Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 107
Filter
2.
Transplant Proc ; 50(10): 4050-4052, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30522857

ABSTRACT

Henoch-Schönlein purpura (HSP) is a systemic vasculitis affecting the small vessels that mainly presents in children and young adults. It is characterized by tissue deposition of immunoglobulin A (IgA) immune complexes with the classic manifestations of purpura, arthritis, arthralgia, and gastrointestinal and renal involvements. We report a case of HSP nephritis that occurred 2 years after living-donor liver transplantation (LDLT). After pulse steroid administration, the patient's symptoms disappeared and blood markers normalized. To the best of our knowledge, this is the first HSP case to be reported in a liver transplant recipient.


Subject(s)
IgA Vasculitis/etiology , Liver Transplantation/adverse effects , Postoperative Complications , Glomerulonephritis, IGA/etiology , Glomerulonephritis, IGA/pathology , Humans , IgA Vasculitis/pathology , Living Donors , Male , Middle Aged , Postoperative Complications/pathology
3.
Transplant Proc ; 50(9): 2775-2778, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401396

ABSTRACT

BACKGROUND: Donor age for intestinal transplantation (ITx) is somewhat younger than that for other solid organs. Clear criteria for adequate donors have not been established. There is a donor scarcity for ITx in Japan due to the shortage of young donors. METHODS: We reviewed outcomes associated with ITx in Japan based on donor age for cadaveric and living donation. RESULTS: Standardized report forms were sent to all known ITx programs, asking for information on ITxs performed between 1996 and 2016. All programs responded. Patient and graft survival estimates were obtained using the Kaplan-Meier method. Five institutions provided data on 27 grafts in 24 patients. There were 14 cadaveric and 13 living donor transplants. Median donor age for ITxs was 40 (range, 17-60) years. Graft survival at 5 years was 66% for patients >40 years old (n = 18) and 47% for those <40 years old (n = 9), not a statistically significant difference (P = .49). Graft survival at 5 years was 60% in those >50 years old (n = 5) and 57% for those <50 years old (n = 22), again not a significant difference (P = .27). CONCLUSION: There is no difference in survival between for those with donor age <40 vs >40 years. Donor age for ITx can be extended from >40 to up to 50 years, which may help to mitigate the donor shortage. It will be necessary to clarify the donor criteria for ITx through accumulation of further data on ITx.


Subject(s)
Age Factors , Donor Selection/statistics & numerical data , Intestines/transplantation , Tissue Donors/statistics & numerical data , Adolescent , Adult , Donor Selection/methods , Female , Graft Survival , Humans , Japan , Male , Middle Aged , Tissue Donors/supply & distribution , Treatment Outcome , Young Adult
4.
Transplant Proc ; 49(7): 1649-1651, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28838457

ABSTRACT

BACKGROUND: Colon cancer accompanying decompensated liver cirrhosis is a rare clinical condition. Usually, treatment of colon cancer is prioritized, with cirrhosis dealt with later. CASE REPORT: We present a case of end-stage liver disease due to nonalcoholic steatohepatitis evaluated for living donor liver transplant. During the pretransplant examination, an ascending colon cancer was detected. Liver function was too poor to perform colon resection first. Simultaneous living donor liver transplant and colonic resection were carried out. The patient developed left lung metastasis at 2 different times during the first postoperative year, and both of them were resected. The patient received the standard chemoradiotherapy. Now, the patient is alive at 42 months postprocedure and recurrence-free at 31 months postoperatively. CONCLUSION: Simultaneous liver transplantation and colon resection are possible with acceptable long-term outcomes. Immunosuppressive therapy after transplantation increases the risk for cancer recurrence. So the patient should undergo close surveillance.


Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , End Stage Liver Disease/surgery , Liver Transplantation/methods , Non-alcoholic Fatty Liver Disease/surgery , Colonic Neoplasms/complications , Combined Modality Therapy , End Stage Liver Disease/etiology , Female , Humans , Living Donors , Middle Aged , Non-alcoholic Fatty Liver Disease/complications , Treatment Outcome
5.
Am J Transplant ; 17(1): 69-80, 2017 01.
Article in English | MEDLINE | ID: mdl-27467205

ABSTRACT

Liver ischemia reperfusion injury (IRI) is an important problem in liver transplantation. Thrombomodulin (TM), an effective drug for disseminated intravascular coagulation, is also known to exhibit an anti-inflammatory effect through binding to the high-mobility group box 1 protein (HMGB-1) known as a proinflammatory mediator. We examined the effect of recombinant human TM (rTM) on a partial warm hepatic IRI model in wild-type (WT) and toll-like receptor 4 (TLR-4) KO mice focusing on the HMGB-1/TLR-4 axis. As in vitro experiments, peritoneal macrophages were stimulated with recombinant HMGB-1 protein. The rTM showed a protective effect on liver IRI. The rTM diminished the downstream signals of TLR-4 and also HMGB-1 expression in liver cells, as well as release of HMGB-1 from the liver. Interestingly, neither rTM treatment in vivo nor HMGB-1 treatment in vitro showed any effect on TLR-4 KO mice. Parallel in vitro studies have confirmed that rTM interfered with the interaction between HMGB-1 and TLR-4. Furthermore, the recombinant N-terminal lectin-like domain 1 (D1) subunit of TM (rTMD1) also ameliorated liver IRI to the same extent as whole rTM. Not only rTM but also rTMD1 might be a novel and useful medicine for liver transplantation. This is the first report clarifying that rTM ameliorates inflammation such as IRI in a TLR-4 pathway-dependent manner.


Subject(s)
Inflammation/prevention & control , Liver/blood supply , Reperfusion Injury/complications , Thrombomodulin/therapeutic use , Toll-Like Receptor 4/metabolism , Animals , Inflammation/etiology , Inflammation/metabolism , Male , Mice , Mice, Inbred C57BL , Signal Transduction
6.
Transpl Infect Dis ; 17(5): 671-8, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26201686

ABSTRACT

BACKGROUND: Herpes zoster (HZ) is the most common manifestation of latent varicella zoster virus reactivation, which occurs naturally as a result of aging or in immunocompromised patients. Solid organ transplant recipients are at increased risk for HZ owing to their chronic immunosuppression. Although several reports investigated risk factors for the development of HZ in heart or renal transplantation, data in liver transplantation (LT) are limited. METHODS: We evaluated clinical data retrospectively in 377 adult patients undergoing LT between January 2005 and December 2012 in our institution. We analyzed the incidence rate of HZ and the standardized incidence ratio (SIR) by comparing with the general Japanese population. We additionally investigated risk factors for HZ after LT. RESULTS: HZ developed in 27 (7.16%) of the 377 patients after LT. The incidence rate of HZ after LT was 17.83 per 1000 person-years, which was significantly higher than in the general Japanese population (SIR = 4.61; 95% confidence interval [CI], 4.13-5.14). Multivariate analysis showed that older age (hazard ratio [HR] = 3.95; P < 0.001) and exposure to mycophenolate mofetil (HR = 3.03; P = 0.007) were independent risk factors for HZ after LT. CONCLUSIONS: This is the first and largest study, to our knowledge, to investigate the incidence rate of HZ and risk factors for development of HZ after LT in the Japanese population. Further investigations to focus on immunosuppressive regimens to reduce the risk for HZ incidence in this high-risk population could establish a new protocol of immunosuppression after LT.


Subject(s)
Herpes Zoster/etiology , Immunocompromised Host , Liver Transplantation , Opportunistic Infections/etiology , Postoperative Complications/etiology , Adolescent , Adult , Aged , Female , Follow-Up Studies , Herpes Zoster/epidemiology , Herpes Zoster/immunology , Humans , Immunosuppression Therapy/adverse effects , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Opportunistic Infections/epidemiology , Opportunistic Infections/immunology , Postoperative Care/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/immunology , Proportional Hazards Models , Retrospective Studies , Risk Factors , Young Adult
7.
Transplant Proc ; 47(3): 804-8, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25891735

ABSTRACT

A 57-year-old man with a history of hepatitis B virus infection was referred to our hospital for living-donor liver transplantation (LDLT). Five years earlier, right lobectomy had been performed for solitary hepatocellular carcinoma (HCC) with bile duct tumor thrombus in segments 5 and 6 in the liver. Two years later, transarterial chemoembolization and radiofrequency ablation were performed for recurrent HCC. Two years after those local therapies, another recurrent HCC was treated with transhepatic arterial infusion chemotherapy with cisplatin and conventional radiation therapy (RT) with 60 Gy in 20 fractions, because the tumor was contiguous to the trunk of the portal vein. After the completion of RT, symptoms due to liver failure and severe infection caused by multiple liver abscesses developed despite the administration of antibiotics and percutaneous transhepatic cholangiodrainage. Therefore, LDLT was performed with the use of a right lobe graft donated by his wife. Vascular anastomosis was successfully performed with the use of normal procedures. The patient recovered uneventfully, and has since been doing well for 34 months, with no evidence of vascular complications. However, the degree of injury to the anastomotic vessels caused by definitive RT before LDLT remains unclear, whereas the safety and efficacy of some forms of RT as a bridge to deceased-donor LT have been reported. Salvage LDLT is effective for patients with liver failure after multidisciplinary treatment including radiation, while carefully taking radiation-induced vessel injury as a potential late complication into consideration, especially in LDLT cases.


Subject(s)
Carcinoma, Hepatocellular/radiotherapy , Liver Failure/surgery , Liver Neoplasms/radiotherapy , Liver Transplantation , Living Donors , Neoplasm Recurrence, Local/radiotherapy , Salvage Therapy , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Combined Modality Therapy , Humans , Liver Failure/etiology , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation/methods , Male , Middle Aged , Neoplasm Recurrence, Local/complications , Neoplasm Recurrence, Local/surgery
8.
Transpl Infect Dis ; 16(5): 790-6, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25154523

ABSTRACT

BACKGROUND: Severe sepsis is a life-threatening complication after liver transplantation (LT) that can be difficult to diagnose and appropriately treat after LT because of patients being treated with immunosuppressants. The present study examines perioperative changes in serum procalcitonin (PCT), a specific marker of systemic bacterial infection, and determines the value of PCT as a diagnostic tool for bacteremia or rejection. METHODS: Perioperative serum PCT levels were prospectively assessed in 104 consecutive adult patients undergoing LT (living-donor LT, n = 90; deceased-donor LT, n = 14) between May 2010 and August 2012. RESULTS: Serum PCT levels remarkably increased soon after LT and gradually decreased thereafter, but were not increased in patients diagnosed with cytomegalovirus infection or acute cellular rejection. Serum PCT levels in patients who underwent deceased-donor LT were significantly higher than in those who underwent living-donor LT until postoperative day (POD) 7. Serum PCT levels were significantly higher in patients with bacteremia than in those without bacteremia after POD 14. In patients with post-transplant bacteremia, PCT levels increased again after POD 7 in patients who died within 3 months of LT, while levels remained low after POD 7 in patients who were alive. A positive predictive value of 83.3% for bacteremia and a negative predictive value of 97.4% were obtained at PCT cutoffs of 2.0 and 0.5 ng/mL, respectively. CONCLUSION: Serum PCT measurement, using appropriate cutoff values, could help diagnose severe infection, and might be able to differentiate bacteremia from acute cellular rejection.


Subject(s)
Bacteremia/blood , Calcitonin/blood , Graft Rejection/blood , Liver Transplantation/adverse effects , Protein Precursors/blood , Adult , Aged , Bacteremia/diagnosis , Biomarkers/blood , Calcitonin Gene-Related Peptide , Cytomegalovirus Infections/blood , Female , Graft Rejection/diagnosis , Graft Rejection/immunology , Humans , Immunity, Cellular , Liver Diseases/surgery , Living Donors , Male , Middle Aged , Perioperative Period , Predictive Value of Tests , Prospective Studies , Time Factors , Young Adult
9.
Transplant Proc ; 45(4): 1472-5, 2013 May.
Article in English | MEDLINE | ID: mdl-23726600

ABSTRACT

BACKGROUND: Mizoribine (MZR) at 3 mg/kg/d shows less potent immunosuppressive effects, but high-dose MZR (6 mg/kg/d) was effective and safe in a 2-year study in conjunction with a regimen of cyclosporine (CsA), basiliximab, and corticosteroids. METHODS: We compared 40 living-related kidney recipients administered MZR (6 mg/kg/d), CsA (7 mg/kg/d), prednisolone (maintenance dose 10 mg/d), and basiliximab (20 mg/body) with control group (n = 38) treated with CsA, mycophenolate mofetil (MMF; 25 mg/kg/d), basiliximab, and corticosteroids. RESULTS: The 4-year graft survival rates for the MZR vs MMF groups were 92.5% vs 94.7%, respectively, with serum creatinine levels of 1.66 ± 1.0 mg/dL vs 1.41 ± 0.42 mg/dL at 3 years, and 1.72 ± 1.16 mg/dL vs 1.56 ± 1.26 mg/dL at 4 years. There was no significant difference in serum creatinine levels between the 2 groups. The MZR group demonstrated a significantly higher rate of elevated serum uric acid values (29.7%). The numbers of patients treated with allopurinol at 4 years were 11/37 (29.7%) for MZR vs 2/36 (5.6%) for the MMF subjects (P < .05). Mean serum uric acid levels of the MZR vs MMF group at 4 years were 7.1 ± 1.9 mg/dL vs 7.0 ± 1.6 mg/dL, respectively (NS). There was no significant difference between the 2 groups regarding bone marrow suppression or liver dysfunction. Severe cytomegalovirus infection was not observed at 3 and 4 years in either group. There were no severe gastrointestinal symptoms among the MZR or the MMF group at 3 or 4 years. CONCLUSIONS: The combination of high-dose MZR with CsA, basiliximab, and corticosteroids displayed excellent results over a 4-year follow-up.


Subject(s)
Antibodies, Monoclonal/administration & dosage , Cyclosporine/administration & dosage , Immunosuppressive Agents/administration & dosage , Kidney Transplantation , Prednisone/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Ribonucleosides/administration & dosage , Antibodies, Monoclonal/adverse effects , Basiliximab , Creatinine/blood , Cyclosporine/adverse effects , Dose-Response Relationship, Drug , Drug Therapy, Combination , Graft Survival , Humans , Immunosuppressive Agents/adverse effects , Prednisone/adverse effects , Recombinant Fusion Proteins/adverse effects , Ribonucleosides/adverse effects
10.
Transplant Proc ; 44(2): 409-11, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22410029

ABSTRACT

Tumor vascular invasion is one of the worst factors of metastasis and/or recurrence in hepatocellular carcinoma (HCC) patients after living donor liver transplantation (LDLT), leading to poor outcomes. We investigated the relevance between preoperative parameters and histological vascular invasion among HCC patients who underwent LDLT. We enrolled 27 HCC patients who underwent LDLT from September 2003 to February 2011 in our hospital. Their primary diseases were hepatitis C (n=16) hepatitis B (n=9), primary biliary cirrhosis (n=1), and cryptogenic liver cirrhosis (n=1). The 2 groups were positive (N=7) versus negative (N=20) histological vascular invasion. We compared the greatest size and numbers of tumors from preoperative enhanced computerized axial tomography (CAT) scans, preoperative serum levels of alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II), as well as preoperative anticancer therapy. The preoperative greatest average diameter and numbers of tumor were 2.99 cm and 2.43, respectively, among positive patients, and 1.93 cm and 1.3, respectively, among patients with negative vascular invasion. The mean values of AFP and PIVKA-II were 3568.7 ng/mL and 2511.7 mAU/mL, respectively, among positive patients, and 812.8 ng/mL and 134.8 mAU/mL, respectively, among patients with negative vascular invasion. Five positive and 11 negative patients received preoperative anticancer therapy. Even if the tumor was within Milan criteria, namely, maximum size 3 cm and number of tumors 3, preoperative treatment may be a preoperative predictive factor for positive histological vascular invasion.


Subject(s)
Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Liver Transplantation , Living Donors , Biomarkers/blood , Carcinoma, Hepatocellular/mortality , Female , Humans , Japan , Liver Neoplasms/mortality , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Predictive Value of Tests , Preoperative Care , Protein Precursors/blood , Prothrombin , Survival Analysis , Survival Rate , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Tumor Burden , alpha-Fetoproteins/analysis
11.
Transplant Proc ; 44(1): 140-3, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22310599

ABSTRACT

BACKGROUND: Mizoribine (MZR) has been developed as an immunosuppressive agent in Japan, but it shows less potent immunosuppressive effects at doses up to 3 mg/kg/d. In this study, we investigated whether high-dose MZR (6 mg/kg/d) was effective for ABO-incompatible (ABO-i) living donor kidney transplantation (LKT) using treatment with anti-CD25 and anti-CD20 monoclonal antibodies without splenectomy. METHODS: Since 2007, we encountered 24 cases of ABO-i LKT using anti-CD20 and anti-CD25 monoclonal antibody without splenectomy. The pretransplant immunosuppressive regimen consisted of two doses of anti-CD20 antibody, mycophenolate mofetil (MMF), prednisolone, a calcineurin inhibitor (cyclosporine [7 mg/kg] or tacrolimus [0.2 mg/kg] and two doses of anti-CD25 antibody. Antibody removal by plasmapheresis was performed before LKT up to several times according to the antibody titer. The posttransplant regimen consisted of high-dose mizoribine (6 mg/kg/d) instead of MMF (MZR group, n = 12). RESULTS: The 1-year graft survival rates for the MZR and MMF groups were both 100%. The rejection rate in the MZR group (eight %) was not significantly higher than that in the MMF group (seventeen %) Serum creatinine level was not significantly different between the two groups. In the MZR group 6 (50%) patients developed CMV antigenemia-positivity versus 11 (92%) in the MMF group (P < .05). The number of patients who developed CMV disease was 0 in the MZR group and 1 (8%) in the MMF group. The number of patients treated with ganciclovir was 0% and 8%, respectively (not significant). CONCLUSIONS: We obtain good clinical results with high-dose MZR in ABO-i LKT using anti-CD20 and anti-CD25 antibody treatment without splenectomy.


Subject(s)
ABO Blood-Group System/immunology , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antibodies, Monoclonal/therapeutic use , Blood Group Incompatibility/immunology , Histocompatibility , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Recombinant Fusion Proteins/therapeutic use , Ribonucleosides/therapeutic use , Splenectomy , Adult , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Murine-Derived/adverse effects , Antigens, CD20/immunology , Antiviral Agents/therapeutic use , Basiliximab , Biomarkers/blood , Creatinine/blood , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/immunology , Drug Therapy, Combination , Female , Graft Rejection/immunology , Graft Rejection/prevention & control , Graft Survival/drug effects , Humans , Immunosuppressive Agents/adverse effects , Interleukin-2 Receptor alpha Subunit/immunology , Japan , Kaplan-Meier Estimate , Kidney Transplantation/adverse effects , Kidney Transplantation/immunology , Living Donors , Male , Middle Aged , Recombinant Fusion Proteins/adverse effects , Ribonucleosides/adverse effects , Rituximab , Time Factors , Treatment Outcome , Young Adult
12.
Transplant Proc ; 43(6): 2418-20, 2011.
Article in English | MEDLINE | ID: mdl-21839281

ABSTRACT

In Japan, amyloidosis is a rare cause of renal failure and of renal transplantation. We treated a patient who underwent a renal transplantation because of chronic renal failure caused by secondary amyloidosis with a good result. The patient was a 50-year-old woman who was diagnosed with secondary amyloidosis and an amyloid kidney. She underwent living donor renal transplantation after about 7 years of hemodialysis. During the 3-year posttransplantation period, she maintained good allograft function with a serum creatinine level about 1.2 mg/dL. Because of amyloidosis is a systemic disease, amyloid kidney patients often experience fatal complications, so the indications for renal transplantation in amyloid patients are still controversial. But if the patient's general condition is good, renal transplantation can be an effective therapy for patients with kidney failure caused by amyloidosis.


Subject(s)
Amyloidosis/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Living Donors , Female , Humans , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/etiology , Middle Aged , Treatment Outcome
13.
Transplant Proc ; 43(6): 2424-7, 2011.
Article in English | MEDLINE | ID: mdl-21839283

ABSTRACT

A 60-year-old male patient with an unknown cause for cirrhosis and a hepatoma underwent an ABO incompatible living donor liver transplantation (LDLT) from his son. The transplanted graft was his son's right lobe. For ABO incompatible transplantation, splenectomy was performed for desensitization. A catheter was inserted into the recipient's right hepatic artery for subsequent local immunosuppression. On the 15th postoperative day, a fusiform 15 × 10 mm aneurysm was observed in the graft right hepatic artery using ultrasonography and hepatic arteriography. At that time, the patient was also diagnosed to have an intraperitoneal abscess at the bottom of his left diaphragm. Administering antibiotics, we tried to embolize the aneurysm because of fear of rupture, but this manever failed because it was difficult to insert the wire in to the aneurysm to produce a stenosis around its proximal neck. However, because the aneurysm was not detectable on the 37th postoperative day, it was assumed to have embolized spontaneously. This relatively rare case revealed a hepatic artery aneurysm that spontaneously regressed after ABO incompatible LDLT.


Subject(s)
ABO Blood-Group System/immunology , Aneurysm/etiology , Blood Group Incompatibility/complications , Hepatic Artery , Histocompatibility , Liver Transplantation/adverse effects , Aneurysm/diagnosis , Blood Group Incompatibility/immunology , Hepatic Artery/diagnostic imaging , Humans , Liver Transplantation/immunology , Living Donors , Male , Middle Aged , Remission, Spontaneous , Time Factors , Tomography, X-Ray Computed , Ultrasonography
14.
Transplant Proc ; 43(6): 2379-82, 2011.
Article in English | MEDLINE | ID: mdl-21839272

ABSTRACT

BACKGROUND: Due to the shortage of deceased donors, we have expanded the indications for living-donor kidney transplantation (LKT) to include ABO-incompatible (ABO-i) individuals. However, which patients with high-titer anti-blood-group antibody can be transplanted successfully is unclear. METHODS: Since 2009 we have performed 2 high-titer ABO-i spousal LKT using anti-CD20 and anti-CD25 monoclonal antibody without splenectomy. In both cases, anti-type A antibody was 2048-fold before antibody removal. The immunosuppressive regimen consisted of 2 doses of anti-CD20 antibody (200 mg/body, day -14 to day -7), mycophenolate mofetil (1000 mg), prednisolone (10 mg starting from day -14), calcineurin inhibitor (cyclosporine [7 mg/kg] or tacrolimus [0.2 mg/kg] starting from day -7), and 2 doses of anti-CD25 antibody (20 mg/body, days 0 and 4). Antibody removal by plasmapheresis was performed up to 4 times before LKT according to the antibody titer. The posttransplantation regimen consisted of mycophenolate mofetil or mizoribine as antimetabolite. A protocol biopsy was performed at 1 month and 1 year after LKT. RESULT: The 60- and 62-year-old men had renal graft transplantation performed in the right hemipelvis without complication. After LKT, urinary output and serum creatinine decrease were within acceptable ranges without evidence of an acute rejection episode for 12 and 7 months, respectively. Patient and graft survival rates were 100%. A protocol biopsy at 1 month after LKT showed additional treatment to be unnecessary. Serious viral infection was not seen, even in the 1 patient who temporarily experienced positive changes in cytomegalovirus antigenemia. CONCLUSIONS: We obtained good clinical results among 2 high-titer ABO-i LKT using anti-CD20 and anti-CD25 antibodies without splenectomy, in conjunction with a calcineurin inhibitor plus mycophenolate mofetil or mizoribine.


Subject(s)
ABO Blood-Group System/immunology , Antibodies, Monoclonal/therapeutic use , Antigens, CD20/immunology , Blood Group Incompatibility/immunology , Histocompatibility , Immunosuppressive Agents/therapeutic use , Interleukin-2 Receptor alpha Subunit/immunology , Kidney Transplantation/immunology , Blood Group Incompatibility/diagnosis , Blood Grouping and Crossmatching , Drug Therapy, Combination , Graft Survival , Humans , Living Donors , Male , Middle Aged , Plasmapheresis , Splenectomy , Time Factors , Treatment Outcome
15.
Am J Transplant ; 7(6): 1629-32, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17511687

ABSTRACT

Grafts used in Domino liver transplantation (LT) obtained from living donor liver transplantation (LDLT) for familial amyloid polyneuropathy (FAP) patients have been mainly used as reduced grafts. Because of small-for-size problems seen in LDLT, using whole liver grafts could improve post-LT outcome. Eight consecutive Domino LDLT using whole livers without retrohepatic inferior vena cava (IVC) from FAP patients were retrospectively analyzed. The graft weight/recipient's body weight ratio (GWRW) in the domino recipients ranged from 1.28% to 2.4% (mean: 1.52). Multiple vascular reconstructions in the whole-liver domino LT resulted in longer than usual warm ischemia time (mean: 64 min); however immediate post-operative recovery of hepatic function was uneventful. At 8-40 months after the transplant, all the FAP patients are well and all of the domino recipients are alive. Domino LT using a whole FAP liver from a LDLT for a FAP patient presents satisfactory results, even though the transplant procedure is technically complicated.


Subject(s)
Amyloid Neuropathies, Familial/surgery , Liver Transplantation/methods , Living Donors , Vena Cava, Inferior/surgery , Adolescent , Adult , Humans , Living Donors/statistics & numerical data , Middle Aged , Retrospective Studies , Treatment Outcome
16.
Redox Rep ; 10(2): 96-102, 2005.
Article in English | MEDLINE | ID: mdl-15949130

ABSTRACT

Garlic extract significantly inhibited the oxidation of methyl linoleate in homogeneous acetonitrile solution, whereas the antioxidant effect of allicin-free garlic extract, prepared by removing allicin by prepared by removing allicin by preparative HPLC, was much lower than that of the garlic extract. These results suggest that the antioxidant properties are mostly attributed to the presence of allicin in the garlic extract. Allicin a major component of the thiosulfinates in garlic extract, was found to be effective for inhibiting methyl linoleate oxidation, but its efficiency was less than that of alpha-tocopherol. Next, the reactivity of allicin toward the peroxyl radical, which is a chain-propagating species, was investigated by direct ESR detection. The addition allicin to 2,2'-azobis(2,4-dimethylvaleronitrile)-peroxyl radical solution caused the signal intensity of the peroxyl radical to dose-dependently decrease, indicating that allicin is capable of scavenging the the peroxyl radical and acting as an antioxidant. Finally, we studied the structure-anioxidant activity relationship for thiosulfinates and suggested that the combination of the allyl group (-CH2CH=CH2) and the -S(O)S- group is necessary for the antioxidant action of thiosulfinates in the garlic extract. In addition, one of the two possible combinations, -S(O)S-CH2CH=CH2, was found to make a much larger contribution to the antioxidant activity of the thiosulfinates than the other, CH2=CH-CH2-S(O)S-.


Subject(s)
Antioxidants/pharmacology , Garlic/metabolism , Plant Extracts/pharmacology , Plants, Medicinal/metabolism , Thiosulfates/chemistry , Acetonitriles/chemistry , Antioxidants/chemistry , Chromatography, High Pressure Liquid , Disulfides , Dose-Response Relationship, Drug , Electron Spin Resonance Spectroscopy , Linoleic Acids/pharmacology , Models, Chemical , Pharmaceutical Preparations , Solvents , Sulfinic Acids/chemistry , Temperature
17.
Redox Rep ; 7(3): 153-7, 2002.
Article in English | MEDLINE | ID: mdl-12189045

ABSTRACT

We recently reported that capsaicin (CAP) is capable of scavenging peroxyl radicals derived from 2,2'-azobis(2,4-dimethylvaleronitrile) as measured by electron spin resonance (ESR) spectroscopy. The present study describes the hydroxyl radical (HO*) scavenging ability of CAP as measured by DNA strand scission assay and by an ESR spin trapping technique with 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). The Fenton reaction [Fe(II)+ H(2)O(2) --> Fe(III) + HO* + HO(-)] was used as a source of HO*. The incubation of DNA with a mixture of FeSO(4) and H(2)O(2) caused DNA strand scission. The addition of CAP to the incubation mixture decreased the strand scission in a concentration-dependent manner. To understand the antioxidative mechanism of CAP, we used an ESR spin trapping technique. Kinetic competition studies using different concentrations of DMPO indicated that the decrease of the oxidative DNA damage was mainly due to the scavenging of HO* by CAP, not to the inhibition of the HO* generation system itself. We estimated the second order rate constants in the reaction of CAP and common HO* scavengers with HO* by kinetic competition studies. By comparison with the common HO* scavengers, CAP was found to scavenge HO* more effectively than mannitol, deoxyribose and ethanol, and to be equivalent to DMSO and benzoic acid, demonstrating that CAP is a potent HO* scavenger. The results suggest that CAP may act as an effective HO* scavenger as well as a peroxyl radical scavenger in biological systems.


Subject(s)
Capsaicin/pharmacology , Free Radical Scavengers/pharmacology , Hydroxyl Radical/metabolism , Cyclic N-Oxides/pharmacology , DNA Damage , Electron Spin Resonance Spectroscopy/methods , Spin Labels
18.
Redox Rep ; 6(2): 117-22, 2001.
Article in English | MEDLINE | ID: mdl-11450982

ABSTRACT

The antioxidant activity of capsaicin (CAP) was measured in the oxidation of methyl linoleate (ML) in homogeneous solution, of ML micelles in aqueous dispersions and also of soybean phosphatidylcholine liposomal membrane, and was compared to that of alpha-tocopherol (alpha-TOH) which is one of the most important antioxidants in vivo. The reactivity of CAP toward galvinoxyl (a model phenoxyl radical) in acetonitrile solution was found to be much smaller than that of alpha-TOH, suggesting that the radical scavenging activity of CAP is much weaker than that of alpha-TOH. In fact, in homogeneous acetonitrile solution where the antioxidant activity is determined primarily by the chemical activity of the antioxidant toward peroxyl radicals, CAP inhibited the oxidation of ML much less efficiently than alpha-TOH and a clear induction period was not observed. The antioxidant activity of CAP was found to be about 60 times smaller than that of alpha-TOH in homogeneous solution. However, in micelle oxidation, the difference in antioxidant activity of the two antioxidants was much smaller than in homogeneous solution. Furthermore, in the membrane, CAP inhibited the oxidation almost as effectively as alpha-TOH. These results suggest that CAP can act as an antioxidant in the biomembrane.


Subject(s)
Antioxidants/pharmacology , Capsaicin/pharmacology , Linoleic Acids/metabolism , Lipid Peroxidation/drug effects , Acetonitriles , Azo Compounds/pharmacology , Benzhydryl Compounds/metabolism , Free Radical Scavengers/pharmacology , Kinetics , Liposomes , Membranes, Artificial , Micelles , Nitriles/pharmacology , Oxidation-Reduction , Peroxides/metabolism , Phosphatidylcholines/metabolism , Solutions , Solvents , Spices , alpha-Tocopherol/pharmacology
19.
Pediatr Dev Pathol ; 1(5): 420-6, 1998.
Article in English | MEDLINE | ID: mdl-9688766

ABSTRACT

Two cases of sacral chordoma in a 7-year, 9-month-old boy and a 3-year, 4-month-old boy are presented. In addition to the typical histology of conventional chordoma, both tumors showed the less differentiated sarcomatoid appearance of atypical chordoma in the major portion. Immunohistochemically, in both cases neoplastic cells in areas of conventional as well as atypical chordoma were positive for keratins (CAM 5.2, AE1 and AE3), epithelial membrane antigen, vimentin, S-100 protein, carcinoembryonic antigen, and glial fibrillary acidic protein. Both patients underwent resection of the tumor and chemotherapy. In comparison with conventional chordomas in adults, however, these two tumors showed more aggressive clinical course and were less amenable to therapeutic control. The older boy died of multiple metastasis 1 year after initial diagnosis. At the last follow-up, 15 months after initial diagnosis, the younger boy was alive, but with recurrent and metastatic disease of the left parasacral area and chest wall. Our studies of these two cases and the reported cases suggest that sacral chordoma in children has distinctive clinicopathologic features denoting a highly aggressive tumor and that it should be treated as such.


Subject(s)
Chordoma/pathology , Sacrum/pathology , Spinal Neoplasms/pathology , Biomarkers, Tumor/analysis , Child , Child, Preschool , Chordoma/chemistry , Chordoma/therapy , Fatal Outcome , Humans , Immunoenzyme Techniques , Magnetic Resonance Imaging , Male , Spinal Neoplasms/chemistry , Spinal Neoplasms/therapy , Tomography, X-Ray Computed , Treatment Outcome
20.
Surgery ; 124(5): 901-10, 1998 Nov.
Article in English | MEDLINE | ID: mdl-9823405

ABSTRACT

BACKGROUND: The goal of this study was to evaluate cause and outcome of biliary complications occurring after pediatric living related liver transplantation (LRLT). METHODS: A database of 205 pediatric patients (71 male and 134 female) undergoing 208 LRLT from June 1990 to April 1996 was reviewed. RESULTS: The overall incidence of bile duct complications was 13.9% (29 patients). There were 19 bile leaks, 7 anastomotic strictures, 8 intrahepatic biliary complications, and the bile duct was ligated inadvertently in 2 cases. Logistic regression analysis revealed hepatic artery thrombosis, ABO incompatible transplantation, intrapulmonary shunting in recipients, mode of artery reconstruction, and cytomegalovirus infection were all significant risk factors for biliary complications. CONCLUSIONS: Avoidance of ABO incompatible transplantation where possible, routine use of microvascular techniques for hepatic artery reconstruction to minimize the risk of artery thrombosis, earlier transplantation for patients with intrapulmonary shunt, and prophylaxis against cytomegalovirus infection should all reduce the rate of biliary complications after LRLT in pediatric recipients.


Subject(s)
Biliary Tract Diseases/etiology , Liver Transplantation , Living Donors , Postoperative Complications , ABO Blood-Group System , Adolescent , Bile/physiology , Bile Ducts, Intrahepatic/physiopathology , Biliary Tract Diseases/epidemiology , Biliary Tract Diseases/physiopathology , Biliary Tract Diseases/virology , Blood Group Incompatibility/complications , Child , Child, Preschool , Cytomegalovirus Infections/complications , Female , Hepatic Artery , Humans , Incidence , Infant , Male , Postoperative Complications/etiology , Postoperative Complications/virology , Risk Factors , Thrombosis/complications
SELECTION OF CITATIONS
SEARCH DETAIL
...