Masahiro Abe

Analysis of postoperative liver function of donors in living-related liver transplantation: comparison of the type of donor hepatectomy.

BACKGROUNDnThere is a potentially significant risk to the donor in living-related liver transplantation.nnnMETHODSnWe analyzed surgical risk and stress to 35 donors in living-related liver transplantation with special reference to the types of donor hepatectomy. Donor surgery was performed in one of three ways: (1) lateral segmentectomy without ligation of the middle hepatic vein (MHV) in the remnant liver (group 1, n=21); (2) lateral segmentectomy with ligation of MHV in the remnant liver (group 2, n=6); and (3) left lobectomy with MHV (group 3, n=8).nnnRESULTSnNo critical complications were observed in any group. The postoperative enzyme levels in group 2 were significantly higher than those in groups 1 and 3 (P<0.01). Although blood loss was covered by autologous blood transfusion in the first six cases, no banked blood was transfused in any of the cases. Surgical duration was significantly longer and blood loss was significantly greater in group 3 than in group 1 (P<0.05). Follow-up computed tomography showed atrophic changes in segment IV in groups 1 and 2. No remarkable changes were seen in segments V or VIII in any of the three groups.nnnCONCLUSIONnRegardless of the donor hepatectomy procedure, serious complications did nor occur after surgery. Although it should be noted that the type of donor hepatectomy affects postoperative donor liver function, left lateral segmentectomy with ligation of MHV in the remnant liver is a useful method for obtaining liver grafts from living-related donors who have unusual anatomic variations of the hepatic veins.

C4d deposition in peritubular capillary and alloantibody in the allografted kidney suffering severe acute rejection

Abstract:u2002 Background:u2002Alloantibodies and C4d deposition in peritubular capillaries (PTCs) are thought to be related to antibody‐mediated acute rejection. The purpose of this study was to evaluate the relationship between C4d deposition in PTCs and alloantibodies at various days after allograft dysfunction due to severe acute rejection. Method:u2002There were 620 renal transplantations (Tx) performed. Forty patients diagnosed with acute humoral and/or vascular rejection showed graft dysfunction with anuria or dysuria. The patients were divided into four groups by ABO compatibility and clinical course after graft dysfunction: compatible recipients with graft loss (c‐GL; nu2003=u20036); compatible recipients with recovery from graft dysfunction (c‐RE; nu2003=u200310); incompatible recipients with graft loss (i‐GL; nu2003=u20039); and incompatible recipients with recovery from graft dysfunction (i‐RE; nu2003=u200315). Results:u2002C4d depositions in 4/6 c‐GL recipients increased, and those in 8/10 c‐RE recipients decreased after graft dysfunction. These changes in C4d deposition between the c‐GL and the c‐RE groups were significantly different (Pu2003<u20030.01). These titres of anti‐A/B IgG antibody in 7/9 i‐GL recipients increased and those in 8/15 i‐RE recipients decreased after graft dysfunction. These changes in titre between the i‐GL and the i‐RE groups were significantly different (Pu2003<u20030.01). All c‐GL recipients and 4/10 c‐RE recipients had anti‐HLA antibody at the last biopsy. There was a significant difference in the number of recipients who had anti‐HLA antibody between the c‐GL and the c‐RE groups (Pu2003<u20030.05). Conclusions:u2002These results indicate that changes in C4d deposition in PTCs in the c‐ABO group and titre of anti‐A/B IgG antibody in the ABO‐incompatible groups exert a strong impact on graft survival after dysfunction in the early period after Tx.

Successful cytokine treatment of aplastic anemia following living‐related orthotopic liver transplantation for non‐A, non‐B, non‐C hepatitis

The relationship between aplastic anemia and viral hepatitis is well recognized, and such patients usually have a high mortality. We successfully treated a case of aplastic anemia following living‐related orthotopic liver transplantation (LROLT) for non‐A, non‐B, non‐C hepatitis.A 2‐yr‐old boy with fulminant hepatic failure from non‐A, non‐B, non‐C hepatitis received LROLT. Before transplantation, he had pancytopenia which was probably hepatitis associated, and viral suppression was suspected after bone marrow (BM) biopsy. After the transplantation, he developed progressive pancytopenia and a diagnosis of aplastic anemia was made via BM biopsy. With immunosuppressant agents (cyclosporine, methylprednisolone), cytokine therapy (granulocyte‐colony stimulating factor (G‐CSF), macrophage‐colony stimulating factor (M‐CSF), recombinant human erythropoietin (rhEPO)) was effectual and the patient recovered from pancytopenia. He was discharged from the hospital 57 d after the liver transplantation and remains well 1 yr after LROLT. Combined cytokine therapy with high doses of G‐CSF, M‐CSF and rhEPO appeared to be effective in the treatment of aplastic anemia following liver transplantation for non‐A, non‐B, non‐C hepatitis. Since M‐CSF activates macrophages, it may have contributed to the graft rejection. Careful consideration should be given to the use of high‐dose M‐CSF in liver transplant patients.

β6 integrin is up-regulated in chronic renal allograft dysfunction

Abstract:u2002 Up‐regulation of β6 integrin, which is indispensable to the activation of transforming growth factor‐β1 (TGF‐β1), was investigated in chronic renal allograft dysfunction (CAD). A total of 103 renal biopsy samples (normal, 10; acute rejection, 30; CAD, 63) were immunohistochemically evaluated for expression of TGF‐β1 and β6 integrin. No TGF‐β1 or ‐β6 integrin was detected in normal kidney, but both TGF‐β1 and ‐β6 integrin reactivity were observed in the distal tubules in acute rejection, and even greater reactivity was observed in the distal tubules in the CAD samples. Semiquantitative analysis revealed that the reactivity of TGF‐β1 and ‐β6 integrin was significantly greater in the CAD kidney than in the normal kidney and the kidney in acute rejection. The results suggest that β6 integrin as well as TGF‐β1 is up‐regulated in CAD and that it may serve as an alternative target for the treatment for CAD.

Photodynamic diagnosis of visceral pleural invasion of lung cancer with a combination of 5-aminolevulinic acid and autofluorescence observation systems

BACKGROUNDnVisceral pleural invasion (PL) is a prognostic factor in lung cancer. In the lung, lymph flows along the pleura, in addition to the flow toward the pulmonary hilum just as the pulmonary arteries and veins run toward it. Even with the same tumor diameter, a PL1 or higher level of pleural invasion is indicative of a more advanced disease stage. Final diagnosis based on the PL level is made by pathological examination of excised specimens. However, if an intraoperative diagnosis can be established, proper selection of the surgical procedure can be made, and unnecessary surgeries for disseminated lesions can be avoided. We investigated optical diagnostic techniques for identifying the presence or absence of visceral pleural invasion in lung cancer by capitalizing on the phenomenon of 5-amino-levulinic acid (5-ALA) being metabolized to a photosensitizing substance or protoporphyrin IX within malignant tumors, generating red luminescence in response to excitation light.nnnMETHODnThis study included 38 patients with primary lung cancer who underwent surgery. They received 5-ALA (20mg/kg) orally 4h before surgery and then we assessed the presence or absence of pleural invasion using an autofluorescence observation system. At visceral pleural invasion sites, we were able to confirm tumor sites visualized in red with a clear border in contrast to the green autofluorescence generated in normal tissues.nnnRESULTnRed luminescence could be confirmed in 100% of PL1-PL3 patients (14/14) and 41.6% of PL0 patients (10/24) with primary lung cancer. PL0 patients in whom visualization was possible were preoperatively diagnosed as having PL1 and many of them showed vascular channel invasion. The sensitivity, specificity, positive predictive value, and negative predictive value of this diagnostic technique were 100%, 58.0%, 63.1%, and 100%, respectively. Red fluorescence emission was observed significantly more often in pleural invasion cases.nnnCONCLUSIONnAccurate intraoperative diagnosis for visceral pleural invasion in lung cancer may contribute to determining the indications for limited operations such as segmental resection. In addition, accurate local diagnosis has the possibility of being applicable to photodynamic therapy.

Peritoneal lavage for acute hemorrhagic necrotic pancreatitis in a patient undergoing chronic hemodialysis.

血液透析導入後13年を経過して発症した重症型急性膵炎に対し, 腹膜灌流を施行し良好な結果を得たので報告する. 症例は, 48歳男性. 昭和51年1月, 血液透析導入し, 昭和63年10月より肝障害あり, 他院にて入院透析中であった. 平成1年7月4日, 嘔気, 腹痛あり, アミラーゼ1,586mg/dl, 腹部超音波検査にて膵腫大あり急性膵炎の診断のもと7月6日当院救命センター, 翌7月7日腎センター入院となる. 血液データ, 画像診断より重症型急性膵炎と診断, 保存的治療のほか同日PDカテーテルを挿入し, 赤褐色, 混濁した約120mlの腹水を排出した. 急性出血性壊死性膵炎と診断, 腹膜灌流を開始した. その後, 臨床症状は改善し, 血中, 灌流液中のアミラーゼ等の酵素は再上昇があるも, 減少傾向を示し, 合併症もなく9月7日に退院した.