導入した症例ではいずれも飲み忘れが減少した。
  • 実験用ミニブタを用いた臓器移植技術トレーニング
    眞田 幸弘, 浦橋 泰然, 脇屋 太一, 梅原 実, 井原 欣幸, 岡田 憲樹, 山田 直也, 水田 耕一, 菱川 修司
    日本肝胆膵外科学会・学術集会プログラム・抄録集 24回 536 - 536 (一社)日本肝胆膵外科学会 2012年05月
  • Yukihiro Sanada, Junko Aida, Youichi Kawano, Ken-ichi Nakamura, Naotaka Shimomura, Naoshi Ishikawa, Tomio Arai, Steven S. S. Poon, Naoya Yamada, Noriki Okada, Taiichi Wakiya, Makoto Hayashida, Takeshi Saito, Satoshi Egami, Shuji Hishikawa, Yoshiyuki Ihara, Taizen Urahashi, Koichi Mizuta, Yoshikazu Yasuda, Hideo Kawarasaki, Kaiyo Takubo
    WORLD JOURNAL OF SURGERY 36 4 908 - 916 2012年04月 [査読有り][通常論文]
     
    Liver transplantation for biliary atresia is indicated whenever a Kasai portoenterostomy is considered unfeasible. However, the timing of liver transplantation in biliary atresia has not been precisely defined. Excessive shortening of hepatocellular telomeres may occur in patients with biliary atresia, and therefore, telomere length could be a predictor of hepatocellular reserve capacity. Hepatic tissues were obtained from 20 patients with biliary atresia who underwent LT and 10 age-matched autopsied individuals (mean age, 1.7 and 1.2 years, respectively). Telomere lengths were measured by Southern blotting and quantitative fluorescence in situ hybridization using the normalized telomere-centromere ratio. The correlation between the normalized telomere-centromere ratio for the hepatocytes in biliary atresia and the pediatric end-stage liver disease score was analyzed. The median terminal restriction fragment length of the hepatic tissues in biliary atresia was not significantly different from that of the control (p = 0.425), whereas the median normalized telomere-centromere ratio of hepatocytes in biliary atresia was significantly smaller than that of the control (p < 0.001). Regression analysis demonstrated a negative correlation of the normalized telomere-centromere ratio with the pediatric end-stage liver disease score in biliary atresia (p < 0.001). Telomere length analysis using quantitative fluorescence in situ hybridization could be an objective indicator of hepatocellular reserve capacity in patients with biliary atresia, and excessive telomere shortening supports the early implementation of liver transplantation.
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Satoshi Egami, Yoshikazu Yasuda, Hideo Kawarasaki
    EXPERIMENTAL AND CLINICAL TRANSPLANTATION 10 2 176 - 179 2012年04月 [査読有り][通常論文]
     
    Background: Nonanastomotic biliary stricture is generally considered the most troublesome biliary complication after liver transplant. Nonanastomotic biliary stricture owing to immunologic cholangiopathy (such as acute cellular rejection) has not been reported. We describe 2 patients with the co-occurrence of nonanastomotic biliary stricture and acute cellular rejection after pediatric live-donor liver transplant. Case 1: A 13-month-old male infant with liver cirrhosis underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Eighty days after the live-donor liver transplant, fever with liver dysfunction and dilatation of the intrahepatic bile duct occurred. Percutaneous transhepatic biliary drainage and a liver biopsy were performed. The histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome. Case 2: A 21-month-old female infant with biliary atresia underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Twenty-six days after the live-donor liver transplant, percutaneous transhepatic biliary drainage for B3 and a liver biopsy were performed, owing to fever, with liver dysfunction, and dilatation of the intrahepatic bile duct. Histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome. Conclusions: It is important for patients with nonanastomotic biliary stricture to undergo early liver biopsy because the nonanastomotic biliary stricture may be coincident with, or caused by, acute cellular rejection.
  • 劇症肝炎/移植 Beta-D glucanの肝代謝からみたpediatric end-stage liver diseaseスコアの有用性
    眞田 幸弘, 浦橋 泰然, 岡田 憲樹, 水田 耕一
    肝臓 53 Suppl.1 A313 - A313 (一社)日本肝臓学会 2012年04月
  • K. Mizuta, T. Urahashi, Y. Ihara, Y. Sanada, T. Wakiya, N. Yamada, N. Okada, S. Egami, H. Kawarasaki
    TRANSPLANTATION PROCEEDINGS 44 3 780 - 783 2012年04月 [査読有り][通常論文]
     
    Objectives. The aim of this study was to evaluate patients who developed varicella zoster virus (VZV) disease after pediatric living donor liver transplantation (PLDLT). Methods. Two hundred fifty-five patients who underwent PLDLT between 1995 and 2010 were included in this study. Pretransplantation vaccination of VZV was performed for all recipients except emergency PLDLTs. Posttransplantation VZV vaccination was administered to the patients with a low VZV antibody titer 2 years or more after transplantation. The clinical course and outcomes of VZV disease in cases were reviewed with the transplant database and hospital medical records. Results. Sixty-three patients developed VZV disease (chicken pox in 61, herpes zoster in 2) at a median onset of 36 months after PLDLT and at a median age of 4 years old, with a cumulative incidence of 25%. All chicken pox occurred in VZV antibody-negative patients. The onset of herpes zoster in the two patients occurred within 3 months after PLDLT; in addition, these patients were VZV antibody-positive patients. The clinical presentations of most patients were not serious and there were no disseminated infections. Although only 3 patients (5%) were hospitalized, the other 60 patients (95%) all showed a good response to oral antiviral therapy. Conclusions. Although VZV disease is an infectious disease with a high morbidity rate after PLDLT, it can normally be successfully managed on an outpatient basis at home. Pre- and posttransplantation vaccinations are effective for delaying the onset of chicken pox after PLDLT and to prevent it from developing into a serious illness.
  • Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Satoshi Egami, Shuji Hishikawa, Youichi Kawano, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Manabu Nakata, Yoshikazu Yasuda, Koichi Mizuta
    SURGERY 151 3 404 - 411 2012年03月 [査読有り][通常論文]
     
    Background and Aims. Congenital extrahepatic portosystemic shunt (CEPS) is a rare venous malformation in which mesenteric venous blood drains directly into the systemic circulation. It is still a matter of debate whether conservative or operative strategies should be used to treat symptomatic CEPS. The aim of this study was to evaluate the role of operative intervention in the management of CEPS. Methods. Between June 2004 and August 2010, 6 consecutive patients with symptomatic CEPS were treated in our department. There were 3 male and 3 female patients, with a median age of 3.5 years (range, 1-8). Their demographic, clinical, and laboratory data were analyzed. All patients were scheduled to undergo shunt ligation or liver transplantation Results. Living donor LT was carried out in 4 patients, and shunt ligation in 2. After a median follow-up of 25 months, all the patients are alive currently with marked relief of symptoms. Conclusion. Shunt ligation or LT for symptomatic CEPS is potentially curative. (Surgery 2012;151:404-11.)
  • Taiichi Wakiya, Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Naoya Yamada, Noriki Okada, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Kei Murayama, Masaki Takayanagi, Kenichi Hakamada, Yoshikazu Yasuda, Koichi Mizuta
    MOLECULAR GENETICS AND METABOLISM 105 3 404 - 407 2012年03月 [査読有り][通常論文]
     
    There are no objective and concrete guidelines for the management of Ornithine transcarbamylase deficiency (OTCD). Based on previous findings, we hypothesized that patients with OTCD have a low Ornithine transcarbamylase (OTC) activity in the liver, and therefore it would be better to determine the appropriate indications and optimal timing for liver transplantation (LT) based on the OTC activity. However, few data have so far been accumulated on the OTC activity in cases that are indicated for LT. The purpose of the present study was to clarify the OTC activity in cases that were indicated for LT. This study involved thirteen children with OTCD (8 males and 5 females) who underwent LT, and two females with OTCD who did not require LT. The OTC activity of the neonatal onset type ranged from 0% to 7.2%, while that of the late onset type who underwent LT ranged from 4.4% to 18.7%. The OTC activity of the late onset type which did not require LT was 33-38% based on a preoperative needle liver biopsy. Some late onset patients that underwent LT, showed an activity that was as low as that observed in the neonatal onset cases. This is the first report to show the results of measuring the OTC activity for serial OTCD cases indicated for LT. OTC activity might be an indicator to determine the indications for and the timing of LT in the late onset type, however, further investigations are necessary. (C) 2011 Elsevier Inc. All rights reserved.
  • 眞田 幸弘, 相田 順子, 川野 陽一, 仲村 賢一, 泉山 七生貴[下村], 石川 直, 山田 直也, 岡田 憲樹, 脇屋 太一, 井原 欣幸, 江上 聡, 菱川 修司, 浦橋 泰然, 水田 耕一, 河原崎 秀雄, 田久保 海誉
    自治医科大学紀要 34 162 - 162 (学)自治医科大学 2012年03月
  • 胆道閉鎖症肝のテロメア長と細胞老化関連β-galactosidaseの解析
    眞田 幸弘, 相田 順子, 川野 陽一, 仲村 賢一, 泉山 七生貴, 石川 直, 新井 冨生, 山田 直也, 岡田 憲樹, 脇屋 太一, 井原 欣幸, 浦橋 泰然, 水田 耕一, 田久保 海誉
    日本病理学会会誌 101 1 287 - 287 (一社)日本病理学会 2012年03月
  • K. Mizuta, T. Urahashi, Y. Ihara, Y. Sanada, T. Wakiya, N. Yamada, N. Okada, S. Egami, S. Hishikawa, M. Hyodo, Y. Sakuma, T. Fujiwara, H. Kawarasaki, Y. Yasuda
    TRANSPLANTATION PROCEEDINGS 44 2 469 - 472 2012年03月 [査読有り][通常論文]
     
    Objectives. Cholestatic liver disease (CLD) is the main indication for liver transplantation in children. This retrospective study evaluated the outcomes of living donor liver transplantation (LDLT) in children with CLD. Methods. One hundred fifty-nine children with CLD who underwent 164 LDLT between May 2001 and May 2011 were evaluated. Their original diseases were biliary atresia (n = 145, 91%), Alagille syndrome (n = 8, 5%), primary sclerosing cholangitis (n = 2), and the others (n = 4). The mean age and body weight of the recipients at LDLT was 42 53 months and 14.0 +/- 11.0 kg, respectively. Results. Parents were living donors in 98%. The left lateral segment was the most common type of graft (77%). There were no reoperations and no mortality in any living donor. Recipients' postoperative surgical complications consisted mainly of hepatic arterial problems (7%), hepatic vein stenosis (5%), portal vein stenosis (13%), biliary stricture (18%), intestinal perforation (3%). The overall rejection rate was 31%. Cytomegalovirus infection and Epstein-Barr virus disease were observed in 26% and 5%, respectively. Retransplantation was performed five times in four patients; the main cause was hepatic vein stenosis (n = 3). Four patients died; the main cause was gastrointestinal perforation (n = 2). The body height of Alagille syndrome patients less than 2 years old significantly improved compared with older patients after LDLT. The 1-, 5-, and 10-year patient survival rates were 98%, 97%, and 97%, respectively. Conclusions. LDLT for CLD is an effective treatment with excellent long-term outcomes.
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 江上 聡, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 山田 直也
    小児外科 44 2 152 - 155 (株)東京医学社 2012年02月
  • Yukihiro Sanada, Taizen Urahashi, Taiichi Wakiya, Noriki Okada, Shuji Hishikawa, Youichi Kawano, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Koichi Mizuta
    PEDIATRICS INTERNATIONAL 53 6 1077 - 1081 2011年12月 [査読有り][通常論文]
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 江上 聡, 藤原 岳人, 佐久間 康成, 俵藤 正信, 安田 是和, 河原崎 秀雄
    日本小児栄養消化器肝臓学会雑誌 25 2 106 - 106 (一社)日本小児栄養消化器肝臓学会 2011年12月
  • 水田 耕一, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 山田 直也, 江上 聡, 菱川 修司, 河原崎 秀雄
    移植 46 6 651 - 651 (一社)日本移植学会 2011年12月
  • 眞田 幸弘, 浦橋 泰然, 脇屋 太一, 岡田 憲樹, 山田 直也, 鯉沼 俊貴, 小山 寛介, 田中 進一郎, 三澤 和秀, 和田 政彦, 草野 英二, 布宮 伸, 水田 耕一
    移植 46 6 675 - 675 (一社)日本移植学会 2011年12月
  • 岡田 憲樹, 眞田 幸弘, 脇屋 太一, 浦橋 泰然, 水田 耕一, 藤原 岳人, 俵藤 正信, 安田 是和
    移植 46 6 686 - 687 (一社)日本移植学会 2011年12月
  • Sanada Y, Mizuta K, Urahashi T, Ihara Y, Wakiya T, Okada N, Yamada N, Egami S, Hishikawa S, Ushijima K, Otomo S, Sakamoto K, Yasuda Y, Kawarasaki H
    Transplantation proceedings 43 4019 - 4024 10 2011年12月 [査読有り][通常論文]
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Yoshiyuki Ihara, Taiichi Wakiya, Noriki Okada, Naoya Yamada, Satoshi Egami, Kentaro Ushijima, Shinya Otomo, Koichi Sakamoto, Yoshikazu Yasuda, Hideo Kawarasaki
    ANNALS OF TRANSPLANTATION 16 4 7 - 11 2011年10月 [査読有り][通常論文]
     
    Background: At the present time, indications of liver transplantation (LT) for jaundice-free biliary atresia (BA) patients include intractable cholangitis, portal hypertension and pulmonary vascular disorders. However, the timing of LT remains unclear. In the current study, we describe the therapeutic strategies for jaundice-free BA patients. Material/Methods: 129 BA patients were undergone LDLT between May, 2001 and April, 2010 in the Department of Transplant Surgery, Jichi Medical University, Japan. Results: The indications of LDLT for jaundice-free BA patients was 30 patients (30/129, 23%), and included portal hypertension (16 patients, 53%). Among the 16 patients with portal hypertension, there were 7 patients (7/16, 23%) in which uncontrollable gastrointestinal bleeding was an indication of LDLT. There were 5 patients (5/7; 71%) in which bleeding sites were not identified, and 3 patients (3/7; 43%) in which supportive treatments against collateral vessels were performed as a previous treatment. Conclusions: Even in jaundice-free BA patients, after supportive treatments for portal hypertension are performed, it is necessary to assess the esophageal and gastrointestinal varices regularly and to also prepare for LT simultaneously because there is a probability of the complication of uncontrollable gastrointestinal bleeding.
  • 浦橋 泰然, 水田 耕一, 眞田 幸弘, 脇屋 太一, 井原 欣幸, 山田 直也, 岡田 憲樹, 安田 是和, 河原崎 秀雄
    移植 46 総会臨時 172 - 172 (一社)日本移植学会 2011年10月
  • 浦橋 泰然, 水田 耕一, 眞田 幸弘, 脇屋 太一, 井原 欣幸, 山田 直也, 岡田 憲樹, 安田 是和, 河原崎 秀雄
    移植 46 総会臨時 227 - 227 (一社)日本移植学会 2011年10月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 藤原 岳人, 安田 是和, 水田 耕一
    移植 46 総会臨時 228 - 228 (一社)日本移植学会 2011年10月
  • 浦橋 泰然, 水田 耕一, 眞田 幸弘, 脇屋 太一, 井原 欣幸, 山田 直也, 岡田 憲樹, 安田 是和, 河原崎 秀雄
    移植 46 総会臨時 230 - 230 (一社)日本移植学会 2011年10月
  • 山田 直也, 浦橋 泰然, 井原 欣幸, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 安田 是和, 水田 耕一
    移植 46 総会臨時 273 - 273 (一社)日本移植学会 2011年10月
  • 松田 淳, 浦橋 泰然, 眞田 幸弘, 脇屋 太一, 井原 欣幸, 山田 直也, 岡田 憲樹, 安田 是和, 水田 耕一
    移植 46 総会臨時 278 - 278 (一社)日本移植学会 2011年10月
  • 井原 欣幸, 浦橋 泰然, 眞田 幸弘, 脇屋 太一, 山田 直也, 岡田 憲樹, 藤原 岳人, 安田 是和, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 25 Suppl. 76 - 76 (一社)日本小児栄養消化器肝臓学会 2011年09月
  • 山田 直也, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 脇屋 太一, 岡田 憲樹, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 25 Suppl. 99 - 99 (一社)日本小児栄養消化器肝臓学会 2011年09月
  • 古川 祥太郎, 脇屋 太一, 眞田 幸弘, 浦橋 泰然, 井原 欣幸, 山田 直也, 岡田 憲樹, 安田 是和, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 25 Suppl. 100 - 100 (一社)日本小児栄養消化器肝臓学会 2011年09月
  • 村橋 賢, 眞田 幸弘, 脇屋 太一, 岡田 憲樹, 浦橋 泰然, 藤原 岳人, 俵藤 正信, 安田 是和, 水田 耕一
    移植 46 2-3 178 - 179 (一社)日本移植学会 2011年06月
  • 新生児期に劇症肝不全を呈した新生児ヘモクロマトーシスの3例
    岡田 憲樹, 眞田 幸弘, 脇屋 太一, 江上 聡, 浦橋 泰然, 菱川 修司, 藤原 岳人, 佐久間 康成, 安田 是和, 水田 耕一, 河原崎 秀雄
    日本小児救急医学会雑誌 10 2 257 - 257 (一社)日本小児救急医学会 2011年06月
  • Yukihiro Sanada, Koichi Mizuta, Tomonori Yano, Wataru Hatanaka, Noriki Okada, Taiichi Wakiya, Minoru Umehara, Satoshi Egami, Taizen Urahashi, Shuji Hishikawa, Takehito Fujiwara, Yasunaru Sakuma, Masanobu Hyodo, Hironori Yamamoto, Yoshikazu Yasuda, Hideo Kawarasaki
    TRANSPLANT INTERNATIONAL 24 1 85 - 90 2011年01月 [査読有り][通常論文]
     
    P>Bilioenteric anastomotic stricture after liver transplantation is still frequent and early detection and treatment is important. We established the management using double-balloon enteroscopy (DBE) and evaluated the intractability for bilioenteric anastomotic stricture after pediatric living donor liver transplantation (LDLT). We underwent DBE at Jichi Medical University from May 2003 to July 2009 for 25 patients who developed bilioenteric anastomotic stricture after pediatric LDLT. The patients were divided into two types according to the degree of dilatation of the anastomotic sites before and after interventional radiology (IVR) using DBE. Type I is an anastomotic site macroscopically dilated to five times or more, and Type II is an anastomotic site dilated to less than five times. The rate of DBE reaching the bilioenteric anastomotic sites was 68.0% (17/25), and the success rate of IVR was 88.2% (15/17). There were three cases of Type I and 12 cases of Type II. Type II had a significantly longer cold ischemic time and higher recurrence rate than Type I (P = 0.005 and P = 0.006). In conclusion, DBE is a less invasive and safe treatment method that is capable of reaching the bilioenteric anastomotic site after pediatric LDLT and enables IVR to be performed on strictures, and its treatment outcomes are improving. Type II and long cold ischemic time are risk factors for intractable bilioenteric anastomotic stricture.
  • Yukihiro Sanada, Koichi Mizuta, Taizen Urahashi, Minoru Umehara, Taiichi Wakiya, Noriki Okada, Satoshi Egami, Shuji Hishikawa, Takehito Fujiwara, Yasunaru Sakuma, Masanobu Hyodo, Yoshikazu Yasuda
    ANNALS OF TRANSPLANTATION 16 1 66 - 69 2011年01月 [査読有り][通常論文]
     
    Background: Although liver transplantation using liver allograft with hemangiomas has been previously reported, little is known about the fate of hemangiomas in the transplanted liver. We herein describe a case of pediatric living donor liver transplantation (LDLT) using living donor liver allograft with a hemangioma which is considered to the first reported case performing in vivo hemangioma resection. Case Report: A 27-year-old female was evaluated as a donor for her 2-year-old son with cholestatic cirrhosis due to biliary atresia. Preoperative ultrasonography and computed tomography revealed a 20-mm hemangioma located at lateral side of segment 3. During LDLT, an in vivo partial hepatic resection of the hemangioma of segment 3 was performed without the Pringle maneuver using intraoperative ultrasonography to keep the main portal triad of segment 3 before the donor liver resection, and the left lateral segment graft without the hemangioma, which underwent an intraoperative pathologic diagnosis, was transplanted into the recipient. The donor's postoperative course was uneventful and the recipient course was not observed subsequent liver necrosis, bleeding or bile leakage from the resection site. Conclusions: Liver allografts with hemangiomas can be accepted as potential liver allografts, and such hemangiomas should undergo be performed in vivo resection during LDLT irrespective of tumor size.
  • Mizuta K, Sanada Y, Wakiya T, Urahashi T, Umehara M, Egami S, Hishikawa S, Okada N, Kawano Y, Saito T, Hayashida M, Takahashi S, Yoshino H, Shimizu A, Takatsuka Y, Kitamura T, Kita Y, Uno T, Yoshida Y, Hyodo M, Sakuma Y, Fujiwara T, Ushijima K, Sugimoto K, Ohmori M, Ohtomo S, Sakamoto K, Nakata M, Yano T, Yamamoto H, Kobayashi E, Yasuda Y, Kawarasaki H
    Transplantation proceedings 42 10 4127 - 4131 10 2010年12月 [査読有り][通常論文]
     
    OBJECTIVES: To describe our experience with 126 consecutive living-donor liver transplantation (LDLT) procedures performed because of biliary atresia and to evaluate the optimal timing of the operation. PATIENTS AND METHODS: Between May 2001 and January 2010,126 patients with biliary atresia underwent 130 LDLT procedures. Mean (SD) patient age was 3.3 (4.2) years, and body weight was 13.8 (10.7) kg. Donors included 64 fathers, 63 mothers, and 3 other individuals. The left lateral segment was the most commonly used graft (75%). Patients were divided into 3 groups according to body weight: group 1, less than 8 kg (n = 40); group 2,8 to 20 kg (n = 63); and group 3, more than 20 kg (n = 23). Medical records were reviewed retrospectively. Follow up was 4.5 (2.7) years. RESULTS: All group 3 donors underwent left lobectomy, and all group 1 donors underwent left lateral segmentectomy. No donors required a second operation or died. Comparison of the 3 groups demonstrated that recipient Pediatric End-Stage Liver Disease score in group 1 was highest, operative blood loss in group 2 was lowest (78 mL/kg), and operative time in group 3 was longest (1201 minutes). Hepatic artery complications occurred more frequently in group 1 (17.9%), and biliary stenosis (43.5%) and gastrointestinal perforation (8.7%) occurred more frequently in group 3. The overall patient survival rates at 1, 5, and 9 years was 98%, 97%, and 97%, respectively. Five-year patient survival rate in groups 1,2, and 3 were 92.5%, 100%, and 95.7%, respectively. Gastrointestinal perforation (n = 2) was the primary cause of death. CONCLUSIONS: Living-donor liver transplantation is an effective treatment of biliary atresia, with good long-term outcome. It seems that the most suitable time to perform LDLT to treat biliary atresia is when the patient weighs 8 to 20 kg.
  • Sanada Y, Mizuta K, Urahashi T, Umehara M, Wakiya T, Okada N, Hayashida M, Egami S, Hishikawa S, Kawano Y, Ushijima K, Otomo S, Sakamoto K, Fujiwara T, Sakuma Y, Hyodo M, Yasuda Y, Kawarasaki H
    Transplantation proceedings 42 10 4555 - 4559 10 2010年12月 [査読有り][通常論文]
     
    BACKGROUND: There have been few reports on the management of intra-abdominal drains after living donor liver transplantation (LDLT). We retrospectively investigated changes in ascitic data related to management of an intra-abdominal drain. PATIENTS AND METHODS: Between March 2008 and June 2009, we performed 28 LDLT. On the first and the fifth postoperative day (POD) after LDLT, we examined the number of ascites cells and cell fractions as well as performed biochemical examination and cultures. RESULTS: The day of removal of the drain for massive ascites (10 mL/kg/d or more) was 14.2 ± 5.4 POD; for less than 10 mL/kg/d it was 8.7 ± 1.9 POD (P < .001). Nine patients were ascites culture positive; long-term placement of the drain caused an infection in two patients. CONCLUSIONS: When the amount of ascitic fluid on the fifth POD after LDLT was small, it was important to assess the properties of the ascitic fluid because of the possibility of a drain infection or of poor drainage. If the ascitic neutrophil count is less than 250/mm(3) or the examined ascites is normal, intra-abdominal drains should be removed.
  • 眞田 幸弘, 岡田 憲樹, 牧田 英士, 脇屋 太一, 梅原 実, 江上 聡, 浦橋 泰然, 河原崎 秀雄, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 24 Suppl. 148 - 148 (一社)日本小児栄養消化器肝臓学会 2010年09月
  • 牧田 英士, 眞田 幸弘, 岡田 憲樹, 脇屋 太一, 梅原 実, 江上 聡, 浦橋 泰然, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 24 Suppl. 149 - 149 (一社)日本小児栄養消化器肝臓学会 2010年09月
  • 岡田 憲樹, 眞田 幸弘, 脇屋 太一, 梅原 実, 江上 聡, 浦橋 泰然, 水田 耕一
    日本小児栄養消化器肝臓学会雑誌 24 Suppl. 153 - 153 (一社)日本小児栄養消化器肝臓学会 2010年09月
  • 水田 耕一, 浦橋 泰然, 梅原 実, 眞田 幸弘, 脇屋 太一, 岡田 憲樹
    今日の移植 23 4 514 - 517 (株)日本医学館 2010年08月 
    欧米では年間6,000例以上の肝移植が行われ、そのほとんどが脳死肝移植という状況である。生体肝移植が99%を占める日本では、年間120〜140例の小児生体肝移植が行われ、手術手技・免疫抑制療法・感染症治療などの進歩により、その成績は安定してきた。近年、劇症肝不全、代謝性疾患の割合が増えつつあるが、それぞれの疾患に応じた適切なタイミングで肝移植を行うことがさらなる成績向上につながる。小児肝移植後の長期的合併症である血管・胆管の吻合部狭窄やグラフト肝の線維化に対しては、標準的肝機能検査だけでなく、定期的な画像検査や肝生検による早期診断が重要である。生涯にわたりグラフトとレシピエントを守りつづけるためには、移植コーディネーターの充実など、移植システムの整備も必要である。(著者抄録)

MISC

共同研究・競争的資金等の研究課題

  • 肝移植における常温酸素化灌流のグラフト肝保存効果の研究
    日本学術振興会:科学研究費助成事業 若手研究
    研究期間 : 2018年04月 -2021年03月 
    代表者 : 岡田 憲樹
     
    実験計画に従い、2018年年度では2回のブタ肝灌流実験を行った。いずれの実験も細胞外液型電解質組成、糖濃度、アミノ酸濃度を調整した灌流液に抗凝固薬としてヘパリンを混注した灌流液に、1回目は酸素運搬体としてブタ血液を10%配合した灌流液を用いて12時間の常温酸素化灌流保存実験を行い、2回目はブタ血液を30%配合した灌流液を用いて12時間の常温酸素化灌流保存実験を行った。いずれの実験も12時間の常温酸素化保存観察においてトラブルなく終了した。1回目の酸素運搬体としてブタ血液を10%配合した実験では灌流前肝重量765gが灌流後肝重量971gと26.9%の重量増であり、2回目の酸素運搬体としてブタ血液を30%配合した実験では灌流前肝重量781gが灌流後肝重量993gと27.1%の重量増であった。常温酸素化灌流においては、血栓の出現による灌流不全のリスクがあるが、今回の実験においては常温酸素化灌流中、ヘパリンを混注した灌流液を用いることにより血栓の出現は防ぐことができ、灌流圧の上昇は認めなかった。また常温酸素化灌流装置には人工心肺用の人工肺を酸素化装置として用いているが、酸素流量をコントロールすることにより、灌流中の灌流液酸素分圧は300-700mmHg程度と良好な酸素化が得られた。一方で灌流液中のカリウム濃度が徐々に上昇していく現象がみられ、肝細胞の破壊を反映している可能性があると考えられる。ブタ血液の配合濃度を変えて実験を続けていく。
  • 文部科学省:科学研究費補助金(若手研究(B))
    研究期間 : 2014年 -2015年 
    代表者 : 岡田 憲樹


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