基本情報
研究分野
1経歴
3-
2018年4月 - 現在
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2011年4月
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2009年4月 - 2011年3月
学歴
2-
2012年4月 - 2016年3月
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2003年4月 - 2009年3月
論文
293-
WORLD JOURNAL OF GASTROENTEROLOGY 23(40) 7337-7342 2017年10月 査読有り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.
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移植 52(総会臨時) 374-374 2017年8月
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LANGENBECKS ARCHIVES OF SURGERY 402(1) 123-133 2017年2月 査読有り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.
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JOURNAL OF GASTROENTEROLOGY 52(2) 245-252 2017年2月 査読有り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.
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World journal of gastroenterology 22(44) 9865-9870 2016年11月28日 査読有り
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Clinical transplantation 30(11) 1425-1432 2016年11月 査読有り
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日本小児外科学会雑誌 52(6) 1236-1240 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)
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移植 51(4-5) 405-410 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。
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Pediatrics international : official journal of the Japan Pediatric Society 58(10) 1059-1061 2016年10月 査読有り
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World journal of gastroenterology 22(34) 7851-6 2016年9月14日 査読有り
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Transplantation Proceedings 48(4) 1110-1114 2016年5月1日 査読有り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.
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Transplantation proceedings 48(4) 1105-1109 2016年5月 査読有り
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Transplantation Proceedings 48(4) 1156-1161 2016年5月 査読有り
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Pediatric surgery international 32(4) 363-8 2016年4月 査読有り
MISC
74-
日本小児栄養消化器肝臓学会雑誌 33(Suppl.) 71-71 2019年10月
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TRANSPLANT INTERNATIONAL 30 277-277 2017年9月
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TRANSPLANT INTERNATIONAL 30 146-146 2017年9月
共同研究・競争的資金等の研究課題
3-
日本学術振興会 科学研究費助成事業 2021年7月 - 2023年3月
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日本学術振興会 科学研究費助成事業 若手研究 2018年4月 - 2021年3月
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文部科学省 科学研究費補助金(若手研究(B)) 2014年 - 2015年