Details of a Researcher - Obara, Hideaki

Papers - Obara, Hideaki

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An operator assistance control system for skill enhancement and safety assurance in cascade tank systems

Ishida, R; Inoue, M; Ishihara, S; Obara, H

SICE JOURNAL OF CONTROL MEASUREMENT AND SYSTEM INTEGRATION 19 ( 1 ) 2026.12

ISSN 1882-4889

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R0 Resection for Pediatric Malignancies Involving the Inferior Vena Cava: A Multidisciplinary Approach

Yamada, Y; Sato, M; Kondo, A; Kumagai, T; Sugiyama, Y; Shirosaki, K; Kano, M; Kato, M; Hayashi, M; Fujimura, N; Hasegawa, Y; Abe, Y; Obara, H; Fujino, A

PEDIATRIC BLOOD & CANCER 73 S73 - S74 2026.04

ISSN 1545-5009

Early Clinical Results From the Japanese Prospective Multicenter Study to Evaluate Zenith Alpha Abdominal Stent Graft for Abdominal Aortic Aneurysm (JUSTICE) Registry Demonstrate Acceptable Limb Patency at 12 Months

Fujimura N., Ichihashi S., Shibata T., Matsumura H., Watanabe M., Morikage N., Kurimoto Y., Banno H., Uchiyama H., Obara H.

Journal of Endovascular Therapy 33 ( 1 ) 227 - 235 2026.02

ISSN 15266028

Purpose: Recent reports of the Zenith Alpha abdominal endovascular graft (Zenith Alpha AAA, Cook, Inc., Bloomington, Indiana) have demonstrated an unexpectedly high incidence of limb graft occlusion (LGO). The purpose of this study was to prospectively evaluate the performance of the Zenith AAA in Japan, with a specific focus on LGO. Materials and methods: All endovascular aneurysm repairs (EVARs) for abdominal aortic aneurysms performed using the Zenith Alpha AAA from July 2020 to October 2021 in 23 Japanese hospitals were prospectively evaluated. All computed tomographic images were analyzed in the core laboratory. Late complications were defined as any aneurysm-related events occurring >30 days after EVAR, including aneurysm sac enlargement of >5 mm and any reinterventions performed. Endoleaks without sac enlargement or reintervention were excluded as late complications. Results: During the study period, 147 EVARs were performed using the Zenith Alpha AAA. The mean patient age was 76.5±7.7 years, 84.4% of patients were male, and the mean aneurysm diameter was 52.4±9.2 mm. Instruction-for-use violations were observed in 76 patients (51.7%), primarily associated with a severely angulated proximal neck (>60°). There were six intraoperative complications and 62 additional intraoperative treatments reported, most of which involved preemptive coil embolization of the inferior mesenteric artery (37 cases). Technical success, defined as the absence of type 1 or 3 endoleaks on final angiography, was achieved in 99.3% of patients. At 12 months, there was only one case of type 1/3 endoleak (0.8%) and one aneurysm sac enlargement exceeding 5 mm (0.8%); however, a high incidence of type 2 endoleaks was observed in 35.2% of patients, and aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients. Nine late complications were observed, and the rate of freedom from late complications at 12 months was 93.5%, encompassing four LGOs and one limb graft stenosis (3.4%). Conclusions: In contrast to recent reports, our Japanese multicenter prospective study demonstrated satisfactory early clinical results, including an acceptable LGO rate, for the low-profile Zenith Alpha AAA. Long-term follow-ups will be performed to confirm the persistence of these outcomes. Clinical Impact: This study prospectively evaluated the performance of 147 Zenith Alpha AAAs used for endovascular aneurysm repair with core-lab adjudication focusing especially on limb graft occlusion (LGO). At 12 months, aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients, and there was only one type 1/3 endoleak, one aneurysm sac enlargement (>5 mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg.” 5mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg.

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Validation of novel scoring systems for acute decompensated cirrhosis identifies PBC as an independent poor prognostic factor: a single-center Japanese cohort study

Nakadai Y., Ojiro K., Kasuga R., Chu P.S., Ueno M., Tabuchi T., Taniki N., Usui S., Hasegawa Y., Abe Y., Kitago M., Obara H., Kanai T., Nakamoto N.

Journal of Gastroenterology 61 ( 1 ) 85 - 95 2026.01

ISSN 09441174

Background: The Model for End-Stage Liver Disease 3.0 (MELD 3.0) was developed in the United States to improve prioritization for liver transplantation (LT); however, its utility in Japanese patients with liver cirrhosis (LC) and acute decompensation (AD) remains invalidated. Methods: We retrospectively analyzed 312 patients with LC and first-time AD admitted to our institution between 2012 and 2022. Prognostic accuracy of MELD 3.0 was evaluated at 90 and 180 days after admission by comparison with other predictive models. Prognoses according to cirrhosis etiology and contributing factors were also examined. Results: MELD 3.0 demonstrated superior prognostic accuracy at day 180 (C-index: 0.770) compared to the original MELD and MELD Na, although its C-index up to day 90 was comparable to that of MELD and MELD Na. A cut-off value of MELD 3.0 > 20.5 predicted LT or liver-related death at day 180. Patients with primary biliary cholangitis (PBC) had poorer outcomes than non-PBC cases through 180 days and remained an independent risk factor in the Cox proportional hazards model incorporating MELD 3.0. A progressive increase in both MELD 3.0 and total bilirubin from day 0 to day 90 after AD was observed specifically in the PBC group, which may have been associated with the poor prognosis at day 180. Conclusions: MELD 3.0 was effective in predicting 180-day outcomes in Japanese patients with LC and AD. Progressive bilirubin elevation in PBC may be associated with poor prognosis. These findings suggest that early consideration of LT is warranted in patients with PBC.

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Retroperitoneal Abdominal Aortic Repair With the da Vinci Single Port System: A Porcine Model Feasibility Study

Takayama, T; Stein, H; Obara, H; Kudo, T; Preuss, M; Berndt, R; Debus, SE; Komiya, T; Kaneta, H; Thaveau, F

EJVES VASCULAR FORUM 65 25 - 31 2026

ISSN 2666-688X

Objective: Robotic surgery is rarely used in vascular surgery but has demonstrated significant potential compared with open or laparoscopic techniques in reports of abdominal aortic surgery. Enabling a standardised retroperitoneal approach (RPA) to abdominal aortic repair might reduce the peri-operative mortality and morbidity rates associated with a transabdominal approach. The aim of this experimental study was to establish surgical techniques for robotically assisted infrarenal abdominal aortic repair using a single port RPA. Methods: Retroperitoneal abdominal aortic repair was performed in four live porcine models by a group of experienced and novice robotic surgeons. The procedures were performed using the da Vinci SP (single port) surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Polytetrafluoroethylene grafts (W.L. Gore & Associates, Inc., Newark, DE, USA) were implanted after aortic resection. Operating times for the main procedure steps were recorded. Results: Abdominal aortic repair was feasible in all porcine models applying an RPA through a single incision with the da Vinci SP system. Creating the retroperitoneal access and docking the da Vinci SP was quick, with durations ranging from eight to 20 minutes. Proximal and distal anastomoses were completed in 26 minutes (range 19–33 minutes) and 31.3 minutes (range 23–42 minutes), respectively. In porcine models 2–4, the anastomoses were patent without haemorrhage, with aortic pulsations confirmed on release of the cross clamps. Porcine model 1 was pulseless owing to uncontrolled haemorrhage caused by left external iliac artery penetration at the end of the procedure, and patency could not be tested. Conclusion: Retroperitoneal single port robotic aortic repair was technically feasible with high accuracy in live porcine models. Anastomotic times were reasonable and surgeon comfort level was adequate, which may enable transfer into clinical routine in the future when true clinical benefits will need to be proven in additional studies.

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A novel tissue-engineered stent graft combining decellularized scaffold and bioresorbable stent: a pilot feasibility study in a porcine model

Shimogawara T., Matsubara K., Tajima K., Shimoda M., Yagi H., Obara H., Kitagawa Y.

Organogenesis 22 ( 1 ) 2610591 2026

ISSN 15476278

Endovascular aneurysm repair (EVAR) is a widely accepted treatment for aortic pathologies owing to its minimally invasive nature. However, long-term complications, such as stent graft migration and infection, remain unresolved, primarily due to the persistent presence of synthetic materials and limited tissue integration. This pilot study evaluated the feasibility of a novel tissue-engineered stent graft (TESG) combining a bioresorbable poly-L-lactic acid (PLLA) stent with decellularized porcine veins. The veins were processed using a sodium dodecyl sulfate and the Triton X-100 decellularization protocol. Histological and ultrastructural analyses confirmed effective cell removal while preserving extracellular matrix components. Quantitative deoxyribonucleic acid (DNA) analysis showed a > 97% reduction in DNA content. The TESGs were assembled by suturing the decellularized veins into bioresorbable PLLA stents and implanted into porcine iliac arteries (n = 3). Commercially available prosthetic grafts were used as control implants to evaluate differences in tissue responses. Graft patency and morphology were assessed at implantation and on postoperative day 14 using angiography and intravascular ultrasonography. All TESGs remained patent, with no evidence of thrombosis or aneurysmal changes. Histological analysis revealed early endothelialization and smooth muscle cell infiltration within the TESG wall, in contrast to the prosthetic graft controls, which lacked comparable cellular integration. This study demonstrated the short-term feasibility and biological compatibility of a fully bioresorbable TESG. Although long-term outcomes remain to be established, these results support further development of TESG to reduce late complications through improved tissue integration and avoidance of permanent synthetic materials.

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Comparison of vascular remodeling between a bioresorbable poly-L-lactic acid scaffold and a bare metal stent: a 6-month angiography and intravascular ultrasound analysis in porcine iliac arteries

Hayashi K., Obara H., Fujimura N., Masugi Y., Sekimoto Y., Matsubara K., Kitagawa Y.

Organogenesis 22 ( 1 ) 2630543 2026

ISSN 15476278

Animal experimental studies involving the Igaki-Tamai stent (ITS), a bioresorbable poly-l-lactic acid scaffold, in peripheral arteries are limited, and existing studies evaluated only short-term (3-month) outcomes. This study compared arterial responses associated with the ITS and bare metal stent (BMS) over 6 months using intravascular ultrasound (IVUS) analysis and evaluated feasibility in porcine iliac arteries. Four miniature pigs underwent stent implantation with the ITS in the right iliac artery and the BMS in the left iliac artery. Follow-up evaluations at 6, 12, and 24 weeks included angiographic and IVUS analyses to assess neointimal hyperplasia, percent area stenosis (%AS), and percent in-stent volume obstruction (%VO). Histological analysis was performed to evaluate tissue injury and inflammation scores. At 6 weeks, the neointimal area did not differ significantly between the ITS and BMS groups (8.49 ± 2.10 mm² vs 13.47 ± 6.67 mm², P =.205). However, the ITS group exhibited a significantly smaller neointimal area at 12 weeks (6.87 ± 1.15 mm² vs 20.65 ± 10.99 mm², P =.050) and 24 weeks (5.20 ± 0.85 mm² vs 22.32 ± 12.03 mm², P =.042). %AS and %VO were significantly lower in the ITS group at all follow-ups. The ITS group showed reduced tissue damage (injury score: 0.80 ± 0.430 vs 1.74 ± 0.908, P <.001) and inflammation (inflammation score: 1.25 ± 0.516 vs 1.67 ± 0.832, P <.001) compared with the BMS group. The ITS was associated with reduced vessel injury, lower inflammatory response, and favorable luminal remodeling over 6 months in healthy porcine iliac arteries.

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Open surgical conversion after endovascular aneurysm repair in Japan: Indications and outcomes from a multicenter study (JAST-CONVERT)

Morisaki K., Sano M., Miyake K., Kikuchi S., Shirasu T., Shibata T., Fukushima S., Takeuchi Y., Fujimura N., Matsubara Y., Orimoto Y., Natsume K., Omori M., Obara H., Azuma N.

Journal of Vascular Surgery 2026

ISSN 07415214

Objective: This study aimed to evaluate indications and outcomes of open surgical conversion (OSC) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm using a multicenter registry in Japan. Methods: Thirteen vascular centers retrospectively reviewed patients who underwent OSC after prior EVAR between 2006 and 2024. Baseline characteristics, indications, procedural details, and outcomes were analyzed. The primary end point was 30-day mortality. Secondary end points were overall survival, aneurysm-related mortality, and freedom from retreatment. Results: A total of 208 patients (85.6% males; median age, 78 years) were included. The median abdominal aortic aneurysm diameter was 62 mm. The median interval from initial EVAR to OSC was 5.2 years. Indications for OSC were type II endoleak with sac enlargement (47.1%), type I endoleak (23.1%), type V endoleak with sac enlargement (13.0%), infection (10.1%), and type III endoleak (9.6%). The most frequently used stent graft was the Excluder, followed by Endurant and Zenith. Complete stent graft removal was performed in 41 patients, partial removal in 51, and 116 underwent OSC with stent graft preservation. Thirty-eight patients (18.3%) presented with rupture and 48 (23.1%) underwent urgent OSC. The 30-day mortality rate was 4.3% in the overall cohort, 2.4% in nonruptured cases, and 13.2% in ruptured cases. Rupture was a risk factor for 30-day mortality (hazard ratio, 5.93; 95% confidence interval, 1.59-22.1; P = .008). At 10 years, overall survival and aneurysm-related mortality were 58.4% and 14.8%, respectively, and freedom from retreatment rate was 87.5% at 10 years. Conclusions: Type II endoleak was the leading common indication for OSC after EVAR in this multicenter retrospective study in Japan. Rupture at OSC markedly increased 30-day mortality, even in patients with type II endoleak. Further studies are needed to refine elective indications for OSC to prevent aneurysmal rupture and avoid treatment delay.

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Safety and efficacy of long-shelf-life allogeneic adipose-derived mesenchymal stem cell line-derived platelet-like cells for refractory foot ulcers: A translational preclinical and phase 1/2a study

Obara H., Matsubara K., Fujimura N., Matsubara Y., Ono-Uruga Y., Yazawa M., Okui J., Sato Y., Kitagawa Y.

Regenerative Therapy 30 606 - 615 2025.12

ISSN 2352-3204

Introduction: Refractory foot ulcers, characterized by prolonged healing and frequent recurrences, challenge existing therapies such as revascularization and compression, which typically fail to prevent amputation. We developed adipose-derived mesenchymal stem cell line-derived platelet-like cells (ASCL-PLCs) for refractory ulcers that are long-lasting and readily available. Methods: A translational preclinical investigation and phase 1/2a first-in-human clinical study assessed the safety and efficacy of a novel allogeneic ASCL-PLC treatment for refractory foot ulcers. In the pre-clinical phase, ASCL-PLCs were cryopreserved for 9 months and then thawed to measure cytokine release after calcium chloride stimulation. The therapeutic efficacy was evaluated in a diabetic mouse wound model, comparing ASCL-PLC treatment with vehicle control. The clinical trial involved topically applying ASCL-PLCs (1.5 × 108 cells/cm2) to the ulcers of four patients (two ischemic, two venous) on days 0, 14, and 28, with safety and efficacy monitored based on adverse events, ulcer size reduction, epithelialization time, and pain score changes. Results: ASCL-PLCs maintained considerable cytokine-releasing activity even after long-term cryopreservation. In the diabetic mouse skin defect model, treatment with ASCL-PLCs substantially enhanced wound closure compared with the controls, demonstrating potent wound-healing capabilities. In the clinical trial, all patients exhibited notable ulcer size reduction without serious adverse events; three achieved epithelialization within 6 months, along with improvements in pain and quality of life without a negative impact on local blood flow. Conclusions: ASCL-PLCs are safe and a promising therapeutic option for refractory ulcers and can potentially reduce amputation rates, improve patient outcomes, and minimize the socioeconomic impact due to chronic wounds. Their long shelf life and cryopreservation stability make wound management practical and accessible. Moreover, their efficacy with simple topical application suggests a minimally invasive strategy suitable for outpatient care. Further large-scale trials are recommended. This study was registered with the Japan Registry of Clinical Trials (jRCT ID: jRCTa030200053; on June 18, 2020, https://jrct.mhlw.go.jp/en-latest-detail/jRCTa030200053).

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Editor's Choice – Comparison of Prognosis in Chronic Limb Threatening Ischaemia after Revascularisation versus Non-revascularisation Treatment: Analysis of Japanese Regional Insurance Claims

Shintani T., Nakatani E., Kaneda H., Hawke P., Obara H., Usui T.

European Journal of Vascular and Endovascular Surgery 70 ( 6 ) 800 - 808 2025.12

ISSN 10785884

Objective: While the prevailing practice for treating chronic limb threatening ischaemia (CLTI) is revascularisation, there is a limited understanding of disease progression in patients with CLTI who do not undergo this intervention. This study compared the prognosis of CLTI patients with tissue loss who underwent revascularisation with the prognosis of those who were managed with non-revascularisation treatment, investigating the efficacy of revascularisation in improving the outcome of patients with CLTI. Methods: Utilising the Shizuoka Kokuho Database, a regionally representative longitudinal cohort in Japan, this retrospective analysis examined CLTI patients with tissue loss (ulcer and gangrene), between April 2012 and September 2020, identifying two distinct cohorts: those receiving non-revascularisation treatment and those undergoing revascularisation. The primary endpoint was amputation free survival, evaluated in both cohorts after applying propensity score matching. Results: Of the 3 160 CLTI patients with tissue loss, 559 received non-revascularisation treatment and 589 underwent revascularisation. The non-revascularisation treatment predominantly involved prostaglandin E1 injections (99.1%). After one to one propensity score matching, the revascularisation cohort (372 patients) exhibited a markedly enhanced amputation free survival rate compared with their non-revascularisation counterparts (amputation free survival rate at one year: 58.0% vs. 45.7%, p = .014). Subgroup analyses underscored the greater efficacy of revascularisation across multiple categories, including males (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.47 – 0.75), patients with diabetes mellitus (HR 0.67, 95% CI 0.50 – 0.89), and patients with severe wounds (HR 0.76, 95% CI 0.61 – 0.93). However, the analysis did not find differences between the revascularisation and non-revascularisation treatment groups among female patients (HR 1.06, 95% CI 0.78 – 1.45) and patients with non-severe wounds (HR 0.87, 95% CI 0.58 – 1.30). Conclusion: This regional Japanese cohort study revealed a potential enhancement in the amputation free survival rate post-revascularisation for CLTI patients with tissue loss compared with non-revascularisation treatment, except in female patients and patients with non-severe wounds. Additional studies are needed to further elucidate these results.

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Direct Comparison of Endurant Stent Graft System and Excluder Endoprosthesis using a Japanese Multicenter Registry

Hosokawa K., Fujimura N., Takahara M., Harada H., Uchida N., Fujii T., Shintani T., Watada S., Ono S., Sekimoto Y., Shimogawara T., Hayashi K., Obara H., Kitagawa Y.

Cardiovascular and Interventional Radiology 48 ( 11 ) 1562 - 1575 2025.11

ISSN 01741551

Objective: This retrospective cohort study aimed to emulate the ADVANCE trial population and directly compare the Endurant and Excluder using propensity score matching. Methods: Patients were included if endovascular aneurysm repair was performed for abdominal aortic aneurysm using either Endurant or Excluder at 10 hospitals in Japan between January 2012 and July 2022. Cases were selected according to the modified ADVANCE trial inclusion and exclusion criteria. To minimize selection bias and simulate a randomized controlled trial setting, propensity score matching was performed using patient and anatomical characteristics. The primary outcome measure was the proportion of patients with sac regression ≥ 5 mm at 1 year. The secondary outcome measures were rates of freedom from late complications, T1aEL, sac enlargement ≥ 5 mm, and overall survival. Outcomes were first analyzed in patients within the instructions for use (IFU) and then in all matched patients including outside IFU patients. Results: After matching, the within-IFU group included 124 pairs and the total cohort of 266 pairs. The primary outcome measures for Endurant and Excluder were met in 38.9% and 36.6% (p = 0.74) in the within-IFU group and 33.5% and 35.0% (p = 0.74) in the total cohort, respectively. No significant differences were observed in any secondary outcome measures. However, T2EL and use of additional proximal cuff were significantly more frequent for Excluder in both the within-IFU and total cohort. Furthermore, T1b and T5ELs occurred significantly more for Endurant in the total cohort. Conclusion: There were no significant differences in all clinical outcome measures between Endurant and Excluder. Levels of evidence: Level IV, multicenter retrospective cohort study.

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Current status of waitlist mortality and transplant probability for adult candidates with chronic end-stage liver disease for deceased donor liver transplantation under the Model for End-Stage Liver Disease score-based allocation policy in Japan

Takemura Y., Ueda Y., Takemura R., Mita J., Ashikari J., Kuramitsu K., Hasegawa Y., Kitago M., Obara H., Kitagawa Y., Ohdan H., Yokota H.

Journal of Gastroenterology 60 ( 11 ) 1414 - 1426 2025.11

ISSN 09441174

Background: In Japan’s deceased-donor liver transplantation (DDLT), a new allocation policy based on the Model for End-Stage Liver Disease (MELD) score, including the exceptional MELD system (Ex-MELD), which periodically assigns additional points to the basal MELD score, was implemented in May 2019. We assessed the current state of this system for adult candidates with chronic end-stage liver disease. Methods: Adult candidates (≥ 18 years) registered in the Japan Organ Transplant Network for DDLT as Status 2 cases (including chronic end-stage liver disease patients) between May 2019 and April 2023 were evaluated. We divided them into the MELD, Ex-MELD (major) [start 16 points, 2 points by 180 days], and Ex-MELD [hepatocellular carcinoma (HCC)] groups. Transplant probability and waitlist mortality rates were compared using competing risk analyses. The annual proportion of DDLT and the transition of median MELD at transplantation were also investigated. Results: There were 757 candidates in MELD,126 in Ex-MELD (major), and 99 in Ex-MELD (HCC) groups. The transplant probability rates were not significantly different (3-year transplant probability rate; MELD: 24.0% vs. Ex-MELD (major): 21.0% vs. Ex-MELD (HCC): 24.1%). The rate in the Ex-MELD (major) increased dramatically as the waiting period lengthened. The waitlist mortality rates in the Ex-MELD (major) group were significantly lower (3-year waitlist mortality rate; MELD: 50.5% vs. Ex-MELD (major): 25.0% vs. Ex-MELD (HCC): 57.0%). Although the proportion of Ex-MELD (major) increased yearly in the transplanted cases, the median MELD at transplantation did not change significantly. Conclusions: We clearly showed the current status of adult Status 2 candidates.

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Trends and Barriers in Liver Transplantation for Patients With Decompensated Cirrhosis: A 15-Year Single-Center Cohort at a Japanese Center

Hasegawa Y., Obara H., Ojiro K., Kitago M., Abe Y., Usui S., Taniki N., Nakamoto N., Kitagawa Y.

Transplantation Proceedings 57 ( 8 ) 1560 - 1564 2025.10

ISSN 00411345

Background and Aim: Liver transplantation is the only curative treatment for end-stage liver disease; however, access remains limited, particularly in Japan, where the severe shortage of deceased donors presents a major challenge. Research comprehensively assessing the full trajectory from referral to either transplantation or death remains scarce. We aimed to analyze long-term trends and propose potential strategies to improve access to liver transplantation in Japan. Patients and Methods: This study included 616 adult patients with decompensated liver cirrhosis referred for liver transplantation. Patients were divided into 3 periods to assess temporal trends: Period 1 (2009-2013), Period 2 (2014-2018), and Period 3 (2019-2023). The primary endpoint was the liver transplantation rate among referred patients. Patient demographics, liver disease etiology and severity, and donor type were analyzed. Results: The transplantation rate declined from 30.2% in Period 1 to 22.1% in Period 3, despite increases in follow-up rates and waitlist registrations. The availability of living donors significantly decreased over time, from 29.5% in Period 1 to 22.4% in Period 2 and 18.6% in Period 3. The rate of death without transplantation remained high (41.0%, 45.0%, and 40.0%, respectively). A higher MELD score at referral was an independent risk factor for both not undergoing transplantation and mortality among transplantation candidates. Conclusion: Over this 15-year period, the transplantation rate declined despite increases deceased donor registrations, resulting in persistently high waitlist mortality. Our findings suggest that expanding deceased donor pool and facilitating earlier referral of transplant candidates are essential to improving access to transplantation and patient outcomes in a Japanese transplant setting.

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Donor-Derived Cell-Free DNA Analyses in Small Intestine Transplantation: A Multicenter Prospective Observational Study in Japan

Yamada, Y; Kanamori, H; Shinoda, M; Kasahara, M; Sakamoto, S; Fukuda, A; Uchida, H; Matsuura, T; Kajihara, K; Hasegawa, Y; Obara, H; Kitagawa, Y; Inoue, I; Mitsunaga, S; Fujino, A

AMERICAN JOURNAL OF TRANSPLANTATION 25 ( 8 ) 2025.08

ISSN 1600-6135

Clinical outcomes in patients with chronic limb-threatening ischemia after femoropopliteal intervention with a drug-coated balloon or stenting

Kobayashi T., Takahara M., Fujimura N., Yamaoka T., Matsuda D., Okazaki T., Mochizuki S., Nagatomi S., Shingaki M., Endo M., Hosokawa K., Furuyama T., Shintani T., Sekimoto Y., Uchiyama H., Kyuragi R., Watada S., Morisaki K., Mitsuoka H., Kawai Y., Hayashi K., Shibata T., Kamei S., Obara H., Ichihashi S.

Journal of Vascular Surgery 82 ( 1 ) 164 - 172.e2 2025.07

ISSN 07415214

Objective: Endovascular treatment (EVT) for patients with an occlusive lesion of the femoropopliteal artery is performed worldwide due to its effectiveness. However, lesions in chronic limb-threatening ischemia (CLTI) are complex and a major concern in superficial femoral artery (SFA) EVT. Despite this, a detailed study of SFA EVT, and especially selection of the final device as a drug-coated balloon (DCB) or a stent, has not been performed in patients with CLTI. The aim of this stud was to compare the clinical outcomes of SFA EVT using a DCB or a stent in patients with CLTI. Methods: A multicenter retrospective observational study was performed at 21 Japanese centers. Comparisons were made between patients undergoing initial SFA EVT with a DCB or stenting after inverse probability of treatment weighting using the propensity score to control for potential confounding (patient demographics, comorbidities, medications, and procedural details). The primary outcome measure was major adverse limb events (MALE). We adopted cause-specific hazard models, using Fine and Gray's proportional hazards model in which death was treated as a competing risk. Secondary outcome measures were also evaluated: (1) technical success; (2) slow flow; (3) death within 30 days; (4) major adverse events within 30 days; (5) restenosis; (6) target lesion revascularization; (7) acute occlusion; (8) wound healing; (9) major amputation; and (10) all-cause mortality. Results: The study included 900 CLTI cases that underwent EVT with a DCB (n = 458) or stenting (n = 442) and had a median follow-up period of 17.5 months (interquartile range, 6.2-31.9 months). The DCB group had a lower risk of MALE than the stent group, with a hazard ratio of 0.68 (95% confidence interval, 0.52-0.89; P = .005). Subsequent analysis for the secondary outcome measures demonstrated that the DCB group had a higher prevalence of postprocedural slow flow and a lower incidence rate of acute occlusion (both P < .005 after Bonferroni correction). Conclusions: DCB angioplasty had a lower risk of MALE than stenting. These results suggest that a DCB might be more beneficial in initial SFA intervention in patients with CLTI.

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Detailed Analysis of Elective Endovascular Aneurysm Repair for Nonagenarians in Japanese Population Shows Comparable Mid-term Results With Octogenarians

Fujimura, N; Obara, H; Shimogawara, T; Ono, S; Hayashi, K; Watada, S; Fujii, T; Sekimoto, Y; Shintani, T; Harada, H; Uchida, N; Kitagawa, Y

JOURNAL OF VASCULAR SURGERY 81 ( 6 ) 2025.06

ISSN 0741-5214

Potential Impact of Screening Examinations on Prognosis of De Novo Malignancies in Adult Patients After Liver Transplantation

Uemura S., Hasegawa Y., Obara H., Kitago M., Yagi H., Abe Y., Hori S., Tanaka M., Nakano Y., Kitagawa Y.

Livers 5 ( 2 ) 2025.06

Background: De novo malignancies (DNMs) after liver transplantation (LT) are a major cause of long-term mortality. However, no definitive screening protocol has been established due to their diversity. This study aimed to evaluate DNM diagnosis methods, screening protocols, and prognoses. Methods: This retrospective study included 231 adult LT recipients from April 1997 to March 2021. Disease-specific survival (DSS) was analyzed to assess the impact of screening on prognosis. Most recipients underwent serum tests every three months, annual gastrointestinal endoscopy, and chest-abdominal CT as part of routine surveillance. Results: Twenty-five DNMs were diagnosed in 22 patients, with median age of 61 years (range, 23–72), of whom 13 (59.1%) were female. The duration from transplantation to DNM diagnosis of DNM was 88 months (range, 4–195). DNM was diagnosed as follows: seven patients (31.8%) through screening (screening group) and 15 patients (68.2%) by other means (non-screening group). Curative treatment was achieved in all of the patients diagnosed by screening, whereas it was possible in only 60.0% of patients diagnosed by other means (p = 0.026). DSS in the screening group was significantly longer than that in the non-screening group (p = 0.024). Conclusions: While screening was associated with earlier-stage diagnosis and improved outcomes in some patients, the overall efficacy of the protocol requires further validation in larger studies.

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A case of hepatic epithelioid hemangioendothelioma with features resembling those of acute-onset autoimmune hepatitis that was undiagnosed before liver transplantation

Usui S., Chu P.S., Hirano M., Hasegawa Y., Ueno A., Nomura R., Obara H., Kitagawa Y., Kanai T., Nakamoto N.

Clinical Journal of Gastroenterology 18 ( 3 ) 514 - 519 2025.06

ISSN 18657257

Hepatic epithelioid hemangioendothelioma (HEHE), which is extremely rare, is considered to have a malignant grade between that of hepatic hemangioma and that of hepatic hemangiosarcoma; however, some cases progress so quickly that they present with portal hypertension. We report the case of a woman with findings similar to those of acute-onset autoimmune hepatitis (AIH) that was not diagnosed before liver transplantation. The patient presented with jaundice and ascites. A hematological examination revealed negative tumor markers, high IgG levels, and negative hepatitis virus markers. Computed tomography findings of the liver showed map-like signs characteristic of acute-onset AIH. Despite some response, immunosuppressive drugs such as prednisolone, cyclosporine, and mycophenolate mofetil did not improve liver failure, and she underwent liver transplantation after 200 days of treatment. The explanted liver exhibited white areas that extended in a map-like manner and were occupied by fibrous stroma. Tumors with WWTR1-CAMTA1 gene fusion were recognized and diagnosed as HEHE. Although a histological examination is essential, a percutaneous liver biopsy could not be performed preoperatively because of the presence of ascites. Furthermore, the rarity of the disease, similarity of imaging findings with non-neoplastic patterns, and serological findings made it difficult to differentiate this case from acute-onset autoimmune hepatitis.

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Efficacy of aqueous olanexidine compared with alcohol-based chlorhexidine for surgical skin antisepsis regarding the incidence of surgical-site infections in clean-contaminated surgery: a randomized superiority trial

Takeuchi M., Obara H., Furube T., Kawakubo H., Kitago M., Okabayashi K., Fujisaki H., Aoyama J., Morimoto Y., Amemiya R., Sano J., Nakadai J., Goto R., Sato Y., Kitagawa Y.

British Journal of Surgery 112 ( 4 ) 2025.04

ISSN 00071323

Background: Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery. Methods: This multicentre randomized trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary-pancreatic surgeries in five hospitals evaluated the efficacy of olanexidine and chlorhexidine-alcohol. The primary endpoint was 30-day SSI. Secondary outcomes included the occurrence of SSI types, intervention-related toxicity, and reoperation caused by SSI. Results: Overall, 700 patients from five institutions underwent randomization; 347 received olanexidine and 345 received chlorhexidine-alcohol in the full analysis set. The 30-day SSI rate was 12.4% (43 of 347) in the olanexidine group and 13.6% (47 of 345) in the chlorhexidine-alcohol group (adjusted risk ratio (aRR) 0.911 (95% c.i. 0.625 to 1.327); P = 0.626). No significant differences were observed between the groups regarding the secondary outcomes, including the occurrence of superficial incisional SSI, deep incisional SSI, organ/space SSI, and reoperation caused by SSI. Overall adverse effects were seen in two patients (0.58%) in the olanexidine group and in three patients (0.87%) in the chlorhexidine-alcohol group (aRR 0.663 (95% c.i. 0.111 to 3.951)). Conclusion: Olanexidine did not significantly reduce the occurrence of overall SSI compared with chlorhexidine-alcohol. Nevertheless, these findings provide valuable insights for developing novel surgical SSI management protocols. Registration number: UMIN 000049712 (University Hospital Medical Information Network Clinical Trials Registry).

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Laparoscopic Donor Left Lateral Sectionectomy Using the Glissonean Pedicle Approach: Technical Details With Video

Hasegawa Y., Abe Y., Obara H., Yamada Y., Kitago M., Fujino A., Kitagawa Y.

Asian Journal of Endoscopic Surgery 18 ( 1 ) e70043 2025.01

ISSN 17585902

Introduction: Pure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery. Surgical Technique: After liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved. Discussion: Our Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.

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A short review of popliteal artery entrapment syndrome

Obara H., Gupta P.C., Levien L., Mistry P., Bollineni V., Shaw P.M.

Jvs Vascular Insights 3 2025.01

Background: Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb ischemia, typically affecting young adults. Case Report: This case report describes a 22-year-old man with severe left calf claudication due to type II PAES, confirmed by imaging. Surgical treatment involved resection of the aberrant gastrocnemius muscle and popliteal artery reconstruction using the great saphenous vein. Postoperative recovery was uneventful, with complete symptom resolution and no recurrence at 2-year follow-up. Conclusions: PAES should be considered in young patients with unexplained claudication, and surgery offers effective long-term outcomes. This article also briefly discusses the classification, diagnosis, and treatment strategies for PAES.

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Contemporary management of arterial thoracic outlet syndrome

Gupta P.C., Obara H., Jindal R., Shah S., Mahapatra S., Vamsi Krishna Y., Sekar N., Vasudevan T.

Jvs Vascular Insights 3 2025.01

Background: Arterial thoracic outlet syndrome (ATOS), although the least common of thoracic outlet syndromes (<1%), often presents with severe upper limb ischemia as a sequel of subclavian artery (SA) dilatation, intimal injury, thrombus formation, and distal embolization, all secondary to extrinsic compression. Methods: Literature was reivewed to see the changing trends and current managment of ATOS. Results: The syndrome affects young adults and women more often than men. Although patients often present with a bony prominence in the neck or upper limb ischemia, rarely they may present with posterior circulation stroke or an asymptomatic ATOS may be detected during evaluation of the contralateral limb. Surgical decompression of the thoracic outlet along with treatment of the involved SA is the accepted treatment modality. Arterial thoracic syndrome is almost always operated via the supraclavicular or paraclavicualr and occasionally transaxillary approach. Stenting still does not find any significant role in the treatment of this disease. This review discusses the clinical presentation, evaluation, and surgical therapy including ways to repair the SA. It also discusses the common complications and their management. Finally, the outcomes of surgery for ATOS are discussed. Conclusions: ATOS can cause significant symptoms and disability. Diagnosis is based on clinical evaluation and imaging and must show evidence of injury to SA. Treatment is surgical and best performed using the supraclavicular or paraclavicular approach and offers good long-term results. A nonculprit first rib may be preserved as evidenced by multiple series showing good medium- to long-term results, and subclavian aneurysm can be treated by different methods.

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Positioning Control for Voice Coil Motor Using Unbalanced Multilevel Inverter Topology

Takei, G; Obara, H; Haneda, R; Nozaki, T

2025 IEEE INTERNATIONAL CONFERENCE ON MECHATRONICS, ICM 2025

ISSN 2837-1143

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Improved survival of pediatric deceased donor liver transplantation recipients after introduction of the pediatric prioritization system: Analysis of data from a Japanese national survey

Takemura Y., Shinoda M., Kasahara M., Sakamoto S., Hatano E., Okamoto T., Ogura Y., Sanada Y., Matsuura T., Ueno T., Obara H., Soejima Y., Umeshita K., Eguchi S., Kitagawa Y., Egawa H., Ohdan H., Ogawa E., Ito T., Sakuma Y., Yoshizumi T., Eguchi H., Shimamura T., Mita A., Hibi T., Fukumoto T., Hasegawa K., Marubashi S., Umeda Y., Nobori S., Hasegawa Y., Yamada Y., Kitago M.

Journal of Hepato Biliary Pancreatic Sciences 31 ( 11 ) 782 - 797 2024.11

ISSN 18686974

Background: In Japan, there has never been a national analysis of pediatric deceased donor liver transplantation (pDDLT) based on donor and recipient factors. We constructed a Japanese nationwide database and assessed outcomes of pDDLT focusing on the pediatric prioritization system introduced in 2018. Methods: We collected data on pDDLTs (<18 years) performed between 1999 and 2021 from the Japan Organ Transplant Network and Japanese Liver Transplantation Society, identified risk factors for graft survival and compared the characteristics and graft survival in pDDLTs conducted before and after the introduction of the pediatric prioritization system. Results: Overall, 112 cases of pDDLT were included, with a 1-year graft survival rate of 86.6%. Four poor prognostic factors were identified: recipient intensive care unit stay, model for end-stage liver disease/pediatric end-stage liver disease score, donor cause of death, and donor total bilirubin. After the introduction of the system, allografts from pediatric donors were more reliably allocated to pediatric recipients and the annual number of pDDLTs increased. The 1-year graft survival rate improved significantly as did pDDLT conditions indicated by the risk factors. Conclusions: Under the revised allocation system, opportunities for pDDLT increased, resulting in favorable recipient and donor conditions and improved survival.

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Long-Term Outcomes of a Japanese Prospective Multicenter Registry Using a Heparin-Bonded Expanded Polytetrafluoroethylene Graft for Above-the-Knee Femoropopliteal Bypasses

Fujimura N., Obara H., Matsubara K., Toya N., Isogai N., Ogino H., Fujii T., Kudo T., Kanaoka Y., Harada H., Uchiyama H., Guntani A., Shimogawara T., Watada S., Shibutani S., Ohki T.

Circulation Journal 88 ( 10 ) 1656 - 1663 2024.10

ISSN 13469843

Background: Despite the widespread use of PROPATEN®, a bioactive heparin-bonded expanded polytetrafluoroethylene graft, in bypass surgery, there are only a few reports of long-term results. We evaluated the long-term results of PROPATEN® use for above-knee femoropopliteal bypass (AKFPB). Methods and Results: After PROPATEN®-based AKFPB, patients were prospectively registered at 20 Japanese institutions between July 2014 and October 2017 to evaluate long-term results. During the median follow-up of 76 months (interquartile range 36–88 months) for 120 limbs (in 113 patients; mean [±SD] age 72.7±8.1 years; 66.7% male; ankle-brachial index [ABI] 0.45±0.27; lesion length 26.2±5.7 cm; chronic limb-threatening ischemia in 45 limbs), there were 8 major amputations; however, clinical improvement was sustained (mean [±SD] ABI 0.87±0.23) and the Rutherford classification grade improved in 105 (87.5%) limbs at the latest follow-up. At 8 years, the primary patency, freedom from target-lesion revascularization, secondary patency, survival, and amputation-free survival, as estimated by the Kaplan-Meier method, were 66.3±4.8%, 71.5±4.4%, 86.5±3.4%, 53.1±5.0%, and 47.4±5.3%, respectively. Conclusions: This multicenter prospective registry-based analysis showed sustained excellent clinical improvement and secondary patency for up to 8 years following PROPATEN®-based AKFPB. PROPATEN® constitutes a durable and good revascularization option for complex superficial femoral artery lesions, especially when endovascular treatment is inappropriate or an adequate venous conduit is unavailable.

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A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure

Shimata K., Yoon Y.I., Hibi T., Morinaga J., Narayanan A.K., Toshima T., Ito T., Akamatsu N., Kotera Y., Hong S.K., Hasegawa Y., Umeda Y., Reddy M.S., Ong A.D.L., Sivaprasadan S., Varghese J., Sugawara Y., Chen C.L., Nakayama N., Mochida S., Tanaka A., Suh K.S., Ikegami T., Lee K.W., Lee S.G., Sudhindran S., Yoshizumi T., Hatano E., Okumura S., Hasegawa K., Egawa H., Obara H., Yasui K., Ogura Y., Jobara K., Nitta H., Katagiri H., Otsuka M., Kuboki S., Eguchi S., Hara T., Eguchi H., Sasaki K., Aoki T., Ohdan H., Ohira M., Takada Y., Ogawa K., Fukumoto T., Kuramitsu K., Saiura A., Ichida H., Hashimoto T., Marubashi S., Sato N., Ushigome H., Harada S., Soejima Y., Masuda Y., Shimada M., Saitou Y., Taketomi A., Goto R., Shimamura T., Mizuno S., Tanemura A., Endo I., Unno M., Miyagi S., Okamura Y., Aramaki O., Hakamada K., Ishido K., Kato Y., Takahara T., Takatsuki M., Ono S.

American Journal of Transplantation 24 ( 10 ) 1857 - 1867 2024.10

ISSN 16006135

Liver transplantation is often the only lifesaving option for acute liver failure (ALF); however, the predictors of short-term mortality (death within one year) after living donor liver transplantation (LDLT) for ALF have yet to be defined. We retrospectively collected patients ≥18 years old who underwent LDLT for ALF between 2010 and 2020 at 35 centers in Asia. Univariate and multivariate logistic regression analyses were conducted to identify the clinical variables related to short-term mortality and establish a novel scoring system. The Kaplan-Meier method was performed to explore the association between the score and overall survival. Of the 339 recipients, 46 (13.6%) died within 1 year after LDLT. Multivariate analyses revealed 4 independent risk factors for death: use of vasopressors or mechanical ventilation, the higher model for end-stage liver disease score, and a lower graft-to-recipient weight ratio. The internally validated c-statistic of the short-term mortality after transplant (SMT) score derived from these 4 variables was 0.80 (95% confidence interval: 0.74-0.87). The SMT score successfully stratified recipients into low-, intermediate-, and high-risk groups with 1-year overall survival rates of 96%, 80%, and 50%, respectively. In conclusion, our novel SMT score based on 4 predictors will guide ALF recipient and living donor selection.

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Characteristics, Antithrombotic Patterns, and Prognostic Outcomes in Claudication and Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy

Kawarada O., Zen K., Hozawa K., Obara H., Matsubara K., Yamamoto Y., Doijiri T., Tamai N., Ito S., Higashimori A., Kawasaki D., Doi H., Matsushita K., Tsukahara K., Noda K., Shimpo M., Tsuda Y., Sonoda S., Taniguchi T., Waseda K., Munehisa M., Taguchi E., Kinjo T., Sasaki Y., Yuba K., Yamaguchi S., Nakagami T., Ayabe S., Sakamoto S., Yagyu T., Ogata S., Nishimura K., Motomura H., Noguchi T., Ishihara M., Ogawa H., Yasuda S.

Journal of Endovascular Therapy 31 ( 4 ) 622 - 633 2024.08

ISSN 15266028

Purpose: The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study aimed to clarify differences in clinical features and prognostic outcomes between IC and CLTI, and prognostic factors in patients undergoing endovascular therapy (EVT). Materials and Methods: A total of 692 patients with 808 limbs were enrolled from 20 institutions in Japan. The primary measurements were the 3-year rates of major adverse cardiovascular event (MACE) and reintervention. Results: Among patients, 79.0% had IC and 21.0% had CLTI. Patients with CLTI were more frequently women and more likely to have impaired functional status, undernutrition, comorbidities, hypercoagulation, hyperinflammation, distal artery disease, short single antiplatelet and long anticoagulation therapies, and late cilostazol than patients with IC. Aortoiliac and femoropopliteal diseases were dominant in patients with IC and infrapopliteal disease was dominant in patients with CLTI. Patients with CLTI underwent less frequently aortoiliac intervention and more frequently infrapopliteal intervention than patients with IC. Longitudinal change of ankle-brachial index (ABI) exhibited different patterns between IC and CLTI (pinteraction=0.002), but ABI improved after EVT both in IC and in CLTI (p<0.001), which was sustained over time. Dorsal and plantar skin perfusion pressure in CLTI showed a similar improvement pattern (pinteraction=0.181). Distribution of Rutherford category improved both in IC and in CLTI (each p<0.001). Three-year MACE rates were 20.4% and 42.3% and 3-year reintervention rates were 22.1% and 46.8% for patients with IC and CLTI, respectively (log-rank p<0.001). Elevated D-dimer (p=0.001), age (p=0.043), impaired functional status (p=0.018), and end-stage renal disease (p=0.019) were independently associated with MACE. After considering competing risks of death and major amputation for reintervention, elevated erythrocyte sedimentation rate (p=0.003) and infrainguinal intervention (p=0.002) were independently associated with reintervention. Patients with CLTI merely showed borderline significance for MACE (adjusted hazard ratio 1.700, 95% confidence interval 0.950–3.042, p=0.074) and reintervention (adjusted hazard ratio 1.976, 95% confidence interval 0.999–3.909, p=0.05). Conclusions: The CLTI is characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared with IC. Also, CLTI has approximately twice MACE and reintervention rates than IC, and the underlying inflammatory coagulation disorder per se is associated with these outcomes. Clinical Impact: The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study, JPASSION study found that CLTI was characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared to IC. Also, CLTI had approximately twice major adverse cardiovascular event (MACE) and reintervention rates than IC. Intriguingly, the underlying inflammatory coagulation disorder per se was independently associated with MACE and reintervention. Further studies to clarify the role of anticoagulation and anti-inflammatory therapies will contribute to the development of post-interventional therapeutics in the context of peripheral artery disease.

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Quantitative evaluation of lower limb varicose veins using photoacoustic imaging

Urano M., Nagae K., Matsuda S., Matsubara K., Yagi T., Imanishi N., Aiso S., Obara H., Jinzaki M.

Journal of Medical Ultrasonics 51 ( 3 ) 507 - 516 2024.07

ISSN 13464523

Purpose: Varicose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively. Methods: Nine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins. Results: The obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins. Conclusion: PAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.

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Early-onset hepatic veno-occlusive disease after liver transplantation: an institutional experience and analysis of a literature-based cohort

Endo Y., Shinoda M., Maehara J., Hibi T., Hasegawa Y., Obara H., Kitago M., Ojima H., Tanabe M., Kitagawa Y.

Surgery Today 54 ( 7 ) 670 - 682 2024.07

ISSN 09411291

Purpose: Hepatic veno-occlusive disease (HVOD) after liver transplantation (LT) is almost always a fatal complication. We assessed the outcomes of HVOD in a single institute and analyzed a literature-based cohort. Methods: We reviewed the medical records of recipients of LT performed between 1995 and 2020 at our institute and the literature on HVOD after LT. We then analyzed the clinical features based on a “pooled” cohort of cases identified in our institute and reported in the literature. Results: HVOD was diagnosed in 3 of 331 LT recipients, all of whom died in hospital, on days 164, 12, and 13, respectively. Our comprehensive review of the literature, as well as our cases, identified eight cases of HVOD that developed within 14 days after LT (early-onset type). Early-onset HVOD had a significantly worse prognosis than HVOD that developed beyond 2 weeks after LT (non-early-onset type), which was identified in 22 cases (25.0% vs. 86.1% of the 3-month graft survival rate). The most common causes of early-onset and non-early-onset types were acute cellular rejection (50%) and drug-induced disease (50%), respectively. Conclusion: Early-onset HVOD developing within 14 days after LT has a poor prognosis.

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Endovascular Treatment as an Alternative to Bypass Surgery for Juxtarenal Aortic Occlusion: Results from the CHAOS (CHronic Abdominal Aortic Occlusion, ASian Multicenter) Registry

Kawai Y., Fujimura N., Obara H., Ichihashi S., Kudo T., Hozawa K., Yamaoka T., Kato T., Kawarada O., Banno H.

Annals of Vascular Surgery 104 174 - 184 2024.07

ISSN 08905096

Background: Juxtarenal aortic occlusion (JRAO), in which the occlusion of the aorta extends to just below the renal artery, is often treated by bypass surgery because of concerns about the risk of procedural failure and fatal embolization to abdominal organs when treated with endovascular treatment (EVT). This study assessed the outcome of EVT for JRAO compared with aorto-biiliac /aorto-bifemoral (AOB) or axillo-bifemoral (AXB) bypass. Methods: A retrospective review of an international database created by 30 centers in Asia (CHronic Abdominal Aortic Occlusion, ASian Multicenter registry) was performed for patients who underwent revascularization for chronic total occlusion of the infrarenal aorta from 2007 to 2017. Of the 436 patients, 130 with JRAO (Forty-seven AOBs, 32 AXBs, and 51 EVTs) from 25 institutions were included in this study. Results: Patients were significantly older in the AXB and EVT groups and more malnourished in the EVT group than the AOB group. EVT was attempted but failed in 1 patient. Seven patients (1 [2.1%] in the AOB group, 1 [3.1%] in the AXB group, and 5 [9.8%] in the EVT group) died during hospitalization, but most of the causes in the EVT group were not related to the revascularization procedure. No visceral embolism was observed, which had been concerned, even though protection was performed only in 2 cases of the EVT group. At the latest follow-up (median duration 3.0 years), the ankle-brachial pressure index was significantly higher in the order of AOB, EVT, and AXB. At 4 years, the estimated primary and secondary patency rates of the AOB group (87.5% and 90.3%, respectively) were significantly higher than the AXB group (66.7% and 68.6%, respectively). Conclusions: AOB remains the gold standard and should be the first choice for acceptable risk patients. For frail patients, EVT is a good option and likely preferable as a first-line treatment compared to AXB.

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Protective Effects of Hydrogen Gas Inhalation for Hindlimb Ischaemia–Reperfusion Injury in a Mouse Model

Hayashi M., Obara H., Matsuda S., Homma K., Sasaki J., Matsubara K., Higuchi M., Sano M., Masugi Y., Kitagawa Y.

European Journal of Vascular and Endovascular Surgery 68 ( 1 ) 120 - 128 2024.07

ISSN 10785884

Objective: Ischaemia–reperfusion (I/R) injury is a severe post-operative complication that triggers an inflammatory response and causes severe damage. Hydrogen gas has anti-oxidant and anti-apoptotic properties and has been shown to be safe in humans. The study aimed to investigate whether hydrogen gas protects against skeletal muscle I/R injury. Methods: Experimental basic research using mice. A total of 160 eight to 10 week old albino laboratory bred strain of house mice (25.8 ± 0.68 g) were used in this study. The mice were cable tied to the hindlimb under anaesthesia and then placed in an anaesthesia box filled with air and 2% isoflurane (control group); 80 mice were additionally subjected to 1.3% hydrogen gas in this mix (hydrogen group). After two hours, the cable ties were removed to initiate reperfusion, and hydrogen inhalation lasted for six hours in the hydrogen group. After six hours, the mice were taken out of the box and kept in cages under standard conditions until time for observation at 16 different time points after reperfusion: zero, two, four, six, eight, and 10 hours and one, two, three, four, five, six, seven, 14, 21, and 28 days. Five mice were sacrificed using excess anaesthesia at each time point, and the bilateral hindlimb tissues were harvested. The inflammatory effects of the I/R injury were assessed by evaluating serum interleukin-6 concentrations using enzyme linked immunosorbent assay, as well as histological and immunohistochemical analyses. Untreated mice with I/R injury were used as controls. Results: Hydrogen gas showed protective effects associated with a reduction in inflammatory cell infiltration (neutrophils, macrophages, and lymphocytes), a reduced area of damaged muscle, maintenance of normal muscle cells, and replacement of damaged muscle cells with neoplastic myocytes. Conclusion: Inhalation of hydrogen gas had a protective effect against hindlimb I/R injury in mice, in part by reducing inflammatory cell infiltration and in part by preserving normal muscle cells.

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Prognostic factors after open and endovascular repair for infected native aneurysms of the abdominal aorta and common iliac artery

Hosaka A., Takahashi A., Kumamaru H., Miyata H., Miyata H., Azuma N., Obara H., Miyata T., Obitsu Y., Zempo N., Komori K., Shigematsu K., Inoue Y., Okazaki J., Obara H., Satokawa H., Sugimoto I., Fujimura N., Mii S., Morikage N., Yamaoka T.

Journal of Vascular Surgery 79 ( 6 ) 1379 - 1389 2024.06

ISSN 07415214

Objective: Infected native aneurysms (INAs) of the abdominal aorta and iliac arteries are uncommon, but potentially fatal. Endovascular aneurysm repair (EVAR) has recently been introduced as a durable treatment option, with outcomes comparable to those yielded by conventional open repair. However, owing to the rarity of the disease, the strengths and limitations of each treatment remain uncertain. The present study aimed to separately assess post-open repair and post-EVAR outcomes and to clarify factors affecting the short-term and late prognosis after each treatment. Methods: Using a nationwide clinical registry, we investigated 600 patients treated with open repair and 226 patients treated with EVAR for INAs of the abdominal aorta and/or common iliac artery. The relationships between preoperative or operative factors and postoperative outcomes, including 90-day and 3-year mortality and persistent or recurrent aneurysm-related infection, were examined. Results: Prosthetic grafts were used in >90% of patients treated with open repair, and in situ and extra-anatomic arterial reconstruction was performed in 539 and 57 patients, respectively. Preoperative anemia and imaging findings suggestive of aneurysm-enteric fistula were independently associated with poor outcomes in terms of both 3-year mortality (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01-2.62; P =.046, and HR, 2.24; 95% CI, 1.12-4.46; P =.022, respectively) and persistent or recurrent infection (odds ratio [OR], 2.16; 95% CI, 1.04-4.49; P =.039, and OR, 4.96; 95% CI, 1.81-13.55; P =.002, respectively) after open repair, whereas omental wrapping or packing and antibiotic impregnation of the prosthetic graft for in situ reconstruction contributed to improved 3-year survival (HR, 0.60; 95% CI, 0.39-0.92; P =.019, and HR, 0.53; 95% CI, 0.32-0.88; P =.014, respectively). Among patients treated with EVAR, abscess formation adjacent to the aneurysm was significantly associated with the occurrence of persistent or recurrent infection (OR, 2.24; 95% CI, 1.06-4.72; P =.034), whereas an elevated preoperative white blood cell count was predictive of 3-year mortality (HR, 1.77; 95% CI, 1.00-3.13; P =.048). Conclusions: Profiles of prognostic factors differed between open repair and EVAR in the treatment of INAs of the abdominal aorta and common iliac artery. Open repair may be more suitable than EVAR for patients with concurrent abscess formation.

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Noninvasive graft monitoring using donor-derived cell-free DNA in Japanese liver transplantation

Kanamori H., Yamada Y., Ito Y., Shirosaki K., Yamagishi S., Maeda Y., Kudo Y., Umeyama T., Takahashi N., Kato M., Hasegawa Y., Matsubara K., Shinoda M., Obara H., Irie R., Tsujikawa H., Okita H., Nguyen P.T., Saigo K., Mitsunaga S., Inoue I., Kitagawa Y., Kuroda T.

Hepatology Research 54 ( 3 ) 300 - 314 2024.03

ISSN 13866346

Aim: To evaluate the use of donor-derived cell-free DNA (dd-cfDNA) in diagnosing graft injuries in Japanese liver transplantation (LTx), including family-related living donors. Methods: A total of 321 samples from 10 newly operated LTx recipients were collected to monitor the early dynamics of dd-cfDNA levels after LTx. Fifty-five samples from 55 recipients were collected during protocol biopsies (PB), whereas 36 samples from 27 recipients were collected during event biopsies, consisting of 11 biopsy-proven acute rejection (AR), 20 acute dysfunctions without rejection (ADWR), and 5 chronic rejections. The levels of dd-cfDNA were quantified using a next-generation sequencer based on single nucleotide polymorphisms. Results: The dd-cfDNA levels were elevated significantly after LTx, followed by a rapid decline to the baseline in patients without graft injury within 30 days post-LTx. The dd-cfDNA levels were significantly higher in the 11 samples obtained during AR than those obtained during PB (p < 0.0001), which decreased promptly after treatment. The receiver operator characteristic curve analysis of diagnostic ability yielded areas under the curve of 0.975 and 0.897 for AR (rejection activity index [RAI] ≥3) versus PB and versus non-AR (ADWR + PB). The dd-cfDNA levels during AR were elevated earlier and correlated more strongly with the RAI (r = 0.740) than aspartate aminotransferase/alanine aminotransferase. The dd-cfDNA levels were neither associated with graft fibrosis based on histology nor the status of donor-specific antibodies in PB samples. Conclusions: Donor-derived cell-free DNA serves as a sensitive biomarker for detecting graft injuries in LTx. Further large-scale cohort studies are warranted to optimize its use in differentiating various post-LTx etiologies.

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Impact of wound management strategies after revascularization for chronic limb-threatening ischemia

Shintani T., Obara H., Matsubara K., Hayashi M., Kita H., Ono S., Watada S., Kikuchi N., Sekimoto Y., Torizaki Y., Asami A., Fujii T., Hayashi K., Harada H., Fujimura N., Hosokawa K., Nakatani E., Kitagawa Y.

Journal of Vascular Surgery 79 ( 3 ) 632 - 641.e3 2024.03

ISSN 07415214

Objective: There is no established consensus or guidelines for wound management after revascularization for patients with chronic limb-threatening ischemia (CLTI) without severe infection. This study is designed to evaluate the clinical effect of the wound management strategy on toe wounds after revascularization for CLTI. Methods: This retrospective cohort study was performed at eight institutions affiliated with Keio University School of Medicine in Japan and included 261 patients who underwent revascularization for CLTI between April 2019 and July 2021. We identified 132 patients with toe wounds from the database who had restored in-line blood flow to the foot. Patients were divided into two groups by the timing of toe resection after revascularization, which dictated the wound management policy. Group A (62 patients) underwent early toe amputation for suspected osteomyelitis, whereas group B (70 patients) underwent watchful waiting. The primary outcome was wound healing after revascularization; the secondary outcome was major amputation. We compared outcomes between groups A and B after propensity score matching. Results: Using propensity score matching, each patient in group A (33 patients) was matched with a patient in group B (33 patients). Wound healing in matched group A was significantly better than that in matched group B (respectively: 1-year wound healing rate: 90.0% vs 68.2%, P < .001; median wound healing time: 65 days vs 258 days, P < .01). Although five major amputations were necessary in matched group B, none were required in matched group A (P = .05). The high rate of major amputations in group B was attributed to the sudden exacerbation of infection. Limb salvage rate in matched group A exceeded matched group B (100.0% vs 90.5%: 1-year limb salvage rate, P = .02). Conclusions: Early toe amputation for highly suspected osteomyelitis in patients with CLTI with toe wounds may expedite wound healing compared with watchful waiting, potentially avoiding unnecessary major amputation. Considering the wound management strategy is crucial when evaluating wound healing outcomes in patients with CLTI with revascularization.

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Evaluation of a web-based surgical training approach and insights from the Distal Bypass Competition 2021 using a simulator kit

Kikuchi S., Komai H., Obara H., Abe K., Ohki T., Mii S., Park Y., Hoshina K., Yamaoka T., Deguchi J., Kodama A., Kokubo T., Kaneko K., Guntani A., Miyama N., Omine T., Fujimura N., Kan C.D., Kim J.Y., Lang W., Conte M.S., Azuma N.

Jvs Vascular Insights 2 2024.01

Objective: The study aimed to assess a novel web-based surgical training approach among young vascular surgeons and validate web-based evaluation methods for assessing anastomosis skills through the online Distal Bypass Competition (DBC). Methods: The OSATS was used to assess anastomosis proficiency using a simulator among 42 participants (17 junior and 25 senior surgeons) in the DBC 2021. An initial evaluation of basic anastomosis skills was conducted via recorded videos, comparing OSATS scores with instructor-derived impression-based scores (Comprehensive Evaluation Score [CES]) during the nomination round. Real-time evaluations conducted over Zoom focused on assessing technical and composition scores of the anastomoses to determine finalists. The ice-skating method addresses potential variability among judges by excluding the highest and lowest scores for each procedural element from the final evaluation. This method, demonstrated in real time, provides trainees with valuable feedback on which movements are highly rated, enhancing the educational impact. Evaluation criteria included precision in needlework, external appearance, handling of the intima, and internal morphology of the anastomosis. Furthermore, voluntary survey questionnaires were administered to gather participant feedback on their experience with DBC 2021. Results: The OSATS was associated with a lower coefficient of variation (CV) than was the CES (0.19 ± 0.07 vs 0.24 ± 0.09) (P = .01) with regard to the evaluation of basic anastomotic skills in the nomination round. Interestingly, there was no significant difference in CV between the Procedural Element Score based on OSATS and CES in the senior class (0.16 ± 0.06 vs 0.22 ± 0.09) (P = .13), but a significant difference was particularly evident in the junior class (0.12 ± 0.07 vs 0.27 ± 09) (P = .03). Lower scores were associated with higher CVs in both classes, but the OSATS improved the CV among participants who had inadequate anastomosis skills. In real-time evaluation, composition scores exhibited higher CVs compared with technical scores, even among high-scoring participants. Notably, the internal morphology of the anastomosis had the largest CV in the composition scores. The ice-skating method decreased the CV as compared with the original data evaluated using the OSATS (0.15 ± 0.04 vs 0.09 ± 0.02 for the technical score [P < .01] and .18 ± 1.00 vs 0.07 ± 0.05 for the composition score [P = .03]); accordingly, the ice-skating method was more conducive to objective, real-time evaluation. The results of the post-DBC survey indicated that 89% of participants reported increased training time, and one-half of these participants indicated that their confidence in their clinical skills related to this procedure increased owing to the process of training for the DBC. Conclusions: The OSATS yielded more detailed evaluations of anastomosis skill with a lower variability compared with the instructor's impression-based evaluation in this web-based training. Real-time evaluation methods, such as the ice-skating method, have proven to be valuable tools for the standardized assessment of web-based surgical education.

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Malignant lymphoma after liver transplantation for liver cirrhosis caused by human immunodeficiency virus and hepatitis C virus co-infection

Hasegawa Y., Obara H., Kikuchi T., Uno S., Tsujikawa H., Yamada Y., Hori S., Eguchi S., Kitagawa Y.

Journal of Infection and Chemotherapy 29 ( 12 ) 1160 - 1163 2023.12

ISSN 1341321X

Here, we describe a rare case of malignant lymphoma after liver transplantation for liver cirrhosis caused by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection. A male patient was diagnosed with hemophilia A at 8 months of age. Since then, he had been receiving blood products, which led to HIV and HCV co‐infection. His HIV viral load was suppressed with antiretroviral therapy, and a sustained virologic response was achieved for HCV using direct-acting antivirals. However, his decompensated liver cirrhosis progressed, and deceased donor liver transplantation was performed. A post-transplant lymphoproliferative disorder (PTLD) developed 105 days after liver transplantation, with enlarged para-aortic and hilar lymph nodes, a right renal mass, and masses in the small and large intestines. Histopathological examination confirmed monomorphic PTLD (diffuse large B-cell lymphoma). Against the treatment (reduction of immunosuppression, rituximab, and chemotherapy), the response was poor, and the patient died 94 days after the outbreak of PTLD. Both transplantation and HIV infection are risk factors for lymphoproliferative diseases. To the best of our knowledge, this is one of the very few reports of PTLD in a patient with HIV/HCV co-infection.

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Comparison of Aortobifemoral Bypass and Endovascular Treatment for Chronic Infrarenal Abdominal Aortic Occlusion From the CHAOS (CHronic Abdominal Aortic Occlusion, ASian Multicenter) Registry

Fujimura N., Takahara M., Obara H., Ichihashi S., George R.K., Igari K., Banno H., Hozawa K., Yamaoka T., Kian C.J., Tan J.W.H., Park K., Skyi P.Y.C., Kato T., Kawarada O.

Journal of Endovascular Therapy 30 ( 6 ) 828 - 837 2023.12

ISSN 15266028

Purpose: To directly compare the clinical outcomes of aortobifemoral bypass surgery (ABF) and endovascular treatment (EVT) for chronic total occlusion (CTO) of the infrarenal abdominal aorta (IAA). Materials and Methods: In this retrospective, multicenter study, we used an international database of 436 patients who underwent revascularization for CTO of the IAA between 2007 and 2017 at 30 Asian cardiovascular centers. After excluding 52 patients who underwent axillobifemoral bypass surgery, 384 patients (139 ABFs and 245 EVTs) were included in the analysis. Propensity score-matched analysis was performed to compare clinical results in the periprocedural period and the long-term. Results: Propensity score matching extracted 88 pairs. Procedure time (ABF; 288 [240–345] minutes vs EVT; 159 [100–205] minutes, p<0.001) and length of hospital stay (17 [12–23] days vs 5 [4–13] days, p<0.001) were significantly shorter in the EVT group than in the ABF group, while the proportions of procedural success (98.9% versus 96.6%, p=0.620), complications (9.1% versus 12.3%, p=0.550), and mortality (2.3% versus 3.8%, p=1.000) were not different between the groups. At 1 months, ABI significantly increased more in the ABF group for both in a limb with the lower (0.56 versus 0.50, p=0.018) and the higher (0.49 versus 0.34, p=0.001) baseline ABI, while the change of the Rutherford category was not significantly different between the groups (p=0.590). At 5 years, compared with the EVT group, the ABF group had significantly better primary patency (89.4±4.3% versus 74.8±4.3%, p=0.035) and survival rates (86.9±4.5% versus 66.2±7.5%, p=0.007). However, there was no significant difference between the groups for secondary patency (100.0%±0.0% versus 93.5%±3.9%, p=0.160) and freedom from target lesion revascularization (TLR) (89.3±4.3% vs 77.3±7.3%, p=0.096). Conclusion: Even with recent advancements in EVT, primary patency was still significantly better for ABF in CTO of the IAA. However, there was no difference between the groups in terms of secondary patency and freedom from TLR at 5 years. Furthermore, there was no difference in procedural success, complications, mortality, and improvement in the Rutherford classification during the periprocedural period, with significantly shorter procedure time and hospital stay in the EVT group.

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Delayed-Onset Organ/Space Surgical Site Infection Worsens Prognosis in High-Risk Stage II and III Colorectal Cancer

Okui J., Shigeta K., Kato Y., Mizuno S., Sugiura K., Seo Y., Nakadai J., Baba H., Kikuchi H., Hirata A., Makino A., Kondo T., Matsui S., Seishima R., Okabayashi K., Obara H., Sato Y., Kitagawa Y.

Journal of Gastrointestinal Surgery 27 ( 11 ) 2515 - 2525 2023.11

ISSN 1091255X

Background: It is unclear how early- and delayed-onset organ/space surgical site infections (SSIs) affect the long-term prognosis of patients with colorectal cancer, who are potential candidates for adjuvant chemotherapy. This study aimed to investigate the association between the timing of SSI onset and clinical outcome. Methods: This retrospective, multicenter cohort study evaluated patients who were diagnosed with high-risk stage II or III colorectal cancer and underwent elective surgery between 2010 and 2020. Five-year recurrence-free survival (RFS) was the primary endpoint and was compared between early SSI, delayed SSI (divided based on the median date of SSI onset), and non-SSI groups. Results: A total of 2,065 patients were included. Organ/space SSI was diagnosed in 91 patients (4.4%), with a median onset of 6 days after surgery. The early-onset SSI group had a higher proportion of patients with Clavien–Dindo grade ≥IIIb SSI than the delayed-onset SSI. Patients who received adjuvant chemotherapy (AC) had earlier organ/space SSI onset than those who did not. The adjusted hazard ratio of 5-year RFS in the delayed-onset SSI was 2.58 (95% confidence interval: 1.43–4.65; p = 0.002): higher than that in the early-onset SSI, with the non-SSI as the reference. Conclusions: Delayed-onset organ/space SSI worsened long-term prognosis compared to early-onset, and this may be due to delayed initiation of AC. Patients who are clinically suspected of having lymph node metastasis might need additional intervention to prevent delays in commencing AC due to the delayed SSI.

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Risk Assessment of Liver Transplantation After Kasai Portoenterostomy in Children and Adults

Udagawa D., Hasegawa Y., Obara H., Yamada Y., Shinoda M., Kitago M., Abe Y., Kuroda T., Kitagawa Y.

Journal of Surgical Research 290 109 - 115 2023.10

ISSN 00224804

Introduction: Reports of liver transplantation (LT) after Kasai portoenterostomy (KPE) in adult patients with biliary atresia are scarce. The aim of this study was to evaluate the outcomes and investigate the risk factors of LT after KPE in both pediatric and adult patients. Methods: We retrospectively reviewed a prospective database of patients with biliary atresia who underwent LT after KPE. Eighty-nine consecutive patients were included, and risk factors for in-hospital mortality after LT were assessed. Results: The median age of the patients was 2 y (range, 0-45 y). Forty-six patients (51.7%) had a history of upper abdominal surgery after KPE. The in-hospital mortality rate was 5.6% (5 patients). Of these, 80% of patients with mortality were aged ≥17 y, and all patients with mortality had a history of two or more upper abdominal surgeries. In the univariate and receiver operating characteristic curve analyses, age ≥17 y and the number of previous upper abdominal surgeries ≥2 were identified as possible risk factors. Conclusions: Our study suggests that older age and multiple previous upper abdominal surgeries are important risk factors for mortality after LT following KPE. We believe that these findings will serve as indications for safe LT in future patients.

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Long-term outcomes following ABO-incompatible living donor liver transplantation for acute liver failure: a single-center experience of over 20 years

Hirukawa K., Shinoda M., Hasegawa Y., Obara H., Kitago M., Yagi H., Abe Y., Yamada Y., Tanabe M., Kitagawa Y.

Surgery Today 53 ( 10 ) 1160 - 1172 2023.10

ISSN 09411291

Purpose: Acute liver failure is a life-threatening condition for which ABO-incompatible living donor liver transplantation (ABOi-LDLT) is sometimes the only life-saving treatment option. We reviewed a single-center experience of adult ABOi-LDLT treatment for acute liver failure (ALF). Methods: Preoperative treatment, immune indices (B cell marker, anti-donor blood-type antibody), and postoperative outcomes were compared between ALF and non-ALF groups. Results: There were 5 and 33 patients in the ALF and non-ALF groups, respectively. The ALF group received higher doses of steroids, underwent more rounds of plasma exchange (PE), and underwent transplantation for ALF with a shorter interval following preoperative rituximab (RTx) administration (median: 2 vs 13 days; P < 0.05) than the non-ALF group. Preoperatively, CD19-positive lymphocytes in the peripheral blood were sufficiently depleted in all of the non-ALF group patients, whereas they were poorly depleted in the ALF group. Postoperatively, neither group suffered anti-donor blood-type antibody titer rebound or antibody-mediated rejection. The ALF group had a comparable 5-year survival rate to the non-ALF group (80.0% vs 77.9%). Conclusions: Despite the delayed preoperative administration of RTx, the ALF group showed an uneventful immunological response and acceptable long-term survival rate. Thus, ABOi-LDLT seems a viable treatment option for ALF.

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Phase I study of neoadjuvant S-1 plus cisplatin with concurrent radiation for biliary tract cancer (Tokyo Study Group for Biliary Cancer: TOSBIC02)

Abe Y., Itano O., Takemura Y., Minagawa T., Ojima H., Shinoda M., Kitago M., Obara H., Shigematsu N., Kitagawa Y.

Annals of Gastroenterological Surgery 7 ( 5 ) 808 - 818 2023.09

ISSN 2475-0328

Aim: Neoadjuvant chemoradiotherapy may improve survival in patients with advanced cholangiocarcinoma. This Phase I study aimed to determine the recommended dose of neoadjuvant chemoradiotherapy and decide whether to move to a Phase II study. Methods: Patients diagnosed with resectable stage II–IVa cholangiocarcinoma were administered cisplatin (40 [level 0], 50 [level 1 as starting dose], or 60 [level 2] mg/m2), 80 mg/m2 of S-1, and 50.4 Gy of external beam radiation. The recommended dose was defined as a dose one-step lower than the maximum-tolerated dose, which was defined when dose-limiting toxicity was observed in three or more of the six patients. Results: Twelve patients were eligible from November 2012 to May 2016. Ten patients had perihilar cholangiocarcinoma and two patients had distal cholangiocarcinoma. Dose-limiting toxicity was observed in one of the first six patients at level 1 and two of the next six patients at level 2; thus, the maximum-tolerated dose was not determined even at level 2 and the recommended dose was determined as level 2. Four patients had partial response, four patients had stable disease, and two patients had progression of disease because of liver metastases. Finally, nine patients underwent radical surgery and seven cases achieved R0 resection. However, five cases suffered biliary leakage and one suffered intrahospital death due to rupture of the hepatic artery. Conclusion: We determined the recommended dose of neoadjuvant chemoradiotherapy for resectable cholangiocarcinoma. However, we terminated the trial due to a high incidence of morbidity and unexpected mortality.

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Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: a Retrospective, Multicentre Study Using a National Clinical Registry

Fujimura N., Obara H., Takahashi A., Miyata H., Hosaka A., Obitsu Y., Zempo N., Miyata T., Azuma N., Komori K.

European Journal of Vascular and Endovascular Surgery 66 ( 3 ) 381 - 388 2023.09

ISSN 10785884

Objective: Surgical treatment is an established method for popliteal artery entrapment syndrome (PAES), which, however, mainly derives from single centre experiences where PAES cases are centralised and treated periodically. This study evaluated clinical outcomes of surgical treatment for PAES in a clinical setting where PAES cases were not centralised. Methods: Multicentre, retrospective cohort study using a national clinical registry. From a Japanese nationwide clinical registry, data for patients who underwent surgical treatment for PAES between 2013 and 2018, including 58 limbs from 41 institutes, were retrieved and evaluated. Patency was analysed using Kaplan–Meier curves. Results: The mean patient age was 36 ± 19 years, 78% were male, and the incidence of PAES was 0.24 limbs/centre/year, reflecting a clinical setting where PAES cases are not centralised. The most frequent arterial symptom was intermittent claudication (90%). Computed tomography was performed in 57 limbs (98%) for the diagnosis, however active manoeuvres such as dorsiflexion and plantarflexion during the examination was performed in only 13 limbs (22%), and occlusion of the popliteal artery was present in 38 limbs (66%) at diagnosis. Regarding surgical treatment, myotomy alone was performed in only seven limbs (12%), and other limbs were revascularised. Mean follow up was 26 ± 20 months, and surgical treatment was effective as it relieved symptoms in > 96% of limbs, with five year primary and secondary patency of the surgical treatment for PAES of 72% and 93%, respectively. Conclusion: Results of surgical treatment were acceptable even in a clinical setting where PAES cases were not centralised. However, a low incidence of active manoeuvres performed during the examination and a high incidence of occlusion at diagnosis suggests there may be delayed or underdiagnosis of PAES in Japan, and increased awareness for PAES is warranted.

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Effect of aqueous olanexidine versus alcohol-based chlorhexidine for surgical skin antisepsis on incidence of surgical site infections in gastrointestinal surgery: multicentre randomised controlled clinical trial (OEDO trial) protocol

Takeuchi M., Obara H., Furube T., Kawakubo H., Kitago M., Okabayashi K., Aoyama J., Amemiya R., Fujisaki H., Sano J., Goto R., Sato Y., Kitagawa Y.

BMJ Open 13 ( 8 ) e074169 2023.08

ISSN 2044-6055

Introduction Surgical site infections (SSIs) are among the most common nosocomial infections in surgery patients. Two types of preparations, povidone-iodine and chlorhexidine-alcohol, are commonly used in preoperative antiseptic procedures worldwide. However, there are inconsistencies among international guideline recommendations concerning skin antiseptics. This trial aimed to evaluate the superiority of olanexidine, which reduced SSI rates more than povidone-iodine in our previous randomised trial, over chlorhexidine-alcohol in clean-contaminated surgery. Methods and analysis This multicentre randomised controlled clinical trial will compare two antiseptics (1.5% olanexidine and 1.0% chlorhexidine-alcohol) to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. On providing consent, patients aged <18 years will be included. The primary outcome will be the postoperative 30-day overall SSI rate, while the secondary outcomes will be the postoperative 30-day superficial incisional SSI rate, deep incisional SSI rate, organ/space SSI rate, positive bacterial wound culture rate, cultured bacterial strains, rates of intervention-related toxicity and allergic events (eg, erythema, pruritus, dermatitis and other symptoms of allergy around the region disinfected by the antiseptic during surgery), rate of reoperations due to SSI, medical economic effect indicators (based on health insurance claims) and hospital duration. The Mantel-Haenszel method will be used to estimate the adjusted risk ratio and its 95% CI for the primary analysis, which will compare the treatment effects. Ethics and dissemination The protocol was approved by the Institutional Review Board of Keio University School of Medicine and subsequently by the board of each participating site. Participant recruitment began in January 2023. The final results will be published in medical journals after international peer review. Trial registration number UMIN000049712.

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Long-term Outcomes of the Endurant and Excluder Stent Grafts for Endovascular Aneurysm Repair in a Japanese Cohort

Sekimoto Y., Fujimura N., Matsubara K., Uchida N., Asami A., Harada H., Shintani T., Watada S., Ono S., Fujii T., Shimogawara T., Hayashi K., Hayashi M., Obara H., Kitagawa Y.

Journal of Endovascular Therapy 30 ( 4 ) 571 - 579 2023.08

ISSN 15266028

Purpose: To compare the long-term outcomes of the most widely used third-generation stent grafts, the Endurant and Excluder stent grafts, in Japanese patients using a multicenter registry. Materials and Methods: A retrospective analysis of endovascular aneurysm repairs for abdominal aortic and iliac artery aneurysms using either the Endurant or the Excluder stent grafts from January 2012 to July 2019 at 10 Japanese hospitals was performed. Results: A total of 332 and 378 repairs using the Endurant and Excluder stent grafts, respectively, were analyzed. Although the patients’ characteristics were generally similar in the two groups, the Endurant group exhibited significantly shorter (Endurant: 31.5±18.6 mm, Excluder: 37.4±21.0 mm; p<0.001), larger (Endurant: 22.4±4.2 mm, Excluder: 21.7±3.8 mm; p=0.029), and more reversed tapered (Endurant: 12.1%, Excluder: 5.8%; p=0.003) proximal necks. The incidence of instructions for use (IFU) violations was similar between the two groups (Endurant: 59.0%, Excluder: 54.5%; p=0.223). However, the Endurant group had significantly more proximal neck-related IFU violations (54.1% and 46.3%, respectively; p=0.039), more access-related IFU violations (8.1% and 4.0%, respectively; p=0.019), and fewer bilateral hypogastric artery embolizations (5.1% and 9.3%, respectively; p=0.035) compared with the Excluder group. The incidence of intraoperative (Endurant: 3.6%, Excluder: 3.7%; p=0.950) and perioperative complications (Endurant: 3.6%, Excluder: 3.4%, p=0.899) was equivalent in the two groups. However, there was a significantly higher incidence of postoperative type II endoleaks in the Excluder group (Endurant: 28%, Excluder: 46.0%, p<0.001). Aneurysm sac regression was more frequent in the Endurant group (Endurant: 40.7%, Excluder: 31.7%, p=0.013). The Endurant group also had significantly higher rates of sac increase (Endurant: 13.0%, Excluder: 7.7%, p=0.020). Kaplan-Meier curve and log-rank analyses revealed no statistical differences in late complications (p=0.868) and overall survival (p=0.926). Conclusions: There were no statistically significant differences between the Endurant and the Excluder stent grafts in terms of intraoperative, perioperative, and late complication rates; however, the anatomical characteristics of the patients were significantly different.

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Japanese national survey on declined liver allografts from brain-dead donors: High decline rate but promising outcomes in allografts with moderate steatosis

Takemura Y., Shinoda M., Hasegawa Y., Yamada Y., Obara H., Kitago M., Kasahara M., Umeshita K., Eguchi S., Kitagawa Y., Ohdan H., Egawa H.

Annals of Gastroenterological Surgery 7 ( 4 ) 654 - 665 2023.07

ISSN 2475-0328

Aim: Liver allografts from brain-dead donors, which were declined and were eventually not transplanted due to accompanying marginal factors, have never been surveyed in Japan. We surveyed the declined allografts and discussed the graft potential focusing on various marginal factors. Methods: We collected data on brain-dead donors between 1999 and 2019 from the Japan Organ Transplant Network. We divided their liver allografts into declined (nontransplanted) and transplanted ones, and then characterized declined ones focusing on their timepoints of decline and accompanying marginal factors. For each marginal factor, we calculated the decline rate from the number of declined and transplanted allografts, and assessed the 1-year graft survival rate from transplanted allografts. Results: A total of 571 liver allografts were divided into 84 (14.7%) declined and 487 (85.3%) transplanted ones. In the declined allografts, a majority was declined after laparotomy (n = 55, 65.5%), most of which had steatosis and/or fibrosis (n = 52). Out of the moderate steatotic (without F ≥ 2 fibrosis) allografts (n = 33), 21 were declined and 12 were transplanted, leading to a 63.6% decline rate. The latter 12 achieved a 92.9% 1-year graft survival rate after transplantation. Comparison of donor background showed no significant difference between the declined and transplanted allografts. Conclusion: Pathological abnormalities of steatosis/fibrosis seem to be the most common donor factor leading to graft decline in Japan. Allografts with moderate steatosis were highly declined; however, transplanted ones achieved promising outcomes. This national survey highlights the potential utility of liver allografts with moderate steatosis.

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Comparison of Clinical Outcomes in Patients Undergoing Common Femoral Thromboendarterectomy With or Without Patch Angioplasty

Kobayashi T., Takahara M., Fujimura N., Ichihashi S., Kudo T., Okadome J., Obara H., Nakama T., Suzuki K., Yamaoka T.

European Journal of Vascular and Endovascular Surgery 65 ( 6 ) 870 - 877 2023.06

ISSN 10785884

Objective: Surgical thromboendarterectomy (TEA) is the standard treatment for an occlusive lesion of the common femoral artery (CFA). However, there is limited knowledge on the need for patch angioplasty in CFA TEA. The objective of this study was to compare the peri-operative and two year results of CFA TEA with or without patch angioplasty. Methods: A multicentre retrospective observational study was performed at 34 Japanese centres. Comparisons were made between patients undergoing CFA TEA with or without patch angioplasty after propensity score matching (PSM). The primary endpoints were primary patency and freedom from target lesion revascularisation (TLR) of the TEA lesion. The secondary endpoints were hospital outcomes, limb salvage, and overall survival. Results: Between 2018 and 2020, 428 TEA procedures (237 with patch angioplasty and 191 with primary closure) were performed. PSM extracted 151 pairs with no significant intergroup differences in baseline characteristics. Peri-operative death and complications occurred in 0.7% vs. 1.3% (p = 1.0) and 6.0% vs. 6.6% (p = 1.0), respectively. The follow up rate was 96% over a median follow up of 14.9 months (interquartile range 8.3, 24.3). Loss of primary patency occurred in 18 patients. The two year primary patency of patch angioplasty cases was statistically significantly higher than that of primary closure cases (97.0% vs. 89.9%; p = .021). TLR was performed in 14 patients. The two year freedom from TLR in patch angioplasty cases was also statistically significantly higher than in primary closure cases (98.6% vs. 92.9%; p = .003). During follow up, seven limbs required major amputation and 40 patients died. There was no statistically significant difference in limb salvage and survival between the two groups after PSM. Conclusions: This is the first report to show that patch angioplasty may decrease re-stenosis and target lesion revascularisation of CFA TEA lesions.

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Five-Year Outcomes of the Bioresorbable Peripheral Remedy Stent in the Treatment of Iliac Artery Disease

Obara H., Matsubara K., Fujimura N., Harada H., Okada M., Okui J., Sato Y., Fukuda K., Kitagawa Y.

Journal of Vascular and Interventional Radiology 34 ( 6 ) 1024 - 1035.e2 2023.06

ISSN 10510443

Purpose: To evaluate the 5-year performance of a bioresorbable vascular scaffold, the Remedy stent, for the treatment of iliac artery atherosclerotic disease. Materials and Methods: This prospective, multicenter, single-arm clinical study evaluated 97 patients (97 lesions) with symptomatic TransAtlantic Inter-Society Consensus II A/B iliac artery lesions for 5 years after stent placement. The primary efficacy end point was 12-month primary patency compared with the prespecified standard derived from historical data with metallic stents, and the primary safety end point was the occurrence of major adverse clinical events within 5 years. All angiographic and computed tomography angiographic findings were evaluated by an independent core laboratory for quantitative vessel analysis. Results: The 12-month primary patency rate was 88.6% (95% CI, 80.1%–94.4%), which was lower than the prespecified standard. No significant difference was noted between the diameter stenosis at 9 and 12 months. There were no device- or procedure-related deaths, major amputation, or distal embolization during the follow-up period. The ankle-brachial index maintained significant improvement through the 5-year period compared with that at baseline. The Kaplan–Meier estimates of freedom from target lesion revascularization (TLR), major adverse cardiovascular events, and major adverse cardiovascular and limb events were 95.8%, 91.7%, and 87.5% at 12 months and 85.4%, 72.1%, and 62.5% at 5 years, respectively. Conclusions: The 5-year follow-up outcomes, including freedom from TLR, of the Remedy stent in iliac artery lesions were satisfactory, with a good safety profile. Nevertheless, the 12-month primary patency did not meet the expected standard compared with that of contemporary metallic stents.

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Long-term Results of a Heparin-bonded Expanded Polytetrafluoroethylene Grafts for Above-the-knee Femoropopliteal Bypasses: A Japanese Prospective Multicenter Registry

Fujimura, N; Obara, H; Matsubara, K; Toya, N; Isogai, N; Ogino, H; Fujii, T; Kudo, T; Kanaoka, Y; Harada, H; Uchiyama, H; Guntani, A; Shimogawara, T; Shibutani, S; Ohki, T

JOURNAL OF VASCULAR SURGERY 77 ( 6 ) E183 - E184 2023.06

ISSN 0741-5214

Clot waveform analysis for perioperative hemostatic monitoring in a hemophilia A patient on emicizumab undergoing liver transplantation

Awane M., Wakui M., Ozaki Y., Kondo Y., Oka S., Fujimori Y., Yatabe Y., Arai T., Yamada Y., Hori S., Obara H., Hasegawa Y., Matsushita H.

Clinica Chimica Acta 544 117339 2023.04

ISSN 00098981

How to optimize perioperative factor VIII (FVIII) replacement through hemostatic monitoring is critically important to manage hemophilia A patients. The bispecific antibody emicizumab binds activated FIX (FIXa) and FX to functionally mimic FVIIIa. While being used for hemostatic control in hemophilia A, this therapeutic antibody inconveniently interferes with coagulation tests using human FIXa and FX, such as activated partial thromboplastin time (APTT) and FVIII activity measurement based on one-stage clotting assays. Clot waveform analysis (CWA) extends the interpretation of measurement curves for coagulation time to provide global information. We performed APTT-CWA to monitor perioperative hemostasis in a hemophilia A patient on emicizumab undergoing liver transplantation. Plasma samples were treated with anti-idiotype monoclonal antibodies against emicizumab to enable accurate coagulation assays. Kinetics of maximum coagulation velocity and acceleration mimicked that of FVIII activity. These CWA parameters better correlated with FVIII activity than APTT. The plateaus of them were observed at FVIII activity of 100% or more, supporting the protocol for perioperative FVIII replacement. Thus, CWA may measure coagulation potential in hemophilia A patients undergoing liver transplantation, aiding in optimizing perioperative hemostasis.

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Early Clinical Outcomes of Initial Launch of the Zenith Alpha Abdominal Endovascular Graft in Japan

Fujimura N., Ichihashi S., Obara H., Asakura T., Komooka M., Onitsuka S., Kurimoto Y., Kato H., Ohki T.

Journal of Endovascular Therapy 30 ( 2 ) 241 - 249 2023.04

ISSN 15266028

Purpose: This study retrospectively evaluated the 12-month outcomes of the Zenith Alpha Abdominal Endovascular graft (Zenith Alpha AAA, Cook, Inc, Bloomington, Indiana), which was launched partially in Japan in March 2019, starting with 9 selected sites. Methods: A retrospective analysis was performed of all endovascular aneurysm repairs (EVAR) for abdominal aortic aneurysms using the Zenith Alpha AAA. Late complications were defined as any aneurysm-related events occurring >30 days after EVAR, including an aneurysm sac enlargement of >5 mm and any reinterventions performed. Endoleaks without sac enlargement or reinterventions were excluded from late complications. Results: During the study period, 79 EVARs using the Zenith Alpha AAA were performed. The mean age was 76.6±6.9 years old, 91.1% of patients were male, and the mean aneurysm diameter was 51.1±7.5 mm. Instructions for use violation was observed in 27 patients (34.2%), most frequently being a severely angulated proximal neck (>60°). There were 4 intraoperative complications, including 2 unintentional partial renal artery coverages caused by the premature anchoring of the exposed suprarenal stent barb to the aortic wall, which was a result of the design change of the top cap deletion. Since it was a partial coverage without flow impairment and since renal stenting was unsuccessful, it was left untreated and had no subsequent renal function impairment. During the mean follow-up of 444±123 days, 74 patients completed 12 months of follow-up. Freedom from late complications at 12 months was 90.8%, which included 2 limb occlusions (2.5%). Of 71 patients with a 12-month computed tomography scan, there was only 1 type 1a endoleak (1.3%), 1 sac enlargement of >5 mm (1.3%), and an aneurysm sac shrinkage of >5 mm was observed in 42.2% of patients. There was no type 3 endoleak during the follow-up. Conclusions: This study demonstrated that the new generation of low-profile Zenith Alpha AAA has satisfactory early clinical outcomes, comparable to those obtained with the conventional Zenith endovascular graft. Long-term follow-up is needed to determine whether these favorable outcomes persist.

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Specificity of Presepsin as a Biomarker of Bacterial Infection in Mouse Sepsis Models

Hosokawa K., Obara H., Fukuda K., Mastubara K., Kitagawa Y.

Journal of Surgical Research 283 572 - 580 2023.03

ISSN 00224804

Introduction: Since its discovery in 2002, presepsin (P-SEP) has been reported to be useful in the early diagnosis of sepsis and has been evaluated in many clinical studies. However, as antibodies that bind to mouse P-SEP were previously unavailable, serum P-SEP levels in mice are limited. This study used a P-SEP enzyme-linked immunosorbent assay kit to evaluate the changes in serum P-SEP levels in mouse sepsis models compared with changes in other inflammatory markers and determine whether P-SEP can function as a biomarker specific to bacterial infections. Methods: Sepsis was induced in mice via cecal ligation and puncture (CLP), induction with lipopolysaccharide (LPS), and cecal ligation (CL) model was created as a control for the CLP model, following which clinical biomarkers (P-SEP, C-reactive protein, and procalcitonin) were evaluated. Results: The 48-h survival rates in the CLP, CL, and LPS-induced sepsis models were 67%, 89%, and 57%, respectively. Serum C-reactive protein levels did not increase in the CLP and CL models within 24 h but significantly increased in the LPS-induced sepsis model. Serum procalcitonin levels increased in the CLP and CL models and especially increased in the LPS-induced sepsis model. In contrast, an increase in serum P-SEP level was found in the CLP model at 6 h compared with those at baseline, the CL, and LPS-induced sepsis models. Conclusions: Mouse P-SEP is elevated early in infection and more specific to bacterial infection compared with other biomarkers.

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Early Clinical Outcomes of the Active Seal Technology of the AFX Endovascular Aortic Aneurysm System With the VELA Cuff for Patients With a Conical Proximal Neck

Fujimura N., Obara H., Nagano T., Ogawa Y., Kobayashi T., Ohmine T., Ozeki Y., Sakaguchi S., Yamaoka T., Ueda H., Sumi M., Taniguchi S., Ichihashi S.

Journal of Endovascular Therapy 30 ( 1 ) 114 - 122 2023.02

ISSN 15266028

Purpose: To evaluate the efficacy of the Active Seal technology employed in the AFX endovascular aortic aneurysm system (AFX), during endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms (AAAs) having a conical proximal neck. Materials and Methods: A retrospective analysis of the EVAR for AAA with a conical proximal neck using the AFX was performed at 17 Japanese hospitals between January 2016 and August 2020. The conical proximal neck was defined as a cone-shaped proximal neck, with more than 10% diameter increase within a 15 mm length at the proximal landing zone. All anatomical analyses were performed in the core laboratory, and cases with parallel walls within the proximal neck adequate for the landing zone were excluded from the study. Results: This study included 53 patients, but only 39 patients (mean age, 76.6 ± 6.7 years; 87.0% males; mean aneurysm diameter, 52.0 ± 8.0 mm) were analyzed after being characterized as having a pure conical neck by the core laboratory. The mean proximal neck diameters at the lower renal artery and proximal edge of the aneurysm were 20.0 ± 2.9 mm and 27.5 ± 4.9 mm, respectively. The mean proximal neck length was 21.5 ± 6.0 mm. Instructions for use violations other than the conical neck were observed in 15 patients (38.5%). The VELA cuff was used in all cases; however, additional proximal cuff was required in 9 more cases (23.1%). The Active Seal technology was able to significantly extend the proximal sealing zone from 21.5 ± 6.0 to 26.0 ± 12.2 mm (p =.047). Thirty-six patients completed the 12-month follow-up (one patient was lost to follow-up, and 2 patients died from causes unrelated to the aneurysm), and there were no type-1a and 3 endoleaks with only one reintervention (2.6%) related to type 1b endoleak in the 12-month period. Furthermore, there was no significant enlargement of the proximal neck diameter at 12 months (at 1 month: 20.6 ± 3.4 mm and at 12 months: 21.3 ± 3.8 mm; p =.420). Conclusion: The Active Seal technology of the AFX significantly extended the proximal seal zone and no type-1a endoleak and proximal neck dilation was observed in patients with conical proximal neck at 12 months.

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Standardized upfront Glissonean approach and liver hanging maneuver reduces bile leakage from the hepatic hilum in living donors

Hirukawa K., Masuda Y., Abe Y., Yagi H., Ibuki S., Itano O., Shinoda M., Kitago M., Hasegawa Y., Hori S., Tanaka M., Nakano Y., Matsubara K., Obara H., Yamada Y., Kuroda T., Hibi T., Kitagawa Y.

Liver Transplantation 29 ( 1 ) 48 - 57 2023.01

ISSN 15276465

Biliary complications after hepatectomy in living donors have yet to be eradicated. We hypothesized that a standardized upfront Glissonean approach and liver hanging maneuver (GH) would prevent mechanical and thermal injuries to the hilar plate of the remnant liver by determining the point of bile duct division and the final destination of hepatectomy preceding liver parenchymal transection (safety) and facilitate liver transection deep within the parenchyma and allow maximum length of hilar structures (rationality). GH was implemented in 2016 and its incidence of bile leakage was retrospectively compared against the conventional technique. GH comprises six steps: (1) development of the retrohepatic avascular plane between the right hepatic vein (RHV) and the middle hepatic vein (MHV) and isolation of the hepatic vein(s); (2) isolation of the right or left Glissonean pedicle with the corresponding Glissonean pedicles of the caudate lobe; (3) for right liver grafts and left liver grafts with the caudate lobe, passage of the tape for the liver hanging maneuver along the retrohepatic avascular plane and above the hilar plate, and for left liver grafts without the caudate lobe and for left lateral section grafts, passage of the tape from between the RHV and the MHV, along the Arantius ligament, and to the right of the umbilical portion; (4) liver transection; (5) isolation of hilar structures; and (6) graft procurement. Until 2020, 62 consecutive living donors underwent GH (success rate, 100%). The incidence of bile leakage from the hepatic hilum (0%) was significantly lower than that among 59 donors who underwent the conventional technique in 2011-2015 (9%; p = 0.01). In conclusion, GH is highly effective in reducing bile leakage from the hepatic hilum in living donors.

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Adverse effects of long-term drain placement and the importance of direct aspiration: a retrospective cohort study

Okui J., Obara H., Uno S., Sato Y., Shimane G., Takeuchi M., Kawakubo H., Kitago M., Okabayashi K., Kitagawa Y.

Journal of Hospital Infection 131 156 - 163 2023.01

ISSN 01956701

Background: Long-term placement of prophylactic drains may result in retrograde infections. Aim: To investigate the association between the timing of drain removal and clinical outcomes. Methods: This retrospective, single-centre cohort study evaluated 110 patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery and developed subsequent organ/space surgical site infection (SSI) between 2016 and 2020. The difference between the culture-positive species of prophylactic drains and direct aspiration was evaluated; whether the prophylactic drains functioned effectively at the time of SSI diagnosis; and whether the empirical antibiotics administered before drainage were effective against all the detected bacteria. Finally, clinical outcomes were compared between early (i.e. cases wherein the prophylactic drain had already been removed or replaced at the time of SSI diagnosis) and late (removal after diagnosis) drain removal. Findings: The prophylactic drains functioned effectively in only 27 (25%) patients at the time of SSI diagnosis. Due to the results of direct aspiration cultures, 43% of patients required antibiotic escalation. The median time to drain removal or first replacement was seven postoperative days. The early removal group included 43 patients (39%). Compared with early removal, late removal resulted in a higher frequency of vancomycin use (7.0% vs 22.4%; P = 0.037). Conclusion: Prolonged prophylactic drain placement is associated with complicated infections requiring vancomycin; therefore, the drains should be removed as soon as possible. Additionally, obtaining the cultures of direct aspiration should be actively considered, as escalation of antimicrobial therapy is often performed based on culture results.

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Prediction of need for bowel resection in acute superior mesenteric artery occlusion: A retrospective study of 48 Japanese patients

Watada S., Obara H., Okui J., Hosokawa K., Matsubara K., Harada H., Fujimura N., Fujii T., Shimogawara T., Kitagawa Y.

Annals of Gastroenterological Surgery 7 ( 1 ) 175 - 181 2023.01

ISSN 2475-0328

Aim: This study aimed to predict cases of acute superior mesenteric artery (SMA) occlusion requiring bowel resection using occlusion site and time from symptom onset to diagnosis at five Japanese institutions. Advances in imaging, endovascular treatment, and perioperative management have improved the clinical outcomes of patients with acute SMA occlusion; however, in clinical practice it remains difficult to effectively determine patients requiring bowel resection. Methods: We retrospectively analyzed the data of 48 patients (mean age: 82.5 y; male: 37.5%) diagnosed with acute SMA occlusion between June 2009 and August 2018. Background data of patients who required and did not require bowel resection were compared. A multivariable predictive model was developed using the time from symptom onset to diagnosis and whether SMA occlusion was proximal, including the origin of the middle colic artery. Results: Fifteen patients (31.3%) died during the hospital stay. Atrial fibrillation (83.3%) was the most common comorbidity. The median time from symptom onset to diagnosis was 13.0 (interquartile range, 4.75–24.0) h. Laparotomy, bowel resection, and thrombus embolectomy were performed in 41 (85.4%), 26 (54.2%), and 21 (43.8%) patients, respectively. A logistic regression model achieved 78.6% sensitivity in predicting cases not requiring bowel resection. Proximal occlusion was significantly associated with the requirement for bowel resection (P =.039). Conclusion: The time from symptom onset to diagnosis and occlusion site contributed to high sensitivity in determining the need for bowel resection in patients with acute SMA occlusion. Further prospective studies are warranted to investigate the clinical impact of this model.

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Successful Case of Deceased Donor Liver Transplant for Polycystic Liver Disease

Sugimoto H., Oshima Y., Oba Y., Ikuma D., Sekine A., Mizuno H., Yamanouchi M., Hasegawa E., Suwabe T., Chu P.S., Hasegawa Y., Obara H., Sawa N., Ubara Y.

Transplantation Proceedings 54 ( 10 ) 2779 - 2783 2022.12

ISSN 00411345

A 58-year-old woman was admitted to hospital for deceased donor liver transplant. Her liver volume, measured by computed tomography, had reached 22,764 cm3 and she was bedridden with performance status 3 because of abdominal distention. The Model for End-Stage Liver Disease score was 24 with exception points. The final weight of the removed liver after cystic fluid puncture was 14 kg. The patient recovered well after transplant and was discharged on postoperative day 43 with a weight of 41 kg and performance status of 1.

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Survey on the current status of the indication and implementation protocols for bile replacement in patients with external biliary drainage with special reference to infection control

Shinkawa H., Kubo S., Mikamo H., Matsuda N., Omura K., Okamoto K., Ono S., Obara H., Kobayashi M., Sasaki J., Shimizu J., Sueyoshi S., Yoshida J., Watanabe M., Takesue Y.

Surgery Today 52 ( 10 ) 1446 - 1452 2022.10

ISSN 09411291

Purpose: This survey of bile replacement (BR) was conducted on patients with external biliary drainage to assess the current status of indication and implementation protocol of BR with special reference to infection control. Methods: A 12-item questionnaire regarding the performance of perioperative BR was sent to 124 institutions in Japan. Results: BR was performed in 29 institutions, and the indication protocol was introduced in 19. BR was performed preoperatively in 11 institutions, pre- and postoperatively in 12, and postoperatively in 6. The methods used for BR administration included oral intake (n = 10), nasogastric tube (n = 1), enteral nutrition tube (n = 3), oral intake and enteral nutrition tube (n = 6), oral intake or nasogastric tube (n = 2), nasogastric tube and enteral nutrition tube (n = 2), and oral intake or nasogastric tube and enteral nutrition tube (n = 5). In 10 of 29 institutions, isolation of multidrug-resistant organisms and a high bacterial load were considered contraindications for the use of BR. Seven institutions experienced environmental contamination. Conclusions: Given the different implementation of BR among institutions, the appropriate indication and protocols for BR should be established for infection control.

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Development of a risk score model for 1-year graft loss after adult deceased donor liver transplantation in Japan based on a 20-year nationwide cohort

Takemura Y., Shinoda M., Takemura R., Hasegawa Y., Yamada Y., Obara H., Kitago M., Sakamoto S., Kasahara M., Umeshita K., Eguchi S., Ohdan H., Egawa H., Kitagawa Y.

Annals of Gastroenterological Surgery 6 ( 5 ) 712 - 725 2022.09

ISSN 2475-0328

Aim: Using nationwide data collected over the past 20 years, we aimed to investigate deceased donor liver transplantation (DDLT) outcomes to develop a unique risk model that can be used to establish a standard for organ acceptance in Japan. Methods: Data were collected for 449 recipients aged ≥18 years who underwent DDLT between 1999 and 2019. Least absolute shrinkage and selection operator (LASSO) regression analysis was utilized to develop an original risk score model for 1-year graft loss (termed the Japan Risk Index [JRI]). We developed risk indices according to recipient, donor, and surgery components (termed JRI-R, D, and S, respectively). The JRI was validated via a 5-fold cross-validation. We also compared DDLT outcomes and risk indices among Era1 (−2011), Era2 (−2015), and Era3 (−2019). Results: The 1-year graft survival rate was 89.5% and improved significantly, reaching 84.7%, 87.6%, and 93.9% in Era1, Era2, and Era3, respectively. The JRI was calculated as JRI-R (re-transplantation, Model for End-Stage Liver Disease score, medical condition in intensive care unit) × JRI-D (age, catecholamine index, maximum sodium, maximum total bilirubin) × JRI-S (total ischemic time) × 0.84. The risk model achieved a mean C-statistic value of 0.81 in the validation analysis. The risk index was significantly lower in Era3 than in Era2. Conclusion: Changes in the risk index over time indicated that avoiding risks contributed to the improved outcomes in Era3. The JRI is unique to adult DDLT in Japan and may be useful as a reference for organ acceptance in the future.

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In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

Janko M.R., Hubbard G., Back M., Shah S.K., Pomozi E., Szeberin Z., DeMartino R., Wang L.J., Crofts S., Belkin M., Davila V.J., Lemmon G.W., Wang S.K., Czerny M., Kreibich M., Humphries M.D., Shutze W., Joh J.H., Cho S., Behrendt C.A., Setacci C., Hacker R.I., Sobreira M.L., Yoshida W.B., D'Oria M., Lepidi S., Chiesa R., Kahlberg A., Go M.R., Rizzo A.N., Black J.H., Magee G.A., Elsayed R., Baril D.T., Beck A.W., McFarland G.E., Gavali H., Wanhainen A., Kashyap V.S., Stoecker J.B., Wang G.J., Zhou W., Fujimura N., Obara H., Wishy A.M., Bose S., Smeds M., Liang P., Schermerhorn M., Conrad M.F., Hsu J.H., Patel R., Lee J.T., Liapis C.D., Moulakakis K.G., Farber M.A., Motta F., Ricco J.B., Bath J., Coselli J.S., Aziz F., Coleman D.M., Davis F.M., Fatima J., Irshad A., Shalhub S., Kakkos S., Zhang Q., Lawrence P.F., Woo K., Chung J.

Journal of Vascular Surgery 76 ( 2 ) 546 - 555.e3 2022.08

ISSN 07415214

Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P < .001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P < .001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective.

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Reappraisal of liver transplantation for erythropoietic protoporphyria: A deadly combination of disease recurrence and biliary complication

Endo Y., Hibi T., Shinoda M., Obara H., Kitago M., Yagi H., Abe Y., Hasegawa Y., Matsubara K., Hori S., Tanaka M., Makiuchi S., Nakano Y., Itano O., Kuroda T., Kitagawa Y.

Pediatric Transplantation 26 ( 4 ) e14261 2022.06

ISSN 13973142

Background: Erythropoietic protoporphyria (EPP) is a rare inherited disorder that causes the accumulation of protoporphyrin in the erythrocytes, skin, and liver. Severe protoporphyric hepatopathy results in liver failure, requiring both liver and bone marrow transplantation as a life-saving procedure and to correct the underlying enzymatic defect, respectively. Case presentation: We report a 20-year-old man who underwent split liver transplantation using a right trisegment and caudate lobe graft for EPP-induced liver failure, but succumbed to a deadly combination of early relapse of EPP and subsequent, intractable, late-onset bile leakage from the cut surface of segment 4. EPP recurrence most likely created a high-risk situation for bile leakage from the non-communicating bile ducts of segment 4; therefore, this case shed light on the potential relationship between EPP recurrence and biliary complications. Conclusion: Physicians should recognize the potentially rapid and life-threatening progression of protoporphyric hepatopathy that leads to liver failure. For young patients with EPP, LT and sequential BMT should thoroughly be considered by a multidisciplinary team as soon as hepatic reserve deterioration becomes evident. Split liver transplantation should preferably be avoided and appropriate post-transplant management is critical before protoporphyrin depositions to the bile duct and hepatocyte causes irreversible damage to the liver graft.

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Severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery

Okui J., Obara H., Shimane G., Sato Y., Kawakubo H., Kitago M., Okabayashi K., Kitagawa Y.

Annals of Gastroenterological Surgery 6 ( 3 ) 445 - 453 2022.05

ISSN 2475-0328

Background: Organ/space surgical site infection (SSI) is a significant clinical problem. The postdiagnosis course of organ/space SSIs and the impact of its early diagnosis on clinical outcomes are yet to be clarified. Thus, we aimed to investigate the association between the timing of diagnosis and the clinical outcome of organ/space SSI. Methods: This retrospective, single-center cohort study evaluated patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery between 2016 and 2020. Clinical outcomes were compared between the early group (ie, SSI diagnosed until postoperative day [POD] 4) and normal-late group (ie, SSI diagnosed after POD 5). The primary outcome was the final C-reactive protein (CRP) level within 14 d after organ/space SSI diagnosis. Results: In total, 110 patients were evaluated. The median time of diagnosis was 7 d postoperatively (interquartile range, 5–9 d postoperatively). Compared with the normal-late group, the early group included a higher proportion of patients with Clavien–Dindo grade ≥IIIb (8/21 vs 11/89, P =.01), higher final CRP value within 14 d after SSI diagnosis (mean, 4.49 mg/dL vs 2.27 mg/dL, P =.01), longer postoperative length of hospitalization (median, 45.0 d vs 33.0 d; P =.028), and worse 1-y overall survival rate (74.8% vs 89.3%, P =.08). Conclusion: Early diagnosed organ/space SSI are originally severe and may therefore be detected earlier. Importantly, early diagnosed organ/space SSI is likely to be severe and refractory.

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Comparative Study of S2-Alar-Iliac Screw Trajectories between Males and Females Using Three-Dimensional Computed Tomography Analysis: The True Lateral Angulation of the S2-Alar-Iliac Screw in the Axial Plane

Funao H., Yamanouchi K., Fujita N., Kado Y., Kato S., Otomo N., Isogai N., Sasao Y., Ebata S., Kitagawa Y., Watanabe K., Obara H., Ishii K.

Journal of Clinical Medicine 11 ( 9 ) 2022.05

ISSN 2077-0383

The S2 alar-iliac screw (S2AIS) is commonly used for long spinal fusion as a rigid distal foundation in spinal deformity surgeries, and it is also used in percutaneous sacropelvic fixation for providing an in-line connection to the proximal spinal constructs without using offset connectors. Although the pelvic shape is different between males and females, reports on S2AIS trajectories according to gender have been scarce in the literature. In this paper, S2AIS trajectories are compared between males and females using pelvic three-dimensional computed tomography (3D-CT) in a normal Japanese population. After resetting the caudal angulation in CT-imaging plane manipulation, the angulation of S2AIS was more lateral in the axial plane and more horizontal in the coronal plane in females. Mean distances from the midline to starting points of S2AIS tended to be shorter in females, whereas mean distances from the midline to the posterior superior iliac spine was significantly longer in females. We also found that there were positive correlations between the patients’ height and the maximal lengths of S2AISs, and the patients’ height and minimal areas of S2AIS pathways. Our results are useful not only for conventional open spinal surgery, but also for minimally invasive spine surgery.

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Patients with liver cirrhosis due to nonalcoholic steatohepatitis have lesser chances for liver transplantation

Hasegawa Y., Obara H., Chu P.S., Shinoda M., Kitago M., Abe Y., Yagi H., Matsubara K., Nakamoto N., Kitagawa Y.

Journal of Hepato Biliary Pancreatic Sciences 29 ( 5 ) 562 - 569 2022.05

ISSN 18686974

Background: The main causes of liver cirrhosis have changed over the past decade. In Japan, the number of deceased donors is increasing but is still insufficient relative to the number of patients awaiting a liver transplant. In the present study we aimed to assess the outcomes of candidates for liver transplantation. Methods: This was a retrospective study of adult patients who visited our department for consultation regarding liver transplantation from January 2009 to December 2020. Of a total of 601 patients, 336 were followed-up. The following data were collected and analyzed: patient's characteristics, liver etiology, Child-Pugh and MELD scores, and the eventual outcome, that is, whether liver transplantation was performed. Results: Only 153 of 336 (45.5%) patients underwent liver transplantation, of which 42 (27.5%) received deceased donor liver transplantation, and 129 (38.4%) died without transplantation. The proportion of patients who underwent liver transplantation was low among patients with nonalcoholic steatohepatitis (NASH) (10.7%) (P <.001). The rate of qualified living donors was the lowest for patients with NASH (28.6%) and that for the other etiologies ranged from 55.6% to 67.4% (P =.050). Conclusion: Patients with liver cirrhosis due to NASH may have a lesser chance of undergoing liver transplantation from both living and deceased donors.

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Adipose-Derived Mesenchymal Stromal/Stem Cell Line Prevents Hepatic Ischemia/Reperfusion Injury in Rats by Inhibiting Inflammasome Activation

Chen K., Obara H., Matsubara Y., Fukuda K., Yagi H., Ono-Uruga Y., Matsubara K., Kitagawa Y.

Cell Transplantation 31 9636897221089629 2022.04

ISSN 09636897

Mesenchymal stromal/stem cells (MSCs) have shown potential in the treatment of degenerative diseases, including ischemia/reperfusion injury (IRI), which occurs during organ transplantation and represents the main cause of post-transplant graft dysfunction. However, MSCs have heterogeneous characteristics, and studies of MSCs therapy have shown a variety of outcomes. To establish a new effective MSCs therapy, we developed an adipose-derived mesenchymal stromal/stem cell line (ASCL) and compared its therapeutic effects on primary adipose-derived MSCs (ASCs) using a hepatocyte co-culture model of hypoxia/reoxygenation in vitro and a rat model of hepatic IRI in vivo. The results showed that both ASCL and ASCs protect against hypoxia by improving hepatocyte viability, inhibiting reactive oxygen species release, and upregulating transforming growth factor-β in vitro. In vivo, ASCL or ASCs were infused into the spleen 24 h before the induction of rat hepatic IRI. The results showed that ASCL significantly improved the survival outcomes compared with the control (normal saline infusion) with the significantly decreased serum levels of liver enzymes and less damage to liver tissues compared with ASCs. Both ASCL and ASCs suppressed NOD-like receptor family pyrin domain-containing 3 inflammasome activation and subsequently reduced the release of activated IL-1β and IL-18, which is considered an important mechanism underlying ASCL and ASCs infusion in hepatic IRI. In addition, ASCL can promote the release of interleukin-1 receptor antagonist, which was previously reported as a key factor in hampering the inflammatory cascade during hepatic IRI. Our results suggest ASCL as a new candidate for hepatic IRI treatment due to its relatively homogeneous characteristics.

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Transplantation of bioengineered liver capable of extended function in a preclinical liver failure model

Higashi H., Yagi H., Kuroda K., Tajima K., Kojima H., Nishi K., Morisaku T., Hirukawa K., Fukuda K., Matsubara K., Kitago M., Shinoda M., Obara H., Adachi S., Nishimura K., Natsume T., Tomi M., Soto-Gutierrez A., Kitagawa Y.

American Journal of Transplantation 22 ( 3 ) 731 - 744 2022.03

ISSN 16006135

Unlimited organ availability would represent a paradigm shift in transplantation. Long-term in vivo engraftment and function of scaled-up bioengineered liver grafts have not been previously reported. In this study, we describe a human-scale transplantable liver graft engineered on a porcine liver-derived scaffold. We repopulated the scaffold parenchyma with primary hepatocytes and the vascular system with endothelial cells. For in vivo functional testing, we performed auxiliary transplantation of the repopulated scaffold in pigs with induced liver failure. It was observed that the auxiliary bioengineered liver graft improved liver function for 28 days and exhibited upregulation of liver-specific genes. This study is the first of its kind to present 28 days of posttransplant evaluation of a bioengineered liver graft using a preclinical large animal model. Furthermore, it provides definitive evidence for the feasibility of engineering human-scale transplantable liver grafts for clinical applications.

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Carotid body tumor with neck metastasis due to germline SDHB variant: a case report and literature review

Mikoshiba, T; Yoshihama, K; Ito, F; Sekimizu, M; Nakamura, S; Nagai, R; Akiyama, T; Matsubara, K; Obara, H; Ozawa, H

INTERNATIONAL CANCER CONFERENCE JOURNAL 11 ( 1 ) 6 - 11 2022.01

ISSN 2192-3183

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Keio Uterus Transplantation Research: From Basic Research toward Future Clinical Application

Kisu I., Banno K., Matoba Y., Yamada Y., Emoto K., Masugi Y., Matsubara K., Obara H., Aoki D.

Keio Journal of Medicine 71 ( 2 ) 33 - 43 2022

ISSN 00229717

Uterus transplantation (UTx) is now a potential option to allow women with uterine factor infertility to give birth. However, UTx is still at an experimental stage, and basic animal studies, including in nonhuman primates, are needed for the accumulation of data prior to clinical application. Considering that UTx may provide new hope to Japanese women, we launched UTx research in 2009 and have since accumulated a large archive of results in the UTx research field. Furthermore, we have carried out various activities aimed at the implementation of clinical applications of UTx in Japan while clarifying the ethical and social issues involved. Currently, the clinical application of UTx in Japan is just around the corner, and it is expected that UTx research will develop further in the future. Herein, we summarize our basic experiences using non-human primates and our activities with the goal of future clinical applications.

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Dynamic contrast-enhanced CT at the early stage confirms two cases of acute liver failure due to acute-onset autoimmune hepatitis with extensive liver necrosis

Watanabe T., Chu P.S., Ehira T., Hasegawa Y., Hattori N., Shinoda M., Ikeda H., Tsujikawa H., Obara H., Hara M., Suzuki T., Matsunaga K., Okuse C., Itoh F.

Kanzo Acta Hepatologica Japonica 63 ( 3 ) 158 - 169 2022

ISSN 04514203

[Case 1] A 54-year-old female presented with severe liver damage. During diagnosis, contrast-enhanced CT enhanced the area of hypoattenuation on unenhanced CT in the arterial phase, after which the enhanced effect was prolonged to the equilibrium phase. Then, we started immunosuppressive therapy based on the results, including corticosteroid administration, and her hepatitis subsided. [Case 2] A 57-year-old female also presented with severe hepatitis. Contrast-enhanced CT findings were similar to those of Case 1. Since hepatic encephalo-pathy developed and worsened to degree IV, a brain-dead liver transplant was conducted on the 21st day. Nev-ertheless, histological diagnosis was challenging in both cases. Therefore, when unenhanced CT shows hetero-geneous hypoattenuation in the liver and contrast-enhanced CT shows a characteristic blood flow disorder, acute-onset autoimmune hepatitis and corticosteroid treatment should be considered, including in complex se-rological or histological case diagnoses.

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Efficacy of Early Closed Toe Amputation for Toe Ulcers with Suspected Osteomyelitis after Revascularization for Chronic Limb-Threatening Ischemia

Shintani, T; Suzuki, S; Kikuchi, N; Ariya, T; Natsume, K; Ookura, K; Okui, J; Sato, Y; Obara, H

ANNALS OF VASCULAR DISEASES 15 ( 2 ) 126 - 133 2022

ISSN 1881-641X

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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Janko M., Hubbard G., Woo K., Kashyap V.S., Mitchell M., Murugesan A., Chen L., Gardner R., Baril D., Hacker R.I., Szeberin Z., ElSayed R., Magee G.A., Motta F., Zhou W., Lemmon G., Coleman D., Behrendt C.A., Aziz F., Black J.H., Tran K., Dao A., Shutze W., Garrett H.E., De Caridi G., Patel R., Liapis C.D., Geroulakos G., Kakisis J., Moulakakis K., Kakkos S.K., Obara H., Wang G., Stoecker J., Rhéaume P., Davila V., Ravin R., DeMartino R., Milner R., Shalhub S., Jim J., Lee J., Dubuis C., Ricco J.B., Coselli J., Lemaire S., Fatima J., Sanford J., Yoshida W., Schermerhorn M.L., Menard M., Belkin M., Blackwood S., Conrad M., Wang L., Crofts S., Nixon T., Wu T., Chiesa R., Bose S., Turner J., Moore R., Smith J., Irshad A., Hsu J., Czerny M., Cullen J., Kahlberg A., Setacci C., Joh J.H., Senneville E., Garrido P., Sarac T.P., Rizzo A., Go M.R., Bjorck M., Gavali H., Wanhainen A., D'Oria M., Lepidi S., Mastrorilli D., Veraldi G., Piazza M., Squizzato F., Beck A., St. John R., Wishy A., Humphries M., Shah S.K., Back M., Chung J., Lawrence P.F., Bath J., Smeds M.R.

Annals of Vascular Surgery 76 202 - 210 2021.10

ISSN 08905096

Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.

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Advantages of extrahepatic glissonean approach in the donor operation in living donor liver transplantation

Hirukawa, K; Yagi, H; Hibi, T; Masuda, Y; Shinoda, M; Obara, H; Kitago, M; Abe, Y; Oshima, G; Hori, S; Kuroda, T; Kitagawa, Y

TRANSPLANTATION 105 ( 8 ) 107 - 107 2021.08

ISSN 0041-1337

HONEDRA® (CLBS12) AUTOLOGOUS CD34+CELLS IMPROVE OUTCOMES IN PATIENTS WITH BUERGER'S DISEASE

Kawamoto, A; Furukawa, Y; Fujita, Y; Kobayashi, S; Tobita, K; Yamaguchi, J; Shimizu, W; Takagi, G; Matsumura, H; Murata, N; Nakamura, M; Kitano, I; Yokoi, H; Azuma, N; Kozuki, A; Obara, H; Furukawa, M; Sietsema, WK; Takagi, H; Wang, J; Bartel, R; Losordo, DW

CYTOTHERAPY 23 ( 5 ) S80 - S81 2021.05

ISSN 1465-3249

Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms

Hosaka A., Kumamaru H., Takahashi A., Azuma N., Obara H., Miyata T., Obitsu Y., Zempo N., Miyata H., Komori K., Shigematsu K., Inoue Y., Okazaki J., Obara H., Satokawa H., Sugimoto I., Banno H., Fujimura N., Mii S., Morikage N., Yamaoka T.

British Journal of Surgery 108 ( 3 ) 286 - 295 2021.03

ISSN 00071323

Background: Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined. Methods: A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR). Results: Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P<0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P=0.093 and P =0.472 respectively). Conclusion: In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.

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Long-term outcomes of living donor liver transplantation after locoregional treatment for hepatocellular carcinoma: an experience from a single institute

Inomata K., Yagi H., Hibi T., Shinoda M., Matsubara K., Abe Y., Kitago M., Obara H., Itano O., Kawachi S., Tanabe M., Wakabayashi G., Shimazu M., Kitagawa Y.

Surgery Today (Surgery Today) 51 ( 3 ) 350 - 357 2021.03

ISSN 09411291

Purpose: The precise role of downstaging or bridge therapy for cirrhotic patients with hepatocellular carcinoma (HCC) beyond or within the Milan criteria (MC) before living donor liver transplantation (LDLT) remains undefined. Methods: We conducted a single-center, retrospective cohort study of 40 cirrhotic patients with HCC who underwent LDLT from 2000 to 2018. Dynamic computed tomography images at the initial presentation and immediately before LDLT as well as the final histopathological findings were reviewed to determine whether they met or exceeded MC. Results: Overall, 29 patients underwent various pre-transplant HCC treatments, including ablation and embolization (bridge therapy, n = 20; downstaging, n = 9). Of the 9 patients who were initially beyond the MC, 4 (44.4%) were successfully downstaged to within the MC. Five patients beyond the MC immediately before LDLT demonstrated a significantly worse 5-year overall survival rate than patients within the MC (16.7% vs. 82.2%, P = 0.004), regardless of the radiological HCC stage at presentation or the final pathological tumor status. All 3 recurrent patients had HCC beyond the MC immediately before transplant and died of their disease at 13, 24, and 50 months after transplantation. Conclusions: Successful downstaging for HCC cases beyond the MC provides similar outcomes to those within the MC at presentation, regardless of the histopathological findings.

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CT screening for COVID-19 in asymptomatic patients before hospital admission

Uchida S., Uno S., Uwamino Y., Hashimoto M., Matsumoto S., Obara H., Jinzaki M., Kitagawa Y., Hasegawa N.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 27 ( 2 ) 232 - 236 2021.02

ISSN 1341321X

Introduction: In the novel coronavirus disease (COVID-19) pandemic era, it is essential to rule out COVID-19 effectively to prevent transmission in both communities and medical facilities. According to previous reports in high prevalence areas, CT screening may be useful in the diagnosis of COVID-19. However, the value of CT screening in low prevalence areas has scarcely been reported. Methods: This report examines the diagnostic efficacy of CT screening before admission to a hospital in Tokyo. We conducted a retrospective analysis at Keio University Hospital from April 6, 2020, through May 29, 2020. We set up an outpatient screening clinic on April 6 for COVID-19, administering both PCR with nasopharyngeal swabs and chest CT for all patients scheduled for surgery under general anesthesia. Results: A total of 292 asymptomatic patients were included in this study. There were three PCR-positive patients, and they all had negative CT findings, which revealed that both the sensitivity and positive predictive value of CT (PPV) were 0%. There were nine CT-positive patients; the specificity and the negative predictive value (NPV) were 96.9% and 98.9%, respectively. Conclusion: CT screening was not useful in low prevalence areas at this time in Tokyo, even with the inclusion of the most prevalent phase. Given that the utility of CT screening depends on disease prevalence, the criteria for performing CT screening based on the prevalence of COVID-19 should be established.

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In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas

Janko M.R., Woo K., Hacker R.I., Baril D., Bath J., Smeds M.R., Kashyap V.S., Szeberin Z., Magee G.A., Elsayed R., Wishy A., St. John R., Beck A., Farber M., Motta F., Zhou W., Lemmon G., Coleman D., Behrendt C.A., Aziz F., Black J., Shutze W., Garrett H.E., De Caridi G., Liapis C.D., Geroulakos G., Kakisis J., Moulakakis K., Kakkos S.K., Obara H., Wang G., Rhéaume P., Davila V., Ravin R., DeMartino R., Milner R., Shalhub S., Jim J., Lee J., Dubuis C., Ricco J.B., Coselli J., Lemaire S., Fatima J., Sanford J., Yoshida W., Schermerhorn M.L., Menard M., Belkin M., Blackwood S., Conrad M., Wang L., Crofts S., Nixon T., Wu T., Chiesa R., Bose S., Turner J., Moore R., Smith J., Ciocca R., Hsu J., Czerny M., Cullen J., Kahlberg A., Setacci C., Joh J.H., Senneville E., Garrido P., Sarac T.P., Rizzo A., Go M.R., Bjorck M., Gavali H., Wanhainen A., Lawrence P.F., Chung J.

Journal of Vascular Surgery (Journal of Vascular Surgery) 73 ( 1 ) 210 - 221.e1 2021.01

ISSN 07415214

Objective: The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. Methods: A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. Results: During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P =.82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P =.01), had less operative hemorrhage (1200 mL vs 2000 mL; P =.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P =.02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P =.03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P =.01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P =.03) independently decreased mortality. Conclusions: These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10 months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population.

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Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature

Abe K., Shinoda M., Uno S., Obara H., Kitago M., Abe Y., Hishida T., Yagi H., Hasegawa Y., Kitagawa Y.

Surgery Today (Surgery Today) 51 ( 8 ) 1361 - 1370 2021

ISSN 09411291

Purpose: Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. Methods: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. Results: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. Conclusions: Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.

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Diagnostic utility of presepsin in infections after liver transplantation: A preliminary study

Yokose T., Takeuchi M., Obara H., Shinoda M., Kawakubo H., Kitago M., Yagi H., Abe Y., Yamada Y., Matsubara K., Oshima G., Hori S., Fujimura T., Takemura R., Ishii R., Kuroda T., Kitagawa Y.

Annals of Transplantation 26 e933774 2021

ISSN 14259524

Background: Infectious complications after solid organ transplantation can be fatal, and early diagnosis and intervention are important. To the best of our knowledge, no study has examined the diagnostic utility of presepsin, a known accurate biomarker, for infectious complications after liver transplantation. This study aimed to evaluate the utility of presepsin for detecting infection and perioperative kinetics of presepsin after liver transplantation. Material/Methods: This single-institutional prospective, observational study included 13 patients who underwent living-donor or de-ceased-donor liver transplantation. Perioperative serum presepsin level was measured 6 times within a week to evaluate its association with infectious complications and compare it with procalcitonin and C-reactive protein levels and leukocyte count. Postoperatively, patients were followed up for 15 days for infectious complications. Results: Five of the 13 patients developed infectious complications after liver transplantation. The median time for infection diagnosis was 9 postoperative days (25th-75th percentile, 7-10). Presepsin levels on 5 and 7 postoperative days were significantly higher in patients with infection than in those without (P=0.019 and P=0.011, re-spectively). In receiver operating characteristic analysis, area under the curve values of presepsin on 5 and 7 postoperative days (0.881 and 0.905, respectively) were higher than those of other biomarkers. The optimal cut-off value of presepsin was 1361 pg/mL on postoperative day 5 and 1375 pg/mL on postoperative day 7. Conclusions: Although this study included a small number of patients, presepsin levels on postoperative days 5 and 7 may be useful indicators for infectious complications after liver transplantation.

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Maintenance treatment with infliximab for ulcerative ileitis after intestinal transplantation: A case report

Fujimura T., Yamada Y., Umeyama T., Kudo Y., Kanamori H., Mori T., Shimizu T., Kato M., Shimojima N., Hoshino K., Kuroda T., Kawaida M., Hosoe N., Hasegawa Y., Matsubara K., Shinoda M., Obara H., Kitagawa Y., Naganuma M.

World Journal of Clinical Cases 9 ( 19 ) 5270 - 5279 2021

ISSN 2307-8960

BACKGROUND Evidence has been published on the successful applications of the anti-tumor necrosis factor alpha antibody infliximab, such as induction therapy, salvage treatment for acute cellular rejection, and treatment for chronic ulcerative inflammation, in intestinal transplant recipients. However, the optimal protocol for the effective use of infliximab remains largely undetermined due to scarcity of available clinical data. We report a continuative application of infliximab as maintenance therapy for recurrent chronic ulcerative ileitis in a recipient of isolated intestinal transplantation (ITx). CASE SUMMARY The patient was a 11-year-old boy with intestinal motility disorder classified as a hypogenic type of intestinal dysganglionosis. The patient underwent living-donor related intestinal transplant. His immunosuppression regimen consisted of daclizumab, tacrolimus, and steroids. Although he did not show rejection while on tacrolimus monotherapy, routine screening endoscopy showed several ulcerative lesions in the distal end of the graft 2 years after the intestinal transplant. Endoscopic work up to evaluate the progression of anemia revealed stenosis with ulcerative inflammatory changes and multiple longitudinal ulcers in the graft. Since the endoscopic findings suggested ulcerative lesions in Crohn's disease, infliximab treatment was considered. Treatment with infliximab and a small dose of oral prednisolone afforded successful withdrawal of total parenteral nutrition and maintenance of a well-functioning graft without infectious complications for 5 years since the administration of the first dose of infliximab. CONCLUSION Infliximab is effective as maintenance therapy for recurrent chronic ulcerative ileitis in an isolated ITx patient.

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The hypotaurine-taurine pathway as an antioxidative mechanism in patients with acute liver failure

Mizota T., Hishiki T., Shinoda M., Naito Y., Hirukawa K., Masugi Y., Itano O., Obara H., Kitago M., Yagi H., Abe Y., Matsubara K., Suematsu M., Kitagawa Y.

Journal of Clinical Biochemistry and Nutrition 70 ( 1 ) 54 - 63 2021

ISSN 09120009

The liver has been thought to protect against oxidative stress through mechanisms involving reduced glutathione (GSH) that consumes high-energy phosphor-nucleotides on its synthesis. However, hepatoprotective mechanisms in acute liver failure (ALF) where the phosphor-nucleotides are decreased in remain to be solved. Liver tissues were collected from patients with ALF and liver cirrhosis (LC) and living donors (HD) who had undergone liver transplantation. Tissues were used for metabolomic analyses to determine metabolites belonging to the central carbon metabolism, and to determine sulfur-containing metabolites. ALF and LC exhibited a significant decline in metabolites of glycolysis and pentose phosphate pathways and high-energy phosphor-nucleotides such as adenosine triphosphate as compared with HD. Conversely, methionine, S-adenosyl-L-methionine, and the ratio of serine to 3-phosphoglycerate were elevated significantly in ALF as compared with LC and HD, suggesting a metabolic boost from glycolysis towards trans-sulfuration. Notably in ALF, the increases in hypotaurine (HTU) + taurine (TU) coincided with decreases in the total amounts of reduced and oxidized glutathione (GSH + 2GSSG). Plasma NH<inf>3</inf> levels correlated with the ratio of HTU + TU to GSH + 2GSSG. Increased tissue levels of HTU + TU vs total glutathione appear to serve as a biomarker correlating with hyperammonemia, suggesting putative roles of the HTU-TU pathway in anti-oxidative protective mechanisms.

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Clinical features of irreversible rejection after allogeneic uterus transplantation in cynomolgus macaques

Kisu I., Emoto K., Masugi Y., Yamada Y., Matsubara K., Obara H., Matoba Y., Banno K., Kato Y., Saiki Y., Itagaki I., Kawamoto I., Iwatani C., Murase M., Nakagawa T., Tsuchiya H., Ishigaki H., Urano H., Ema M., Ogasawara K., Aoki D., Nakagawa K., Shiina T.

Scientific Reports (Scientific Reports) 10 ( 1 ) 2020.12

Uterus transplantation (UTx) is a potential option for women with uterine factor infertility to have a child. The clinical features indicating irreversible rejection of the uterus are unknown. In our experimental series of allogeneic UTx in cynomolgus macaques, six female macaques were retrospectively examined, which were unresponsive to treatment with immunosuppressants (i.e. irreversible rejection). Clinical features including general condition, hematology, uterine size, indocyanine green (ICG) fluorescence imaging by laparotomy, and histopathological findings of the removed uterus were evaluated. In all cases, general condition was good at the time of diagnosis of irreversible rejection and thereafter. Laboratory evaluation showed temporary increases in white blood cells, lactate dehydrogenase and C-reactive protein, then these levels tended to decrease gradually. In transabdominal ultrasonography, the uterus showed time-dependent shrinkage after transient swelling at the time of diagnosis of irreversible rejection. In laparotomy, a whitish transplanted uterus was observed and enhancement of the transplanted uterus was absent in ICG fluorescence imaging. Histopathological findings in each removed uterus showed hyalinized fibrosis, endometrial deficit, lymphocytic infiltration and vasculitis. These findings suggest that uterine transplantation rejection is not fatal, in contrast to rejection of life-supporting organs. Since the transplanted uterus with irreversible rejection atrophies naturally, hysterectomy may be unnecessary.

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Living donor liver transplantation for idiopathic portal hypertension with extrahepatic portal vein stenosis and splenic artery aneurysms: a case report and review of the literature

Kawachi S., Chiba N., Nakagawa M., Kobayashi T., Hikita K., Sano T., Tomita K., Hirano H., Abe Y., Obara H., Shimazu M.

BMC Surgery (BMC Surgery) 20 ( 1 ) 2020.12

Background: Idiopathic portal hypertension (IPH) generally has a good prognosis and rarely results in liver transplantation. Furthermore, there are few reports of living donor liver transplantation (LDLT) for IPH with extrahepatic portal vein stenosis. Case presentation: We report the case of a 51-year-old female patient diagnosed with IPH more than 20 years ago. She suffered severe jaundice, massive ascites, and encephalopathy at the time of her visit to our hospital. The patient’s extrahepatic portal vein showed a scar-like stenosis, and the portal flow was completely hepatofugal. Collateral circulation such as the splenorenal shunt was well developed, and multiple splenic artery aneurysms up to 2 cm were observed in the splenic hilum. Her Model for End-Stage Liver Disease score increased to over 40 because of renal dysfunction, requiring temporary dialysis. We performed LDLT using her husband’s right lobe graft and splenectomy. The extrahepatic stenotic portal vein was completely resected, and the superficial femoral vein (SFV) graft collected from the recipient’s right leg was used for portal reconstruction as an interposition graft. Although the clinical course after LDLT had many complications, the patient was discharged on postoperative day 113 and has been fine for 2 years after LDLT. Histopathologically, the explanted liver had obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal cirrhosis. Conclusion: This case showed that severe IPH is occasionally associated with extrahepatic portal vein stenosis and can be treated with LDLT with portal vein reconstruction using an interposition graft. It was also suggested that the SFV is a useful choice for the interposition graft.

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Control of a Nosocomial Outbreak of COVID-19 in a University Hospital

Harada S., Uno S., Ando T., Iida M., Takano Y., Ishibashi Y., Uwamino Y., Nishimura T., Takeda A., Uchida S., Hirata A., Sata M., Matsumoto M., Takeuchi A., Obara H., Yokoyama H., Fukunaga K., Amagai M., Kitagawa Y., Takebayashi T., Hasegawa N.

Open Forum Infectious Diseases (Open Forum Infectious Diseases) 7 ( 12 ) 1 - 9 2020.12

Background: Nosocomial spread of coronavirus disease 2019 (COVID-19) causes clusters of infection among high-risk individuals. Controlling this spread is critical to reducing COVID-19 morbidity and mortality. We describe an outbreak of COVID-19 in Keio University Hospital, Japan, and its control and propose effective control measures. Methods: When an outbreak was suspected, immediate isolation and thorough polymerase chain reaction (PCR) testing of patients and health care workers (HCWs) using an in-house system, together with extensive contact tracing and social distancing measures, were conducted. Nosocomial infections (NIs) were defined as having an onset or positive test after the fifth day of admission for patients and having high-risk contacts in our hospital for HCWs. We performed descriptive analyses for this outbreak. Results: Between March 24 and April 24, 2020, 27 of 562 tested patients were confirmed positive, of whom 5 (18.5%) were suspected as NIs. For HCWs, 52 of 697 tested positive, and 40 (76.9%) were considered NIs. Among transmissions, 95.5% were suspected of having occurred during the asymptomatic period. Large-scale isolation and testing at the first sign of outbreak terminated NIs. The number of secondary cases directly generated by a single primary case found before March 31 was 1.74, compared with 0 after April 1. Only 4 of 28 primary cases generated definite secondary infection; these were all asymptomatic. Conclusions: Viral shedding from asymptomatic cases played a major role in NIs. PCR screening of asymptomatic individuals helped clarify the pattern of spread. Immediate large-scale isolation, contact tracing, and social distancing measures were essential to containing outbreaks.

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Late-onset acute liver failure due to Wilson’s disease managed by plasmapheresis and hemodiafiltration successfully serving as a bridge for deceased donor liver transplantation: a case report and literature review

Sukezaki A., Chu P.s., Shinoda M., Hibi T., Taniki N., Yoshida A., Kawaida M., Hori S., Morikawa R., Kurokouchi A., Wakino S., Kameyama K., Obara H., Kitagawa Y., Saito H., Kanai T., Nakamoto N.

Clinical Journal of Gastroenterology (Clinical Journal of Gastroenterology) 13 ( 6 ) 1239 - 1246 2020.12

ISSN 18657257

Late-onset acute liver failure due to Wilson’s disease (WD-ALF) is rare. A 44-year-old female patient presenting acute hepatic decompensation with extreme coagulopathy was transferred to our hospital for evaluation for liver transplantation (LT). Alveolar hemorrhage and Coombs-negative acute hemolysis occurred during workup. Mechanical ventilation, plasmapheresis, and hemodiafiltration with zinc and chelation were started immediately before placing the patient on the waitlist for deceased donor LT (DDLT), with a tentative diagnosis of WD-ALF using the Leipzig score and quick diagnostic criteria suggested by the Acute Liver Failure Study Group Registry. The peak MELD score was 40, and the revised version of King’s score for WD was 13. Serum free copper levels and the patient’s overall general condition were stabilized with artificial support systems, although triphasic wave on electroencephalogram and liver atrophy were noted. She successfully underwent emergent DDLT approximately 2 weeks after suffering from acute hemolysis and survived. The genetic tests confirmed mutations at 2 loci in the ATP7B gene and, therefore, the diagnosis of WD. This is the first and oldest patient reported in Japan to present late-onset WD-ALF that was successfully treated with emergent DDLT.

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Effectiveness of active nasal surveillance culture for Methicillin-resistant Staphylococcus aureus in patients undergoing colorectal surgery

Kondo T., Okabayashi K., Sugiura K., Obara H., Takeuchi H., Wada N., Takano Y., Iwata S., Hasegawa N., Kitagawa Y.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 26 ( 12 ) 1244 - 1248 2020.12

ISSN 1341321X

Objective: The aim of this study was to clarify the role of Methicillin-resistant Staphylococcus aureus (MRSA) carriers in the development of surgical site infection (SSI) after colorectal surgery. Summary background data: MRSA is commonly implicated in hospital-acquired infections. Active surveillance culture (ASC) using the nasal swab test is useful to detect MRSA in surgical patients. We hypothesized that MRSA carriers would be more susceptible to SSI after colorectal surgery Methods: Patients who underwent ASC between 2010 and 2013 were included in this study. The incidence of SSI was compared between MRSA carriers and non-carriers using the chi-square test. The odds ratio for SSI was computed using logistic regression analyses. Results: Among 355 patients, 12 (3.4%) were identified as MRSA carriers and 343 as non-carriers. Of all the patients, 65 patients (18.3%) developed an SSI. Of these, 6 cases were in MRSA carriers and 59 cases were in non-carriers (p < 0.01). This meant that half of the 12 MRSA carriers developed an SSI, compared with only 17.2% of non-carriers (59 cases out of 343 patients). Therefore, MRSA carriers had a significantly higher risk of SSI (adjusted odds ratio = 4.77 [1.37 to 16.6], p = 0.01). Conclusions: Detection of MRSA via ASC is significantly associated with the development of SSI after colorectal surgery. These findings indicate that ASC for MRSA is useful to predict an SSI.

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Experimental techniques for the development of a uterus transplantation model in cynomolgus macaques

Kisu I., Banno K., Obara H., Kato Y., Yamada Y., Matsubara K., Matoba Y., Adachi M., Emoto K., Masugi Y., Saiki Y., Ishigaki H., Itagaki I., Kawamoto I., Iwatani C., Nakagawa T., Murase M., Tsuchiya H., Nakagawa K., Shiina T., Aoki D.

Journal of Obstetrics and Gynaecology Research (Journal of Obstetrics and Gynaecology Research) 46 ( 11 ) 2251 - 2260 2020.11

ISSN 13418076

Uterus transplantation (UTx) is now a treatment for women with uterine factor infertility to have a child. However, UTx is still largely at the experimental stage, and many medical issues remain unsolved. Therefore, adequate studies in large animals including non-human primates are required for validation of these issues. UTx research, especially in non-human primates, can provide important information for its full establishment in humans due to the anatomical and physiological similarities between the two. We accumulated data from UTx studies using cynomolgus macaques since 2009 and established autologous and allogeneic UTx models which led to deliveries after performing the procedure. In this paper, we summarized key points to develop UTx models in cynomolgus macaques based on our experience. UTx models in non-human primates can surely contribute new and beneficial knowledge in this field and can be useful for the further development of UTx in humans.

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Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomised controlled trial

Obara H., Takeuchi M., Kawakubo H., Shinoda M., Okabayashi K., Hayashi K., Sekimoto Y., Maeda Y., Kondo T., Sato Y., Kitagawa Y.

The Lancet Infectious Diseases (The Lancet Infectious Diseases) 20 ( 11 ) 1281 - 1289 2020.11

ISSN 14733099

Background: Surgical site infection (SSI) is the most common problem after surgery. Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine-alcohol and povidone-iodine, in reducing SSI rate, the optimal recommendation is still not established. Olanexidine might have higher bactericidal activity than other antiseptic agents. However, no randomised study has evaluated the efficacy and safety of olanexidine over conventional antiseptics. We compared the effect of aqueous olanexidine and aqueous povidone-iodine on the incidence of SSI following clean-contaminated surgery. Methods: This was a multicentre, prospective, randomised, blinded-endpoint superiority trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary pancreatic surgeries in four Japanese hospitals. Patients aged 20 years or older who underwent elective clean-contaminated wound surgery were randomly assigned in a 1:1 replacement ratio using a computer-generated block randomisation. Patients were randomly assigned to surgical skin antisepsis with an aqueous formulation of 1·5% olanexidine or surgical skin antisepsis with an aqueous formulation of 10% povidone-iodine before surgery. We used olanexidine in a ready-to-use applicator, and povidone-iodine was administered by a brush or by compression using pliers. Both antiseptics were applied from the papilla with a cranial limit and to the upper thigh with a caudal limit. The antiseptics were allowed to dry for 3 min, and then surgery started. Participants, some investigators, and data analysts were masked to treatment allocation. Participant enrolment was done by non-masked investigators. The primary outcome was 30-day SSI assessed in the intention-to-treat population. The surgical wound site of each participant was observed daily. After discharge, participants underwent at least one outpatient visit within 30 days after surgery. This trial is registered with University hospital Medical Information Network, 000031560. Findings: Between June 10, 2018, and April 18, 2019, 883 patients were assessed for eligibility. 587 patients were eligible and 294 received olanexidine and 293 received aqueous povidone-iodine before surgery. 30-day SSI occurred in 19 (7%) patients in the olanexidine group and 39 patients (13%) patients in the povidone-iodine group (adjusted risk difference −0·069; 90% CI −0·109 to −0·029; adjusted risk ratio [RR] 0·48, 90% CI 0·30 to 0·74; p=0·002). Five patients (2%) in the olanexidine group and five (2%) in the povidone-iodine group developed adverse skin reactions (adjusted RR 0·99, 95% CI 0·29 to 3·40; p=1·00). Interpretation: Olanexidine significantly reduced the occurrence of overall SSI and superficial incisional SSI compared with aqueous povidone-iodine in clean-contaminated surgery. Our results indicate that olanexidine might have a role to prevent SSI in patients who undergo clean-contaminated surgeries. Funding: Keio University and Ohyama Health Foundation.

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The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagectomy: a prospective cohort study

Takeuchi M., Yokose T., Kawakubo H., Matsuda S., Mayanagi S., Irino T., Fukuda K., Nakamura R., Wada N., Obara H., Kitagawa Y.

Esophagus (Esophagus) 17 ( 4 ) 399 - 407 2020.10

ISSN 16129059

Background: Presepsin is suggested to be an accurate sepsis diagnostic biomarker, playing an important role in distinguishing infection from no-infection status. However, to date, there is no study determining presepsin’s role in diagnosing post-esophagectomy infectious complications. Methods: Thirty patients who underwent esophagectomy for esophageal carcinoma were included in this prospective observational study. We investigated preoperative presepsin levels’ changes and evaluated the relationship between infectious complications and presepsin levels. Moreover, we analyzed the classification and regression tree (CART) to determine presepsin’s optimal cutoff values for discriminating infectious complications. Results: For 10 patients with infectious complications, median presepsin levels were 168, 337, 303, 271, 314, 978, and 752 pg/ml, pre- and immediately post-surgery, and 1, 2, 3, 5, 7 days post-surgery, respectively. Presepsin levels were significantly higher in the infectious complication group exclusively from preoperation to POD 7 (p = 0.048). Furthermore, area under the curve’s value of presepsin on POD 5 and 7 was higher than the other three biomarkers included for discriminating infectious complications (i.e., procalcitonin, leukocyte, and C-reacted protein). We set an optimal cutoff value for presepsin calculated by CART. Specifically, on POD 5, the cutoff was 888 pg/ml with a sensitivity of 60% and a specificity of 90%, and on POD 7, the cutoff was 668 pg/ml with a sensitivity of 60% and a specificity of 85%. Conclusions: Presepsin levels on POD 5 and 7 after esophagectomy are a valuable indicator of infectious complication’s detection vs. leukocyte, C-reacted protein, and procalcitonin.

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Two-year results of a multicenter prospective observational study of the Zenith Spiral-Z limb deployed in the external iliac artery during endovascular aneurysm repair

Fujimura N., Imazuru T., Matsumura H., Shibata T., Furuyama T., Kaneko K., Uchiyama H., Morikage N., Uchida T., Teshima E., Yamaoka T., Masuhara H., Ueda H., Arakawa M., Norimatsu T., Obara H., Onitsuka S.

Circulation Journal (Circulation Journal) 84 ( 10 ) 1764 - 1770 2020.09

ISSN 13469843

Background: Limited data is available on the use of a polyester graft limb with a helical stent configuration deployed in the external iliac artery (EIA) during endovascular aneurysm repair (EVAR), so we prospectively analyzed the efficacy of the Zenith Spiral-Z limb deployed in the EIA. Methods and Results: Patients undergoing EVAR using a Zenith stent-graft and Spiral-Z limb deployed in the EIA were prospectively registered in 24 Japanese institutions from June 2017 to November 2017. In total, 65 patients (74 limbs) (mean age: 77.1±8.0 years, 87.7% men, mean abdominal aortic aneurysm (AAA) diameter: 51.9±7.2mm, mean iliac artery aneurysm (IAA) diameter: 38.3±10.0mm) were registered and followed up. The most common reason for deployment in the EIA was a common IAA (43 limbs, 58.1%), and 8 limbs (10.8%) had a bare nitinol stent placed at the Spiral-Z limb. A total of 61 patients (70 limbs) completed a 24-month follow-up. There were 2 Spiral-Z limb stenoses and 1 occlusion, leading to a primary patency of 95.5% and a secondary patency of 100%, at 24 months. Buttock claudication occurred in 24.3% of the limbs treated at 1 month but decreased to 4.3% at 24 months. Conclusions: Our multicenter prospective study showed that Spiral-Z limb deployed in the EIA was associated with satisfactory results and seems to be a durable option, even in the era of iliac branch devices.

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Importance of Distal Sealing during Endovascular Aneurysm Repair Using Aneurysmal Common Iliac Artery as Landing Zone

Shintani T., Mitsuoka H., Hasegawa Y., Hayashi M., Natsume K., Ookura K., Sato Y., Obara H.

Annals of Vascular Surgery (Annals of Vascular Surgery) 66 120 - 131 2020.07

ISSN 08905096

Background: Although the use of aneurysmal common iliac artery (CIA) as the landing zone during endovascular aortic aneurysm repair EVAR remains an essential procedure, this procedure may increase the risk of late complications such as ongoing CIA dilatation and type Ib endoleak (CIA-related complications). We hypothesized that incomplete sealing of the aneurysmal CIA segment during EVAR could increase the incidence of CIA-related complications. In this study, we evaluated the midterm results of EVAR with aneurysmal CIA used as the landing zone and assessed the importance of distal sealing in this procedure. Methods: We retrospectively reviewed all cases of endovascular aneurysm repair using CIA as landing zone between 2007 and 2015 that had at least 3 years’ follow-up. We defined aneurysmal CIA as maximum diameter ≥18 mm. The main outcome was the incidence of CIA-related complications. We compared midterm results between normal CIA and aneurysmal CIA. Next, we analyzed risk factors for CIA-related complications in aneurysmal CIA. Results: Four complications occurred in normal CIA (mean follow-up, 66.5 ± 22.1 months); 21 occurred in aneurysmal CIA (mean follow-up, 62.2 ± 20.5 months). The 5-year portion of freedom from CIA-related complications was 97.3% in normal CIA and 69.4% in aneurysmal CIA (P < 0.001). Multivariable analysis in aneurysmal CIA showed that unsealed CIA segment length was only risk factor for CIA-related complications. Given the receiver operating characteristic curve results, we defined the unsealed CIA segment ≥10 mm as incomplete sealing. The hazard ratio for incomplete sealing associated with CIA-related complications was 3.92 (95% confidence interval 1.62–9.46, P = 0.02). Conclusions: Use of aneurysmal CIA as landing zone increases the risk of CIA-related complications. However, maximum sealing of the aneurysmal CIA segment could prevent these complications.

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Midterm Results of a Japanese Prospective Multicenter Registry of Heparin-Bonded Expanded Polytetrafluoroethylene Grafts for Above-the-Knee Femoropopliteal Bypass

Shibutani S., Obara H., Matsubara K., Toya N., Isogai N., Ogino H., Watada S., Asami A., Kudo T., Kanaoka Y., Fujimura N., Harada H., Uchiyama H., Sato Y., Ohki T.

Circulation journal : official journal of the Japanese Circulation Society (Circulation journal : official journal of the Japanese Circulation Society) 84 ( 3 ) 501 - 508 2020.02

BACKGROUND: This study prospectively analyzed the midterm results of above-the-knee femoropopliteal bypass (AKb) using bioactive heparin-bonded expanded polytetrafluoroethylene (HB-ePTFE) graft in patients with femoropopliteal occlusive disease.Methods and Results:This prospective, multicenter, non-randomized study reviewed limbs undergoing AKb with HB-ePTFE graft for femoropopliteal lesion in 20 Japanese institutions between July 2014 and October 2017. Primary efficacy endpoints were primary, primary assisted, and secondary graft patency. Safety endpoints included any major adverse limb event and perioperative mortality. During the study period, 120 limbs of 113 patients (mean age, 72.7 years) underwent AKb with HB-ePTFE grafts. A total of 45 patients (37.5%) had critical limb ischemia and 17 (15.0%) were on hemodialysis (HD). Median duration of follow-up was 16 months (range, 1-36 months). Estimated 1- and 2-year primary, primary assisted, and secondary graft patency rates were 89.4% and 82.7%, 89.4% and 87.2%, and 94.7% and 92.5%, respectively. On univariate analysis of 2-year primary graft patency, having 3 run-off vessels, cuffed distal anastomoses, no coronary artery disease, and no chronic kidney disease requiring HD were significantly associated with favorable patency. CONCLUSIONS: AKb using HB-ePTFE grafts achieved favorable 2-year graft patency. AKb using HB-ePTFE grafts may therefore be an acceptable, highly effective treatment option for femoropopliteal artery lesions.

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Preliminary Experience of Viabahn Stent Graft Inside the Occluded Prosthetic Bypass Graft for the Treatment of Above Knee Femoropopliteal Bypass Occlusion

Fujimura N., Obara H., Iwasa K., Hattori T., Yamamoto H., Watada S., Kobayashi T., Suematsu N., Mitsuoka H., Soga Y., Nakama T., Sakamoto R., Ichihashi S.

CardioVascular and Interventional Radiology (CardioVascular and Interventional Radiology) 43 ( 2 ) 223 - 230 2020.02

ISSN 01741551

Purpose: To describe a multi-center preliminary experience of treating prosthetic above knee femoropopliteal (AKFP) bypass occlusion by placing a Viabahn stent graft inside the occluded prosthetic bypass graft. Materials and Methods: Retrospective analysis of consecutive 14 patients (mean age 73.2 ± 10.2, 78.6% male) receiving Viabahn stent graft inside the occluded prosthetic bypass graft for the treatment of prosthetic AKFP bypass occlusion in the collaborating hospitals from November 2016 to June 2019 was performed. Results: Technical success was achieved in all patients. Mean lesion length was 34.0 ± 3.5 cm, concomitant thrombectomy or thrombus aspiration was performed in 11 patients (78.6%), and average of 1.57 ± 0.65 Viabahn stent grafts were used. Mean ankle–brachial index improved from 0.24 ± 0.23 to 0.98 ± 0.14 after the treatment. All patients had preoperative ischemic symptoms with 9 patients (64.3%) having Rutherford class > 4 symptoms; however, all preoperative symptoms resolved after the treatment. During the mean follow-up of 450.9 ± 234.7 days, there were two target lesion revascularizations, leading to a primary patency rate of 92.9% and a secondary patency of 100.0% at 1 year. Conclusion: Placing a Viabahn stent graft inside the occluded prosthetic bypass graft for the treatment of prosthetic AKFP bypass occlusion appears to be effective from our preliminary experience. Even though sample size is limited in our study, it may be considered as a potential treatment option before surgical reintervention.

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Current management strategies for visceral artery aneurysms: an overview

Obara H., Kentaro M., Inoue M., Kitagawa Y.

Surgery Today (Surgery Today) 50 ( 1 ) 38 - 49 2020.01

ISSN 09411291

Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.

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Peak systolic velocity ratio derived from quantitative vessel analysis for restenosis after femoropopliteal intervention: a multidisciplinary review from Endovascular Asia

Kawarada O., Hozawa K., Zen K., Huang H.L., Kim S.H., Choi D., Park K., Kato K., Kato T., Tsubakimoto Y., Ichihashi S., Fujimura N., Higashimori A., Sato T., Yan B.P.Y., Pang S.Y.C., Wongwanit C., Leong Y.P., Chua B., George R.K., Chen I.C., Lee J.K., Hsu C.H., Pua U., Iwata Y., Miki K., Okada K., Obara H.

Cardiovascular Intervention and Therapeutics (Cardiovascular Intervention and Therapeutics) 35 ( 1 ) 52 - 61 2020.01

ISSN 18684300

With technological improvements in the endovascular armamentarium, there have been tremendous advances in catheter-based femoropopliteal artery intervention during the last decade. However, standardization of the methodology for assessing outcomes has been underappreciated, and unvalidated peak systolic velocity ratios (PSVRs) of 2.0, 2.4, and 2.5 on duplex ultrasonography have been arbitrarily but routinely used for assessing restenosis. Quantitative vessel analysis (QVA) is a widely accepted method to identify restenosis in a broad spectrum of cardiovascular interventions, and PSVR needs to be validated by QVA. This multidisciplinary review is intended to disseminate the importance of QVA and a validated PSVR based on QVA for binary restenosis in contemporary femoropopliteal intervention.

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Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan

Fujimura N., Hosokawa K., Obara H., Igari K., Akamatsu D., Matsumoto H., Asami A., Shibutani S., Akiyoshi T., Nunokawa M., Harada H., Inoue K., Koya A., Furuyama T., Sagara D., Shintani T., Yamaoka T., Akiyama Y., Inoue Y., Hoshina K.

Cardiovascular Intervention and Therapeutics (Cardiovascular Intervention and Therapeutics) 36 ( 4 ) 506 - 513 2020

ISSN 18684300

Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.

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Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation

Takemura Y., Hibi T., Shinoda M., Obara H., Minagawa T., Kitago M., Yagi H., Abe Y., Matsubara K., Oshima G., Hori S., Hoshino K., Yamada Y., Itano O., Takano Y., Kuroda T., Hasegawa N., Kitagawa Y.

Clinical Transplantation (Clinical Transplantation) 33 ( 12 ) 2019.12

ISSN 09020063

Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT. 2

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Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database

Shintani T., Obara H., Matsubara K., Hayashi K., Hayashi M., Ono S., Shimogawara T., Shibutani S., Watada S., Sekimoto Y., Uchida N., Asami A., Fujii T., Harada H., Fujimura N., Sato Y., Kitagawa Y.

European Journal of Vascular and Endovascular Surgery (European Journal of Vascular and Endovascular Surgery) 58 ( 6 ) 839 - 847 2019.12

ISSN 10785884

Objective/Background: It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was conducted to assess the impact of the stent graft design on EIA limb occlusion rates. Methods: Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine–Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR). Results: One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039). Conclusion: Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion.

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Achievement of Durable and Complete Remission of Graft-versus-host Disease After Liver Transplantation With Ruxolitinib: A Case Report

Endo Y., Oshima G., Hibi T., Shinoda M., Sakurai M., Koda Y., Izawa Y., Obara H., Kitago M., Yagi H., Abe Y., Matsubara K., Yamada Y., Fukushima A., Yokose T., Mori T., Kuroda T., Kitagawa Y.

Transplantation (Transplantation) 103 ( 11 ) e375 - e377 2019.11

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Type IIIb Endoleak Is Not Extremely Rare and May Be Underdiagnosed after Endovascular Aneurysm Repair

Fujimura N., Ichihashi S., Matsubara K., Shibutani S., Harada H., Obara H., Kichikawa K., Kitagawa Y.

Journal of Vascular and Interventional Radiology (Journal of Vascular and Interventional Radiology) 30 ( 9 ) 1393 - 1399.e1 2019.09

ISSN 10510443

Purpose: To investigate the real incidence of type IIIb endoleaks associated with the Zenith stent graft, currently the most widely used third-generation polyester stent graft, in a Japanese multicenter database. Materials and Methods: Retrospective analysis was conducted of 433 patients who underwent endovascular aneurysm repair (EVAR) of aortoiliac aneurysms with the use of Zenith stent grafts from 2007 to 2016. The mean age of patients was 75.6 y ± 7.8, and 85.2% of patients were men. Mean transverse diameters of abdominal aortic aneurysms and common iliac artery aneurysms were 50.8 mm ± 9.9 and 42.2 mm ± 10.3, respectively. Results: During a mean follow-up period of 41.9 mo, 7 type IIIb endoleaks (1.6%) were identified. Four patients were definitively diagnosed during repeat intervention, and 3 were diagnosed based on postoperative CT images. Three patients were treated surgically, 2 were treated by relining with an additional stent graft, and 2 were conservatively followed with CT imaging. Only 1 of 5 patients who underwent repeat intervention had a preoperative diagnosis of type IIIb endoleak, reflecting the difficulty in its diagnosis. Conclusions: The incidence of type IIIb endoleak in Zenith stent grafts was 1.6% in this study, suggesting that type IIIb endoleaks are not extremely rare. In addition, type IIIb endoleak may be underdiagnosed or misdiagnosed as a different type of endoleak. Type IIIb endoleaks should always be considered in patients with sac expansion after EVAR.

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Comparison of olanexidine versus povidone-iodine for preventing surgical site infection in gastrointestinal surgery: Study protocol for a multicentre, single-blind, randomised controlled clinical trial

Takeuchi M., Obara H., Kawakubo H., Shinoda M., Okabayashi K., Mayanagi S., Irino T., Fukuda K., Nakamura R., Wada N., Kitago M., Yagi H., Abe Y., Oshima G., Hori S., Tsuruta M., Ishida T., Yokose T., Hirukawa K., Isobe Y., Sekimoto Y., Harada H., Maeda Y., Shito M., Kondo T., Sato Y., Kitagawa Y.

BMJ Open (BMJ Open) 9 ( 5 ) 2019.05

Introduction: The prevalence of surgical site infection (SSI) remains higher in gastrointestinal surgery than in other surgeries. Although several guidelines have indicated the efficacy of chlorhexidine and povidone-iodine in reducing the SSI rate, the optimal recommendation has still not been established. Therefore, it is necessary to determine the more effective antiseptic for surgical site preparation. Olanexidine (1.5% olanedine, Otsuka Pharmaceutical Factory, Tokushima, Japan), which is a new antiseptic in Japan, has antimicrobial activity against a wide range of bacteria, including Gram-positive and Gram-negative bacteria. Our study will contribute to determining a new antiseptic for use in gastrointestinal and other surgeries. Methods and analysis: We propose a multicentre, randomised controlled clinical trial for comparing two treatments, that is, 1.5% olanexidine or 10% povidone-iodine, for surgical skin preparation to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. Patients aged ≥20 years at the time of consent will be included. The primary outcome measure is the 30-day postoperative SSI rate. For the primary analysis, which is aimed at comparing the treatment effects, the adjusted risk ratio and its 95% CI will be estimated using the Mantel-Haenszel method. Ethics and dissemination: The protocol was first approved by the Institutional Review Board of Keio University School of Medicine, followed by the institutional review board of each participating site. Participant recruitment began in June 2018. The final results will be published in international peer-reviewed medical journals.

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Living donor liver re-transplantation for recurrent hepatoblastoma in the liver graft following complete eradication of peritoneal metastases under indocyanine green fluorescence imaging

Takahashi N., Yamada Y., Hoshino K., Kawaida M., Mori T., Abe K., Fujimura T., Matsubara K., Hibi T., Shinoda M., Obara H., Isshiki K., Shima H., Shimada H., Kameyama K., Fuchimoto Y., Kitagawa Y., Kuroda T.

Cancers (Cancers) 11 ( 5 ) 2019.05

The curability of chemotherapy-resistant hepatoblastoma (HB) largely depends on the achievement of radical surgical resection. Navigation techniques utilizing indocyanine green (ICG) are a powerful tool for detecting small metastatic lesions. We herein report a patient who underwent a second living donor liver transplantation (LDLTx) for multiple recurrent HBs in the liver graft following metastasectomy for peritoneal dissemination with ICG navigation. The patient initially presented with ruptured HB at 6 years of age and underwent 3 liver resections followed by the first LDLTx with multiple sessions of chemotherapy at 11 years of age. His alpha-fetoprotein (AFP) level increased above the normal limit, and metastases were noted in the transplanted liver and peritoneum four years after the first LDLTx. The patient underwent metastasectomy of the peritoneally disseminated HBs with ICG navigation followed by the second LDLTx for multiple metastases in the transplanted liver. The patient has been recurrence-free with a normal AFP for 30 months since the second LDLTx. To our knowledge, this report is the first successful case of re-LDLTx for recurrent HBs. Re-LDLTx for recurrent HB can be performed in highly select patients, and ICG navigation is a powerful surgical tool for achieving tumor clearance.

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A Hybrid Technique to Manage a Large Perigraft Seroma after an Open Abdominal Aortic Aneurysm Repair: A Case Report

Ono S., Obara H., Hagiwara K., Saida F., Oshiro K., Matsubara K., Shibutani S., Kitagawa Y.

Annals of Vascular Surgery (Annals of Vascular Surgery) 56 352.e1 - 352.e4 2019.04

ISSN 08905096

Perigraft seroma (PGS) is a relatively rare complication of aortoiliac reconstructive surgery. We, herein, describe a case of a large PGS that was managed by using a hybrid technique of relining the original graft with simultaneous open drainage. An 86-year-old man with a 17.3-cm diameter PGS after prosthetic bifurcated graft replacement for abdominal aortic aneurysm was admitted to our hospital. He presented with abdominal distension and discomfort and had difficulty in taking food. The entire relining of the original covered stent graft with GORE EXCLUDER using aortic extension cuff and iliac extenders and simultaneous open evacuation of PGS were successfully performed. The symptoms of the patient totally improved, and no recurrence was detected at 2 years after the operation. This technique would be a feasible treatment option for this rare complication. ® ®

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Myelopathy due to human T-cell leukemia virus type-1 from the donor after ABO-incompatible liver transplantation

Wakabayashi T., Obara H., Seki M., Shinoda M., Kitago M., Yagi H., Abe Y., Matsubara K., Yamada Y., Oshima G., Oki K., Nagoshi N., Watanabe K., Hibi T., Itano O., Hoshino K., Suzuki N., Kuroda T., Kitagawa Y.

Annals of Hepatology (Annals of Hepatology) 18 ( 2 ) 397 - 401 2019.03

ISSN 16652681

We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000 mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.

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Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

Yokose T., Obara H., Shinoda M., Nakano Y., Kitago M., Yagi H., Abe Y., Yamada Y., Matsubara K., Oshima G., Hori S., Ibuki S., Higashi H., Masuda Y., Hayashi M., Mori T., Kawaida M., Fujimura T., Hoshino K., Kameyama K., Kuroda T., Kitagawa Y.

World Journal of Gastroenterology (World Journal of Gastroenterology) 25 ( 15 ) 1899 - 1906 2019

ISSN 10079327

BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

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A Pre-Clinical Large Animal Model of Sustained Liver Injury and Regeneration Stimulus

Inomata K., Tajima K., Yagi H., Higashi H., Shimoda H., Matsubara K., Hibi T., Abe Y., Tsujikawa H., Kitago M., Shinoda M., Obara H., Itano O., Soto-Gutierrez A., Kitagawa Y.

Scientific Reports (Scientific Reports) 8 ( 1 ) 2018.12

A feasible large animal model to evaluate regenerative medicine techniques is vital for developing clinical applications. One such appropriate model could be to use retrorsine (RS) together with partial hepatectomy (PH). Here, we have developed the first porcine model using RS and PH. RS or saline control was administered intraperitoneally to Göttingen miniature pigs twice, two weeks apart. Four weeks after the second dose, animals underwent PH. Initially, we tested different doses of RS and resection of different amounts of liver, and selected 50 mg/kg RS with 60% hepatectomy as our model for further testing. Treated animals were sacrificed 3, 10, 17 or 28 days after PH. Blood samples and resected liver were collected. Serum and liver RS content was determined by Liquid Chromatograph-tandem Mass Spectrometer. Blood analyses demonstrated liver dysfunction after PH. Liver regeneration was significantly inhibited 10 and 17 days after PH in RS-treated animals, to the extent of 20%. Histological examination indicated hepatic injury and regenerative responses after PH. Immunohistochemical staining demonstrated accumulation of Cyclin D1 and suppression of Ki-67 and PCNA in RS-treated animals. We report the development of the first large animal model of sustained liver injury with suppression of hepatic regeneration.

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Decreased Incidence of Acute Cellular Rejection in Low-Muscle-Mass Recipients After Living-donor Liver Transplantation

Wakabayashi T., Shinoda M., Obara H., Kitago M., Yagi H., Abe Y., Matsubara K., Yamada Y., Oshima G., Hirukawa K., Mizota T., Hibi T., Itano O., Hoshino K., Kuroda T., Kitagawa Y.

Transplantation Proceedings (Transplantation Proceedings) 50 ( 10 ) 3626 - 3634 2018.12

ISSN 00411345

Background: Sarcopenia has recently been studied as a potential risk factor for mortality and complications after liver transplantation. We investigated the impact of low muscle mass on postoperative outcomes after living-donor liver transplantation. Methods: Our study population consisted of 100 adult recipients who underwent living-donor liver transplantation in our department between 2005 and 2017. Recipients were divided into a low-muscle-mass group (L group) and a normal-muscle-mass group (N group) based on skeletal muscle index (SMI) values, and postoperative outcomes were compared between the groups. Regarding factors that were significantly different between the groups, multivariate analyses were performed to identify predictive factors. Results: Based on the SMI definition, 47 and 53 of the recipients were categorized as having low muscle mass (L group) and normal muscle mass (N group), respectively. Comparison between the groups revealed a significantly reduced incidence of rejection (10.6% in L group vs 30.2% in N group, P =.017) and increased incidences of bacterial infection (61.7% in L group vs 37.7% in N group, P =.017) in the L group compared with the N group. The survival rate did not differ significantly between the groups. Multivariate analyses indicated that muscle mass was a significant predictive factor for both rejection and bacterial infection. Conclusion: It is important to recognize that muscle mass has an impact not only on bacterial infection but also on rejection in recipients with low muscle mass in the postoperative course of living-donor liver transplantation.

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Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care

Kawarada O., Zen K., Hozawa K., Ayabe S., Huang H.L., Choi D., Kim S.H., Kim J., Kato T., Tsubakimoto Y., Nakama T., Ichihashi S., Fujimura N., Higashimori A., Fujihara M., Sato T., Yan B.P.Y., Pang S.Y.C., Wongwanit C., Leong Y.P., Chua B., George R.K., Yokoi Y., Motomura H., Obara H.

Cardiovascular Intervention and Therapeutics (Cardiovascular Intervention and Therapeutics) 33 ( 4 ) 297 - 312 2018.10

ISSN 18684300

The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.

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Retroperitoneal hematoma volume is a good predictor of perioperative mortality after endovascular aneurysm repair for ruptured abdominal aortic aneurysm

Fujimura N., Takahara M., Isogai N., Yashiro H., Shibutani S., Inoue M., Obara H., Ogino H.

Journal of Vascular Surgery (Journal of Vascular Surgery) 68 ( 4 ) 998 - 1006.e2 2018.10

ISSN 07415214

Objective: The objective of this study was to validate the usefulness of retroperitoneal hematoma volume as a predictor of perioperative mortality after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). Methods: We retrospectively reviewed consecutive patients with rAAA who underwent the unified EVAR first protocol between 2012 and 2016 at any one of three participating institutions in Japan and were prospectively registered in a dedicated database. Only patients with preoperative computed tomography scans adequate for three-dimensional volumetric analysis were included. Volumetry was used to measure the retroperitoneal hematoma volume. To adjust for body size differences between patients, the retroperitoneal hematoma volume was divided by the abdominal cavity volume, and the predictive power of this ratio was validated using appropriate statistical methods. Results: Of 114 patients with rAAA managed during the study period, 101 (88.6%) underwent EVAR, 9 (7.9%) underwent open surgical repair, and 4 (3.5%) did not undergo any repair. Finally, 82 of 101 patients treated with EVAR were included in the analysis. Within 30 days after EVAR, the mortality rates for the 82 patients included in the analysis and the 19 excluded patients were 24.4% and 31.6%, respectively, without statistically significant differences (P =.518). The retroperitoneal hematoma volume ratio was 3.59% ± 2.46% and 7.63% ± 3.45% in survivors and nonsurvivors, respectively (P <.001). Univariate analysis of other preoperative demographic and anatomic factors revealed that a Glasgow Aneurysm Score >85, systolic blood pressure <90 mm Hg, loss of consciousness, and mean minimum right external iliac artery diameter were statistically significant. Receiver operating characteristic curve analysis for the prediction of perioperative mortality revealed that retroperitoneal hematoma volume ratio was the best predictor of perioperative mortality in patients with rAAA of type >III in the Fitzgerald classification (area under the curve: retroperitoneal hematoma volume ratio, 0.880; Glasgow Aneurysm Score, 0.587; P <.001). Based on the Youden index, the optimal cutoff for the retroperitoneal hematoma volume ratio was 6.97%, providing a sensitivity of 0.833 and specificity of 0.860. Conclusions: Our study suggests that retroperitoneal hematoma volume may be a good predictor of perioperative mortality after EVAR for rAAA, especially for patients with Fitzgerald classification >III and a best cutoff value of 6.97%.

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Early sac shrinkage is a good surrogate marker of durable success after endovascular aneurysm repair in Japanese patients

Fujimura N., Matsubara K., Takahara M., Harada H., Asami A., Shibutani S., Watada S., Obara H., Kitagawa Y.

Journal of Vascular Surgery (Journal of Vascular Surgery) 67 ( 5 ) 1410 - 1418.e1 2018.05

ISSN 07415214

Objective: The applicability of early sac shrinkage as a predictor of a low risk of late complications after endovascular aneurysm repair (EVAR) in Asian populations has not been validated. This study aimed to analyze early sac shrinkage and its relationship with late complications in Asian people using a Japanese multicenter database. We also assessed the impact of endoleaks. Methods: A retrospective analysis of 697 patients who had undergone EVAR of abdominal aortic aneurysms from 2008 to 2015 and were followed up for at least 1 year was conducted. Late complications were defined as any aneurysm-related events occurring >1 year after EVAR, including >5-mm aneurysm sac enlargements and any reinterventions performed. Endoleaks without any evidence of sac enlargement or a requirement for additional treatment were not considered late complications. Results: Early sac shrinkage, defined as a >5-mm-diameter decrease within 1 year of EVAR, occurred in 335 patients (48.1%); type I endoleaks (T1ELs) and isolated type II endoleaks (iT2ELs; type II endoleaks without evidence of other endoleaks) were observed in 4.0% and 29.4%, respectively. During the mean follow-up period of 45.5 months, 93 late complications (13.3%) occurred. Kaplan-Meier curve and log-rank analyses showed that early sac shrinkage was a significant predictor for a lower risk of late complications (P <.001). Multivariate analysis revealed that early sac shrinkage was independently associated with a lower risk of late complications (adjusted hazard ratio, 0.425; P =.004). Conversely, T1ELs and iT2ELs were positively associated with late complication (adjusted hazard ratio, 11.774 and 5.137, respectively; both P <.001). Subsequent multivariate analysis demonstrated that T1ELs and iT2ELs were negatively associated with early sac shrinkage (adjusted odds ratio, 0.102 and 0.285, respectively; both P <.001). Conclusions: Early sac shrinkage was associated with a low risk of late complications in Asian people and may be a good surrogate marker of durable success after EVAR. T1ELs and iT2ELs were negatively associated with early sac shrinkage and positively associated with late complications. Along with the high incidence of iT2ELs observed, T2ELs may be an important condition to consider after EVAR in the Asian population.

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Successful management of living donor liver transplantation for biliary atresia with single ventricle physiology—from peri-transplant through total cavopulmonary connection: A case report

Yamada Y., Hoshino K., Oyanagi T., Gatayama R., Maeda J., Katori N., Fuchimoto Y., Hibi T., Shinoda M., Matsubara K., Obara H., Aeba R., Kitagawa Y., Yamagishi H., Kuroda T.

Pediatric Transplantation (Pediatric Transplantation) 22 ( 3 ) 2018.05

ISSN 13973142

Children with single ventricle physiology have complete mixing of the pulmonary and systemic circulations, requiring staged procedures to achieve a separation of these circulations, or Fontan circulation. The single ventricle physiology significantly increases the risk of mortality in children undergoing non-cardiac surgery. As liver transplantation for patients with single ventricle physiology is particularly challenging, only a few reports have been published. We herein report a case of successful LDLTx for an 8-month-old pediatric patient with biliary atresia, heterotaxy, and complex heart disease of single ventricle physiology. The cardiac anomalies included total anomalous pulmonary venous return type IIb, intermediate atrioventricular septal defect, tricuspid regurgitation grade III, coarctation of aorta, interrupted inferior vena cava, bilateral superior vena cava, and polysplenia syndrome. Following LDLTx, the patient sequentially underwent total cavopulmonary shunt + Damus-Kaye-Stansel at 3 years of age and extracardiac total cavopulmonary connection (EC-TCPC) completion at 5 years of age; 7 years have now passed since LDLTx (2 years post–EC-TCPC). We describe the details of the management of LTx in the presence of cardiac anomalies and report the long-term cardiac and liver function, from peri-LDLTx through EC-TCPC completion.

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Concurrent presentation of an intraductal tubulopapillary neoplasm and intraductal papillary mucinous neoplasm in the branch duct of the pancreas, with a superior mesenteric artery aneurysm: A case report

Inomata K., Kitago M., Obara H., Fujii-Nishimura Y., Shinoda M., Yagi H., Abe Y., Hibi T., Matsubara K., Oshima G., Sekimoto Y., Inoue M., Itano O., Sakamoto M., Kitagawa Y.

World Journal of Surgical Oncology (World Journal of Surgical Oncology) 16 ( 1 ) 2018.04

Background: Since the concept of intraductal tubulopapillary neoplasm (ITPN) was introduced in the current World Health Organization classification of tumors, the number of reports of ITPN occurrence has increased gradually. However, ITPN is usually located in the main pancreatic duct, with few reports of a branch duct ITPN. As a result, imaging protocols for the diagnosis of a branch duct ITPN have not been established. Case presentation: We report a case of a concurrent presentation of a branch duct ITPN and intraductal papillary mucinous neoplasm (IPMN) in the head of the pancreas, with a superior mesenteric artery (SMA) aneurysm. Initially, the cystic masses in the pancreatic head were diagnosed as branch duct IPMNs, with treatment consisting of a pylorus-preserving pancreaticoduodenectomy, in combination with an aneurysmectomy performed for treatment of the SMA aneurysm. Pathological examination confirmed these cysts were a combination of branch-type ITPN and IPMN. The patient recovered from the treatment without complication, with no evidence of recurrence over a period of 34 months post-surgery. Conclusion: This case report of a synchronous presentation of an ITPN and IPMN indicates the difficulty in differentiating these two types of neoplasms in the branch duct of the pancreatic head.

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Hemoadsorption of high-mobilitygroup box 1 using a porous polymethylmethacrylate fiber in a swine acute liver failure model

Amemiya R., Shinoda M., Yamada M., Ueno Y., Shimada K., Fujieda H., Yagi H., Mizota T., Nishiyama R., Oshima G., Yamada S., Matsubara K., Abe Y., Hibi T., Kitago M., Obara H., Itano O., Kitagawa Y.

International Journal of Artificial Organs (International Journal of Artificial Organs) 41 ( 4 ) 190 - 200 2018.02

ISSN 03913988

Background: High-mobility-group box chromosomal protein 1 has been identified as an important mediator of various kinds of acute and chronic inflammation. In this study, we aimed to develop a column that effectively adsorbs highmobility- group box chromosomal protein 1 by altering the pore size of the fiber. Materials and methods: First, we produced three types of porous polymethylmethacrylate fiber by altering the concentration of polymethylmethacrylate dissolved in dimethylsulfoxide. We then selected a fiber based on the results of an in vitro incubation test of high-mobility-group box chromosomal protein 1 adsorption. Using the selected fiber, we constructed a new column and tested its high-mobility-group box chromosomal protein 1 adsorption capacity during 4-h extracorporeal hemoperfusion in a swine acute liver failure model. Results: Electron microscope observation showed that the three types of fibers had different pore sizes on the surface and in cross section, which were dependent on the concentration of polymethylmethacrylate. In the in vitro incubation test, fiber with moderate-sized pores demonstrated the highest adsorption capacity. In the in vivo hemoperfusion study, the ratio of the high-mobility-group box chromosomal protein 1 concentration at the outlet versus the inlet of the column was significantly lower with the new column than with the control column during 4-h extracorporeal hemoperfusion. The normalized plasma level of high-mobility-group box chromosomal protein 1 at 12 h after the completion of hemoperfusion was significantly lower with the new column than with the control column. Conclusion: The newly developed polymethylmethacrylate column adsorbs high-mobility-group box chromosomal protein 1 during hemoperfusion in swine ALF model.

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Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection

Yamada Y., Hoshino K., Mori T., Kawaida M., Abe K., Ishihama H., Shimizu T., Takahashi N., Matsubara K., Hibi T., Abe Y., Yagi H., Shimojima N., Shinoda M., Kitago M., Obara H., Fuchimoto Y., Kameyama K., Kitagawa Y., Kuroda T.

Hepatology Research (Hepatology Research) 48 ( 3 ) E360 - E366 2018.02

ISSN 13866346

Growing evidence suggests a relationship between antibody-mediated rejection (AMR) and early graft failure due to a previously unknown etiology in liver transplantation (LTx). We herein report a 3-year-old boy who developed rapid graft failure due to de novo donor-specific antibody (DSA)-driven AMR a week after living donor LTx, requiring a second transplant on the 10th day after the first LTx. The pathology of the first graft showed massive necrosis in zone 3 along with positive C4d and inflammatory cell infiltrates in portal areas. The mean fluorescence intensity against human leukocyte antigen (HLA)-DR15, which was possessed by both the first and the second donor, peaked at 12 945 on the day before the second LTx. Antithymocyte globulin, plasma exchange along with i.v. immunoglobulin, rituximab, and the local infusion of prostaglandin E1, steroids, and Mesilate gabexate through a portal catheter were provided to save the second graft. To our knowledge, this is the first report to show a clear association between de novo DSA and acute AMR within 7 days of a LTx. Furthermore, we successfully rescued the recipient with a second graft despite possessing the same targeted HLA. The rapid decision to carry out retransplantation and specific strategies overcoming AMR were crucial to achieving success in this case of immunologically high-risk LTx.

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Rituximab induction to prevent the recurrence of PSC after liver transplantation—the lessons learned from ABO-incompatible living donor liver transplantation

Yamada Y., Hoshino K., Fuchimoto Y., Matsubara K., Hibi T., Yagi H., Abe Y., Shinoda M., Kitago M., Obara H., Yagi T., Okajima H., Kaido T., Uemoto S., Suzuki T., Kubota K., Yoshizumi T., Maehara Y., Inomata Y., Kitagawa Y., Egawa H., Kuroda T.

Transplantation Direct (Transplantation Direct) 4 ( 2 ) 2018.02

Background. Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx. Methods. We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively. Results. All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (n = 1) or recurrence of PSC (n = 2). In contrast, we found that all 5 recipients from 2006 (who were treated with rituximab) retained an excellent graft function for more than 7 years without any recurrence of PSC. Conclusions. The findings of this study shed light on the efficacy of a novel strategy to prevent the recurrence of PSC and the possible mechanisms provided by rituximab treatment are discussed.

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Tolvaptan for fluid management in living donor liver transplant recipients

Imai S., Shinoda M., Obara H., Kitago M., Hibi T., Abe Y., Yagi H., Matsubara K., Higashi H., Itano O., Kitagawa Y.

Annals of Transplantation (Annals of Transplantation) 23 25 - 33 2018

ISSN 14259524

Background: Tolvaptan, an antagonist of the vasopressin V2 receptor is a novel oral diuretic that promotes water excretion selectively. We have used furosemide as a primary diuretic and added human atrial natriuretic peptide (hANP) if necessary for fluid management postoperatively in living-donor liver transplantation (LDLT) recipients. Recently we introduced tolvaptan and used both tolvaptan and furosemide as primary diuretics. Material/Methods: Clinical outcomes were compared between LDLT recipients whose postoperative fluid management was performed before (control group, n=10) and after (tolvaptan group, n=16) introduction of tolvaptan. Results: Preoperative and intraoperative demographic data did not differ significantly between the groups except for the period of post-surgical follow-up and total ischemic time. Urine volume was 1,242±692, 2,240±1307, and 2,268±1262 mL on postoperative day 1, 3, and 7, respectively, in the tolvaptan group. These volumes did not significantly differ from those in control group (1,027±462, 1,788±909, and 2,057±1216 mL on day 1, 3, and 7 postoperatively, respectively). Body weight gain and fluid volume from abdominal drainage tubes postoperatively did not differ significantly between groups. The time from hANP initiation to discontinuation and the time to removal of central vein catheters were significantly reduced in tolvaptan-treated patients. No severe side effects directly related to tolvaptan were observed. The survival rate at month 6 was 90.0% in control patients versus 93.8% in tolvaptan-treated patients. Conclusions: The outcomes of this investigation indicate that tolvaptan in combination with furosemide provides an adequate diuretic for fluid management subsequent to LDLT without causing adverse effects.

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Outcome from a randomized controlled clinical trial ― Improvement of peripheral arterial disease by granulocyte colony-stimulating factor-mobilized autologous peripheral-blood-mononuclear cell transplantation (IMPACT) ―

Horie T., Yamazaki S., Hanada S., Kobayashi S., Tsukamoto T., Haruna T., Sakaguchi K., Sakai K., Obara H., Morishita K., Saigo K., Shintani Y., Kubo K., Hoshino J., Oda T., Kaneko E., Nishikido M., Ioji T., Kaneda H., Fukushima M., Akamatsu M., Ichikawa Y., Ishida A., Iwashita C., Kawamura A., Mizuiri K., Otake T., Sakata A.

Circulation Journal (Circulation Journal) 82 ( 8 ) 2165 - 2174 2018

ISSN 13469843

Background: The clinical usefulness of peripheral blood (PB) mononuclear cell (MNC) transplantation in patients with peripheral arterial disease (PAD), especially in those with mild-to-moderate severity, has not been fully clarified. Methods and Results: A randomized clinical trial was conducted to evaluate the efficacy and safety of granulocyte colony-stimulating factor (G-CSF)-mobilized PBMNC transplantation in patients with PAD (Fontaine stage II–IV and Rutherford category 1–5) caused by arteriosclerosis obliterans or Buerger’s disease. The primary endpoint was progression-free survival (PFS). In total, 107 subjects were enrolled. At baseline, Fontaine stage was II/III in 82 patients and IV in 21, and 54 patients were on hemodialysis. A total of 50 patients had intramuscular transplantation of PBMNC combined with standard of care (SOC) (cell therapy group), and 53 received SOC only (control group). PFS tended to be improved in the cell therapy group than in the control group (P=0.07). PFS in Fontaine stage II/III subgroup was significantly better in the cell therapy group than in the control group. Cell therapy-related adverse events were transient and not serious. Conclusions: In this first randomized, large-scale clinical trial of G-CSF-mobilized PBMNC transplantation, the cell therapy was tolerated by a variety of PAD patients. The PBMNC therapy was significantly effective for inhibiting disease progression in mild-to-moderate PAD.

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Effects of Addition of Early Enteral Nutritional Support During the Postoperative Phase in Patients after Living-Donor Liver Transplantation

Ei, Shigenori, Shinoda, Masahiro, Itano, Osamu, Obara, Hideaki, Kitago, Minoru, Hibi, Taizo, Yagi, Hiroshi, Abe, Yuta, Matsubara, Kentaro, Ono, Yoshihiro, Kawachi, Shigeyuki, Hoshino, Ken, Kuroda, Tatsuo, Tanabe, Minoru, Kitagawa, Yuko

ANNALS OF TRANSPLANTATION 20 357 - 365 2015.06

Research paper (scientific journal), ISSN 1425-9524

Idiopathic splenic arteriovenous fistula without splenic artery aneurysm

Shigeshi Ono; Hideaki Obara; Masayuki Shimoda; Yuko Kitagawa

BMJ Case Reports 2015 571 - 580 2015.04

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Gene transfer of high-mobility group box 1 box-A domain in a rat acute liver failure model

Masayuki Tanaka; Masahiro Shinoda; Atsushi Takayanagi; Go Oshima; Ryo Nishiyama; Kazumasa Fukuda; Hiroshi Yagi; Tetsu Hayashida; Yohei Masugi; Koichi Suda; Shingo Yamada; Taku Miyasho; Taizo Hibi; Yuta Abe; Minoru Kitago; Hideaki Obara; Osamu Itano; Hiroya Takeuchi; Michiie Sakamoto; Minoru Tanabe; Ikuro Maruyama; Yuko Kitagawa

Journal of Surgical Research 194 ( 2 ) 571 - 580 2015.04

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A novel rat model of incisional surgical site infection model developed using absorbable multifilament thread inoculated with Escherichia coli

Naoki Fujimura; Hideaki Obara; Koichi Suda; Hiroya Takeuchi; Sachiko Matsuda; Tomoko Kurosawa; Yasuhiro Katono; Mitsuru Murata; Kazuo Kishi; Yuko Kitagawa

Journal of Infection and Chemotherapy 21 ( 4 ) 312 - 315 2015.04

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Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis

Taizo Hibi; Masahiro Shinoda; Osamu Itano; Hideaki Obara; Minoru Kitago; Yuta Abe; Hiroshi Yagi; Masayuki Tanaka; Ken Hoshino; Akihiro Fujino; Tatsuo Kuroda; Shigeyuki Kawachi; Minoru Tanabe; Motohide Shimazu; Yuko Kitagawa

Hepatology Research 571 - 580 2015.01

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Preliminary report of endovascular treatment for critical limb ischemia patients with connective tissue disease: Cases series and review of the literature

Hideaki Obara; Kentaro Matsubara; Naoki Fujimura; Yasuhito Sekimoto; Yuko Kitagawa

International Journal of Angiology 24 ( 2 ) 137 - 142 2014.12

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Safety and Pharmacokinetics of Mizoribine in Adult Living Donor Liver Transplantation.

Katsuki, Yusuke, Shinoda, Masahiro, Itano, Osamu, Obara, Hideaki, Kitago, Minoru, Yagi, Hiroshi, Abe, Yuta, Hoshino, Ken, Kuroda, Tatsuo, Kitagawa, Yuko

LIVER TRANSPLANTATION 20 S107 - S107 2014.06

Research paper (scientific journal), ISSN 1527-6465

Emergency Living Donor Liver Transplantation Using ABO-Incompatible Donor for Acute Liver Failure

Shinoda, Masahiro, Itano, Osamu, Obara, Hideaki, Kitago, Minoru, Hibi, Taizo, Abe, Yuta, Yagi, Hiroshi, Tanabe, Minoru, Kitagawa, Yuko

LIVER TRANSPLANTATION 20 S316 - S316 2014.06

Research paper (scientific journal), ISSN 1527-6465

Mesenchymal stem cells support hepatocyte function in engineered liver grafts

Yoshie Kadota; Hiroshi Yagi; Kenta Inomata; Kentaro Matsubara; Taizo Hibi; Yuta Abe; Minoru Kitago; Masahiro Shinoda; Hideaki Obara; Osamu Itano; Yuko Kitagawa

Organogenesis 10 ( 2 ) 268 - 277 2014.04

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Hemoadsorption of high-mobility group box chromosomal protein 1 using a column for large animals

R. Nishiyama; M. Shinoda; M. Tanabe; G. Oshima; K. Takano; T. Miyasho; Y. Fuchimoto; S. Yamada; T. Inoue; K. Shimada; K. Suda; M. Tanaka; T. Hayashida; H. Yagi; M. Kitago; H. Obara; O. Itano; H. Takeuchi; S. Kawachi; I. Maruyama; Y. Kitagawa

European Surgical Research 51 ( 3-4 ) 181 - 190 2014.02

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Clinical utility of the Revised Cardiac Risk Index in non-cardiac surgery for elderly patients: A prospective cohort study

Yuki Hirano; Hiroya Takeuchi; Koichi Suda; Takashi Oyama; Rieko Nakamura; Tsunehiro Takahashi; Hirofumi Kawakubo; Norihito Wada; Yoshiro Saikawa; Hideaki Obara; Hiromitsu Jinno; Hirotoshi Hasegawa; Minoru Tanabe; Yuko Kitagawa

Surgery Today 44 ( 2 ) 277 - 284 2014.02

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Left-side hepatectomy in living donors: Through a reduced upper-midline incision for liver transplantation

M. Shinoda; M. Tanabe; O. Itano; H. Obara; M. Kitago; Y. Abe; T. Hibi; H. Yagi; A. Fujino; S. Kawachi; K. Hoshino; T. Kuroda; Y. Kitagawa

Transplantation Proceedings 46 ( 5 ) 1400 - 1406 2014.01

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[Diagnosis and treatment of embolism and thrombosis of abdominal aorta and superior mesenteric artery].

Kentaro Matsubara; Hideaki Obara; Yuko Kitagawa

Nihon rinsho. Japanese journal of clinical medicine 72 ( 7 ) 1289 - 1293 2014.01

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Endovascular repair of abdominal aortic aneurysm using bifurcated stent-graft in a patient with complete occlusion from the common to the external iliac artery

Naoki Fujimura; Hirohisa Harada; Hideki Yashiro; Takurin Akiyoshi; Motohito Nakagawa; Toshio Kanai; Hideaki Obara; Yuko Kitagawa

Annals of Vascular Surgery 28 ( 3 ) 740.e1 - 740.e5 2014.01

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HEALTH-RELATED QUALITY OF LIFE IN LIVER TRANSPLANT RECIPIENTS IN JAPAN

Soeda, Etsuko, Tanabe, Minoru, Kawachi, Shigeyuki, Izawa, Yuka, Takaoka, Chie, Sano, Yuko, Hayakawa, Tomohisa, Shinoda, Masahiro, Itano, Satoshi, Obara, Hideaki, Kitago, Minoru, Hibi, Taizo, Abe, Yuta, Yagi, Hiroshi, Kitagawa, Yuko

TRANSPLANT INTERNATIONAL 26 195 - 195 2013.11

Research paper (scientific journal), ISSN 0934-0874

Bone Marrow Mesenchymal Stem Cells Support the Regeneration of Transplantable Liver Graft Using Decellularized Whole Organ Scaffold

Kadota, Yoshie, Yagi, Hiroshi, Soto-Gutierrez, Alejandro, Inomata, Kenta, Hibi, Taizo, Abe, Yuta, Kitago, Minoru, Shinoda, Masahiro, Obara, Hideaki, Itano, Osamu, Kitagawa, Yuko

HEPATOLOGY 58 369A - 369A 2013.10

Research paper (scientific journal), ISSN 0270-9139

Outcomes of Adult Living Donor Liver Transplantation for Acute Liver Failure: The Impact of ABO-Incompatibility and Validation of a Novel Japanese Scoring System.

Hibi, Taizo, Tanabe, Minoru, Itano, Osamu, Obara, Hideaki, Shinoda, Masahiro, Kitago, Minoru, Tanaka, Katsunori, Yagi, Hiroshi, Abe, Yuta, Kitagawa, Yuko

LIVER TRANSPLANTATION 19 S125 - S125 2013.06

Research paper (scientific journal), ISSN 1527-6465

Rapid development of aneurysmal formation after successful endovascular treatment of chronic total occlusion of a persistent sciatic artery

Shintaro Shibutani; Eijiro Hayashi; Hideaki Obara; Yoshiaki Narimatsu; Hiroaki Sato; Shigeshi Ono; Toshihiro Kakefuda; Yuko Kitagawa

Annals of Vascular Surgery 27 ( 4 ) 499.E5 - 499.E8 2013.05

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Neutrophil elastase inhibitor improves survival rate after ischemia reperfusion injury caused by supravisceral aortic clamping in rats

Naoki Fujimura; Hideaki Obara; Koichi Suda; Hiroya Takeuchi; Taku Miyasho; Kazufumi Kawasako; Wenlin Du; Shingo Yamada; Shigeshi Ono; Kenji Matsumoto; Sachiko Matsuda; Hiroshi Yagi; Minoru Kitago; Masahiro Shinoda; Osamu Itano; Minoru Tanabe; Michiie Sakamoto; Ikuro Maruyama; Yuko Kitagawa

Journal of Surgical Research 180 ( 1 ) E31 - E36 2013.03

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Neutrophil elastase inhibitor improves survival rate after ischemia reperfusion injury caused by supravisceral aortic clamping in rats

Fujimura, Naoki, Obara, Hideaki, Suda, Koichi, Takeuchi, Hiroya, Miyasho, Taku, Kawasako, Kazufumi, Du, Wenlin, Yamada, Shingo, Ono, Shigeshi, Matsumoto, Kenji, Matsuda, Sachiko, Yagi, Hiroshi, Kitago, Minoru, Shinoda, Masahiro, Itano, Osamu, Tanabe, Minoru, Sakamoto, Michiie, Maruyama, Ikuro, Kitagawa, Yuko

JOURNAL OF SURGICAL RESEARCH 180 ( 1 ) E31 - E36 2013.03

Research paper (scientific journal), ISSN 0022-4804

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Large renal arteriovenous fistula with left-sided inferior vena cava

Hideaki Obara; Katsunori Tanaka; Kentaro Matsubara; Akira Miyajima; Masanori Inoue; Subaru Hashimoto; Sachio Kuribayashi; Yuko Kitagawa

Annals of Vascular Surgery 27 ( 8 ) 1185.e9 - 1185.e12 2013.01

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Effect of sarpogrelate hydrochloride, a 5-hydroxytryptamine2 receptor antagonist, on allograft arteriosclerosis after aortic transplantation in rats

Susumu Watada; Hirohisa Harada; Kentaro Matsubara; Hideaki Obara; Kenji Matsumoto; Nobutoshi Ando; Yuko Kitagawa

Transplant Immunology 29 ( 1-4 ) 162 - 166 2013.01

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Human-scale whole-organ bioengineering for liver transplantation: A regenerative medicine approach

Hiroshi Yagi; Ken Fukumitsu; Kazumasa Fukuda; Minoru Kitago; Masahiro Shinoda; Hideaki Obara; Osamu Itano; Shigeyuki Kawachi; Minoru Tanabe; Gina M. Coudriet; Jon D. Piganelli; Thomas W. Gilbert; Alejandro Soto-Gutierrez; Yuko Kitagawa

Cell Transplantation 22 ( 2 ) 231 - 242 2013.01

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Estrogen deficiency attenuates neovascularization in a murine model of hindlimb ischemia

Kentaro Matsubara; Hirohisa Harada; Nobutoshi Ando; Susumu Watada; Hideaki Obara; Kenji Matsumoto; Yuko Kitagawa

Journal of Surgical Research 178 ( 2 ) 1022 - 1028 2012.12

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Role of high mobility group box chromosomal protein 1 in ischemia-reperfusion injury in the rat small intestine

Masayuki Kojima; Minoru Tanabe; Masahiro Shinoda; Shingo Yamada; Taku Miyasho; Koichi Suda; Taizo Hibi; Hideaki Obara; Osamu Itano; Shigeyuki Kawachi; Masaki Kitajima; Ikuro Maruyama; Yuko Kitagawa

Journal of Surgical Research 178 ( 1 ) 466 - 471 2012.11

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Gene transfer of A Box domain of High Mobility Group Box 1 in rat acute liver failure model

Tanaka, Masayuki, Shinoda, Masahiro, Tanabe, Minoru, Takayanagi, Atsushi, Nishiyama, Ryo Ryo, Oshima, Go, Sanuki, Naoko, Abe, Yuta, Yagi, Hiroshi, Hayashida, Tetsu, Kitago, Minoru, Obara, Hideaki, Takeuchi, Hiroya, Itano, Osamu, Maruyama, Ikuro, Kitagawa, Yuko

HEPATOLOGY 56 957A - 957A 2012.10

Research paper (scientific journal), ISSN 0270-9139

Hemoadsorption of high-mobility group box 1 in a swine acute liver failure model

Shinoda, Masahiro, Tanabe, Minoru, Nishiyama, Ryo, Oshima, Go, Takano, Kiminori, Tanaka, Masayuki, Fuchimoto, Yasushi, Miyasho, Taku, Yamada, Shingo, Suda, Koichi, Abe, Yuta, Yagi, Hiroshi, Kitago, Minoru, Obara, Hideaki, Takeuchi, Hiroya, Itano, Osamu, Maruyama, Ikuro, Kitagawa, Yuko

HEPATOLOGY 56 966A - 967A 2012.10

Research paper (scientific journal), ISSN 0270-9139

Risk factor analysis and procedural modifications for biliary stricture after adult living donor liver transplantation

M. Shinoda; M. Tanabe; S. Kawachi; O. Itano; H. Obara; T. Hibi; K. Matsubara; N. Shimojima; Y. Fuchimoto; K. Hoshino; G. Wakabayashi; M. Shimazu; Y. Morikawa; M. Kitajima; Y. Kitagawa

European Surgery - Acta Chirurgica Austriaca 44 ( 4 ) 267 - 273 2012.08

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Suppressive effects of interleukin-18 on liver function in rat liver allografts

Shigeshi Ono; Hideaki Obara; Atsushi Takayanagi; Minoru Tanabe; Shigeyuki Kawachi; Osamu Itano; Masahiro Shinoda; Minoru Kitago; Taizo Hibi; Tomohiro Chiba; Wenlin Du; Kenji Matsumoto; Arno W. Tilles; Martin L. Yarmush; Sadakazu Aiso; Nobuyoshi Shimizu; Michiie Sakamoto; Yuko Kitagawa

Journal of Surgical Research 176 ( 1 ) 293 - 300 2012.07

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Pharmacokinetics of mizoribine in adult living donor liver transplantation

M. Shinoda; M. Tanabe; S. Kawachi; Y. Ono; T. Hayakawa; O. Iketani; M. Kojima; O. Itano; H. Obara; M. Kitago; T. Hibi; K. Matsubara; N. Shimojima; Y. Fuchimoto; K. Hoshino; G. Wakabayashi; M. Shimazu; Y. Tanigawara; T. Kuroda; Y. Morikawa; M. Kitajima; Y. Kitagawa

Transplantation Proceedings 44 ( 5 ) 1329 - 1335 2012.06

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Increased plasma levels of high mobility group box 1 in patients with acute liver failure

G. Oshima; M. Shinoda; M. Tanabe; H. Ebinuma; R. Nishiyama; K. Takano; S. Yamada; T. Miyasho; Y. Masugi; S. Matsuda; K. Suda; K. Fukunaga; K. Matsubara; T. Hibi; H. Yagi; T. Hayashida; Y. Yamagishi; H. Obara; O. Itano; H. Takeuchi; S. Kawachi; H. Saito; T. Hibi; I. Maruyama; Y. Kitagawa

European Surgical Research 48 ( 3 ) 154 - 162 2012.06

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Specific Inhibition of Interleukin-18 Improves Liver Function in Rat Liver Transplantation.

Ono, Shigeshi, Obara, Hideaki, Takayanagi, Atsushi, Tanabe, Minoru, Kawachi, Shigeyuki, Itano, Osamu, Shinoda, Masahiro, Kitago, Minoru, Yagi, Hiroshi, Matsubara, Kentaro, Tilles, Arno W., Yarmush, Martin L., Chiba, Tomohiro, Du, Wenlin, Aiso, Sadakazu, Sakamoto, Michiie, Shimizu, Nobuyoshi, Kitagawa, Yuko

LIVER TRANSPLANTATION 18 S144 - S144 2012.05

Research paper (scientific journal), ISSN 1527-6465

Nonanastomotic pseudoaneurysm with complete disruption of an expanded polytetrafluoroethylene axillofemoral bypass graft

Shintaro Shibutani; Hideaki Obara; Toshihiro Kakefuda; Yuko Kitagawa

Annals of Vascular Surgery 26 ( 3 ) 422.e9 - 422.e12 2012.04

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Nonanastomotic Pseudoaneurysm With Complete Disruption of an Expanded Polytetrafluoroethylene Axillofemoral Bypass Graft

Shibutani, Shintaro, Obara, Hideaki, Kakefuda, Toshihiro, Kitagawa, Yuko

ANNALS OF VASCULAR SURGERY 26 ( 3 ) S269 - S269 2012.04

Research paper (scientific journal), ISSN 0890-5096

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Discontinuation of living donor liver transplantation due to donor's intraoperative latex-induced anaphylactic shock

Masahiro Shinoda; Minoru Tanabe; Keisuke Nagao; Minoru Kitago; Hiroto Fujisaki; Masanori Odaira; Shigeyuki Kawachi; Osamu Itano; Hideaki Obara; Kentaro Matsubara; Naoki Shimojima; Yasushi Fuchimoto; Ken Hoshino; Masayuki Amagai; Tatsuo Kuroda; Yuko Kitagawa

International Surgery 97 ( 4 ) 356 - 359 2012.01

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Successful endovascular treatment of hemosuccus pancreaticus due to splenic artery aneurysm associated with segmental arterial mediolysis

Hideaki Obara; Kentaro Matsubara; Masanori Inoue; Seishi Nakatsuka; Sachio Kuribayashi; Yuko Kitagawa

Journal of Vascular Surgery 54 ( 5 ) 1488 - 1491 2011.11

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Complete removal of infected abdominal aortic stent-graft with suprarenal fixation

Shintaro Shibutani; Hideaki Obara; Shigeshi Ono; Toshihiro Kakefuda; Yuko Kitagawa

Annals of Vascular Surgery 25 ( 7 ) 980.e7 - 980e.10 2011.10

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LARGE-SCALE WHOLE-ORGAN DECELLULARIZATION OF SWINE LIVER FOR TRANSPLANTATION

Yagi, Hiroshi, Fukumitsu, Ken, Kadota, Yoshie, Kitago, Minoru, Shinoda, Masahiro, Obara, Hideaki, Itano, Osamu, Kawachi, Shigeyuki, Tanabe, Minoru, Soto-Gutierrez, Alejandro, Kitagawa, Yuko

HEPATOLOGY 54 763A - 763A 2011.10

Research paper (scientific journal), ISSN 0270-9139

ORGAN DONATION IN JAPAN: A LONGITUDINAL STUDY OF QUALITY OF LIFE OF LIVING LIVER DONORS

Soeda, Etsuko, Tanabe, Minoru, Hoshino, Ken, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Obara, Hideaki, Shinoda, Masahiro, Shimojima, Naoki, Morikawa, Yasuhide, Kitagawa, Yuko

TRANSPLANT INTERNATIONAL 24 275 - 275 2011.09

Research paper (scientific journal), ISSN 0934-0874

The influence of donor age on liver regeneration and hepatic progenitor cell populations

Yoshihiro Ono; Shigeyuki Kawachi; Tetsu Hayashida; Masatoshi Wakui; Minoru Tanabe; Osamu Itano; Hideaki Obara; Masahiro Shinoda; Taizo Hibi; Go Oshima; Noriyuki Tani; Kisyo Mihara; Yuko Kitagawa

Surgery 150 ( 2 ) 154 - 161 2011.08

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MECHANISM OF DONOR-SPECIFIC B-CELL TOLERANCE AFTER ABO-INCOMPATIBLE INFANT LIVER TRANSPLANTATION

Fuchimoto, Yasushi, Yamada, Yohei, Tababe, Minoru, Hoshino, Ken, Matsubara, Kentarou, Shimojima, Naoki, Shinoda, Masahiro, Obara, Hideaki, Itano, Osamu, Kawachi, Sigeyuki, Kitagawa, Yuko, Ohdan, Hideki, Morikawa, Yasuhide

PEDIATRIC TRANSPLANTATION 15 50 - 50 2011.08

Research paper (scientific journal), ISSN 1397-3142

Cyclosporine a-based immunotherapy in adult living donor liver transplantation: Accurate and improved therapeutic drug monitoring by 4-hr intravenous infusion

Taizo Hibi; Minoru Tanabe; Ken Hoshino; Yasushi Fuchimoto; Shigeyuki Kawachi; Osamu Itano; Hideaki Obara; Masahiro Shinoda; Naoki Shimojima; Kentaro Matsubara; Yasuhide Morikawa; Yuko Kitagawa

Transplantation 92 ( 1 ) 100 - 105 2011.07

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The role of a real-time PCR technology for rapid detection and identification of bacterial and fungal pathogens in whole-blood samples

Hideaki Obara; Naoki Aikawa; Naoki Hasegawa; Shingo Hori; Yasuo Ikeda; Yoshio Kobayashi; Mitsuru Murata; Shinichiro Okamoto; Junzo Takeda; Minoru Tanabe; Yasuhiko Sakakura; Hiroyuki Ginba; Masaki Kitajima; Yuko Kitagawa

Journal of Infection and Chemotherapy 17 ( 3 ) 327 - 333 2011.06

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Combination Therapy with Intra-Portal Infusion and Rituximab for Adult ABO-Incompatible Living Donor Liver Transplantation

Tanabe, Minoru, Kawachi, Shigeyuki, Itano, Osamu, Obara, Hideaki, Masahiro, Shinoda, Matsubara, Kentaro, Shimojima, Naoki, Fuchimoto, Yasushi, Hoshino, Ken, Morikawa, Yasuhide, Kitagawa, Yuko

LIVER TRANSPLANTATION 17 ( 6 ) S99 - S99 2011.06

Research paper (scientific journal), ISSN 1527-6465

Gene Transfer of the High Mobility Group Box 1 Inhibitor in Rat Acute Liver Failure Model

Shinoda, Masahiro, Tanabe, Minoru, Takayanagi, Atsushi, Nishiyama, Ryo, Oshima, Go, Takano, Kiminori, Yagi, Hiroshi, Suda, Koichi, Takeuchi, Hiroya, Hayashida, Tetsu, Yamada, Shingo, Miyasho, Taku, Fukunaga, Koichi, Obara, Hideaki, Itano, Osamu, Kawachi, Shigeyuki, Maruyama, Ikuro, Kitagawa, Yuko

LIVER TRANSPLANTATION 17 ( 6 ) S139 - S139 2011.06

Research paper (scientific journal), ISSN 1527-6465

Unexpected Graft Loss Due to Humoral Rejection in Crossmatch Negative, and ABO-Compatible Recipients after Living Donor Liver Transplantataion: Case Report and Literature Review

Kawachi, Shigeyuki, Tanabe, Minoru, Handa, Kan, Itano, Osamu, Obara, Hideaki, Shinoda, Masahiro, Tani, Noriyuki, Kitagawa, Yuko

LIVER TRANSPLANTATION 17 ( 6 ) S284 - S284 2011.06

Research paper (scientific journal), ISSN 1527-6465

Dieulafoy lesion in the ileum of a child: A case report

Shintaro Shibutani; Hideaki Obara; Shigeshi Ono; Yasuo Kabeshima; Hirofumi Kawakubo; Masaya Shito; Toshihiro Kakefuda; Tai Omori; Hiroaki Sato; Yoshiaki Narimatsu; Yuko Kitagawa

Journal of Pediatric Surgery 46 ( 5 ) E17 - E19 2011.05

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Mycotic aneurysm of the superior gluteal artery in a patient with bacterial endocarditis: Case report and review of the literature

Naoki Fujimura; Hideaki Obara; Kenji Matsumoto; Yuko Kitagawa

Vascular 19 ( 1 ) 47 - 50 2011.02

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Protective effect of high-mobility group box 1 blockade on acute liver failure in rats

Kiminori Takano; Masahiro Shinoda; Minoru Tanabe; Taku Miyasho; Shingo Yamada; Shigeshi Ono; Yohei Masugi; Koichi Suda; Koichi Fukunaga; Tetsu Hayashida; Taizo Hibi; Hideaki Obara; Hiroya Takeuchi; Shigeyuki Kawachi; Kazufumi Kawasako; Minoru Okamoto; Hiroshi Yokota; Ikuro Maruyama; Yuko Kitagawa

Shock 34 ( 6 ) 573 - 579 2010.12

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Current progress in ABO-incompatible liver transplantation

Minoru Tanabe; Shigeyuki Kawachi; Hideaki Obara; Masahiro Shinoda; Taizo Hibi; Yuko Kitagawa; Go Wakabayashi; Motohide Shimazu; Masaki Kitajima

European Journal of Clinical Investigation 40 ( 10 ) 943 - 949 2010.10

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HIGH MOBILITY GROUP BOX 1 IN ACUTE LIVER FAILURE PATIENTS AND SWINES AND ESTABLISHMENT OF AN ADSORPTION COLUMN

Oshima, Go, Shinoda, Masahiro, Tanabe, Minoru, Ebinuma, Hirotoshi, Takano, Kiminori, Fuchimoto, Yasushi, Miyasho, Taku, Yamada, Shingo, Suda, Koichi, Hibi, Taizo, Hayashida, Tetsu, Fukunaga, Koichi, Obara, Hideaki, Takeuchi, Hiroya, Kawachi, Shigeyuki, Mukai, Makio, Hoshino, Ken, Hibi, Toshifumi, Morikawa, Yasuhide, Maruyama, Ikuro, Kitagawa, Yuko

HEPATOLOGY 52 ( 4 ) 1095A - 1095A 2010.10

Research paper (scientific journal), ISSN 0270-9139

Evaluation of pathogen detection from clinical samples by real-time polymerase chain reaction using a sepsis pathogen DNA detection kit

Katsunori Yanagihara; Yuko Kitagawa; Masao Tomonaga; Kunihiro Tsukasaki; Shigeru Kohno; Masafumi Seki; Hisashi Sugimoto; Takeshi Shimazu; Osamu Tasaki; Asako Matsushima; Yasuo Ikeda; Shinichiro Okamoto; Naoki Aikawa; Shingo Hori; Hideaki Obara; Akitoshi Ishizaka; Naoki Hasegawa; Junzo Takeda; Shimeru Kamihira; Kazuyuki Sugahara; Seishi Asari; Mitsuru Murata; Yoshio Kobayashi; Hiroyuki Ginba; Yoshinobu Sumiyama; Masaki Kitajima

Critical Care 14 ( 4 ) 129 - 949 2010.08

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Idiopathic hypereosinophilic syndrome in a case with ABO-incompatible liver transplantation for biliary atresia complicated by portal vein thrombosis

Yohei Yamada; Ken Hoshino; Naoki Shimojima; Masahiro Shinoda; Hideaki Obara; Shigeyuki Kawachi; Yasushi Fuchimoto; Minoru Tanabe; Yuko Kitagawa; Yasuhide Morikawa

Pediatric Transplantation 14 ( 5 ) e49 - e53 2010.08

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The influence of Donor Age on Liver Regeneration and Hepatic Progenitor Cells Population of Donor Liver

Ono, Yoshihiro, Kawachi, Shigeyuki, Hayashida, Tetsu, Tanabe, Minoru, Obara, Hideaki, Shinoda, Masahiro, Hibi, Taizo, Kitagawa, Yuko

LIVER TRANSPLANTATION 16 ( 6 ) S187 - S187 2010.06

Research paper (scientific journal), ISSN 1527-6465

Hemoabsorption of High-Mobility Group Box 1 in Swine Fulminant Hepatic Failure Model

Oshima, Go, Shinoda, Masahiro, Tanabe, Minoru, Takano, Kiminori, Fuchimoto, Yasushi, Miyasho, Taku, Yamada, Shingo, Suda, Koichi, Fukunaga, Koichi, Obara, Hideaki, Kawachi, Shigeyuki, Mukai, Makio, Hoshino, Ken, Morikawa, Yasuhide, Maruyama, Ikuro, Kitagawa, Yuko

LIVER TRANSPLANTATION 16 ( 6 ) S105 - S106 2010.06

Research paper (scientific journal), ISSN 1527-6465

Serum Level of High Mobility Group Box 1 in Patients with Fulminant Hepatic Failure and Its Blockade in Rat Model

Oshima, Go, Shinoda, Masahiro, Tanabe, Minoru, Takayanagi, Atsushi, Miyasho, Taku, Yamada, Shingo, Ebinuma, Hirotoshi, Takano, Kiminori, Hibi, Taizo, Suda, Koichi, Obara, Hideaki, Takeuchi, Hiroya, Kawachi, Shigeyuki, Fukunaga, Koichi, Hibi, Toshifumi, Maruyama, Ikuro, Kitagawa, Yuko

LIVER TRANSPLANTATION 16 ( 6 ) S104 - S104 2010.06

Research paper (scientific journal), ISSN 1527-6465

Intraportal Infusion Technique as a Novel Therapy To Avoid Graft Loss to Living Donor Liver Transplantation for Infantile Fulminant Hepatitis

Hoshino, Ken, Mori, Masaharu, Yamamoto, Yuki, Shimojima, Naoki, Hibi, Taizo, Shinoda, Masahiro, Obara, Hideaki, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Tanabe, Minoru, Kitagawa, Yuko, Morikawa, Yasuhide

LIVER TRANSPLANTATION 16 ( 6 ) S252 - S252 2010.06

Research paper (scientific journal), ISSN 1527-6465

The Impact of Donor Age on the Outcome and Graft Regeneration in Adult Living Donor Liver Transplantation

Kawachi, Shigeyuki, Tanabe, Minoru, Obara, Hideaki, Shinoda, Masahiro, Hibi, Taizo, Handa, Kan, Ono, Yasuhiro, Hayashida, Tetsu, Kitagawa, Yuko

LIVER TRANSPLANTATION 16 ( 6 ) S83 - S83 2010.06

Research paper (scientific journal), ISSN 1527-6465

Protective Effect of High-Mobility Group Box 1 Blockade on Acute Liver Failure in Rats

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Ono, Shigeshi, Miyaho, Taku, Yamada, Shingo, Suda, Koichi, Fukunaga, Koichi, Hibi, Taizo, Obara, Hideaki, Takeuchi, Hiroya, Kawachi, Shigeyuki, Yokota, Hiroshi, Maruyama, Ikuro, Kitagawa, Yuko

LIVER TRANSPLANTATION 16 ( 6 ) S105 - S105 2010.06

Research paper (scientific journal), ISSN 1527-6465

PROTECTIVE EFFECT OF BLOCKING HIGH MOBILITY GROUP BOX 1 ON ACUTE LIVER FAILURE IN RAT

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Yamada, Shingo, Miyasho, Taku, Ono, Shigeshi, Oshima, Go, Obara, Hideaki, Takeuchi, Hiroya, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Hoshino, Ken, Morikawa, Yasuhide, Ishizaka, Akitoshi, Maruyama, Ikuro, Kitagawa, Yuko

HEPATOLOGY 50 ( 4 ) 400A - 400A 2009.10

Research paper (scientific journal), ISSN 0270-9139

LONG TERM GRAFT FUNCTION AFTER PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION - IMPACT ON GRAFT FIBROSIS

Hoshino, Ken, Mori, Masaharu, Yamamoto, Yuki, Yamada, Yohei, Shimojima, Naoki, Shinoda, Masahiro, Obara, Hideaki, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Tanabe, Minoru, Kitagawa, Yuko, Morikawa, Yasuhide

LIVER TRANSPLANTATION 15 ( 7 ) S269 - S269 2009.07

Research paper (scientific journal), ISSN 1527-6465

ANTI-HIGH MOBILITY GROUP Box-1 ANTIBODY IMPROVED FULMINANT HEPATIC FAILURE IN A RAT MODEL

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Oshima, Go, Miyasho, Taku, Yamada, Shingo, Takeuchi, Hiroya, Fukunaga, Koichi, Obara, Hideaki, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Hoshino, Ken, Morikawa, Yasuhide, Maruyama, Ikuro, Ishizaka, Akitoshi, Kitagawa, Yuko

LIVER TRANSPLANTATION 15 ( 7 ) S124 - S124 2009.07

Research paper (scientific journal), ISSN 1527-6465

Multiple Aneurysms of the Splenic Artery Caused by Fibromuscular Dysplasia

Susumu Watada; Hideaki Obara; Masayuki Shimoda; Kentaro Matsubara; Kenji Matsumoto; Masaki Kitajima

Annals of Vascular Surgery 23 ( 3 ) 411.e5 - 411.e7 2009.05

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Anti-High Mobility Group Box Chromosomal Protein 1 Antibodies Improve Survival of Rats with Fulminant Hepatic Failure

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Ono, Shigeshi, Oshima, Go, Yamada, Shingo, Miyasho, Taku, Suda, Koichi, Fukunaga, Koichi, Obara, Hideaki, Takeuchi, Hiroya, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Morikawa, Yasuhide, Maruyama, Ikuro, Ishizaka, Akitoshi, Kitagawa, Yuko

GASTROENTEROLOGY 136 ( 5 ) A810 - A810 2009.05

Research paper (scientific journal), ISSN 0016-5085

Reconstructive surgery for a fusiform common celiomesenteric trunk aneurysm and coexistent abdominal aortic aneurysm: Report of a case

Hideaki Obara; Kenji Matsumoto; Naoki Fujimura; Shigeshi Ono; Toshiaki Hattori; Yuko Kitagawa

Surgery Today 39 ( 1 ) 55 - 58 2009.01

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Anti-High Mobility Group Box Chromosomal Protein 1 Antibodies Improve Survival of Rats with Fulminant Hepatic Failure.

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Ono, Shigeshi, Oshima, Go, Yamada, Shingo, Miyasho, Taku, Obara, Hideaki, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Takeuchi, Hiroya, Morikawa, Yasuhide, Maruyama, Ikuro, Ishizaka, Akitoshi, Kitagawa, Yuko

AMERICAN JOURNAL OF TRANSPLANTATION 9 376 - 376 2009

Research paper (scientific journal), ISSN 1600-6135

Increased Hemeoxygenase-1 Expression in the Liver of Patients with Hyperbilirubinemia.

Takano, Kiminori, Shinoda, Masahiro, Tanabe, Minoru, Kawachi, Shigeyuki, Obara, Hideaki, Hibi, Taizo, Suematsu, Makoto, Kitagawa, Yuko

AMERICAN JOURNAL OF TRANSPLANTATION 9 686 - 687 2009

Research paper (scientific journal), ISSN 1600-6135

The role of interleukin-18 in the rat orthotopic liver transplant model.

Ono, Shigeshi, Obara, Hideaki, Matsumoto, Kenji, Tanabe, Minoru, Kawachi, Shigeyuki, Shinoda, Masahiro, Kitagawa, Yuko

AMERICAN JOURNAL OF TRANSPLANTATION 8 415 - 415 2008.05

Research paper (scientific journal), ISSN 1600-6135

Risk factor and treatment of biliary stricture after adult living donor liver transplantation

Shinoda, Masahiro, Kawachi, Shigeyuki, Tanabe, Minoru, Hibi, Taizo, Obara, Hideaki, Kitajima, Masaki, Kitagawa, Yuko

AMERICAN JOURNAL OF TRANSPLANTATION 8 379 - 379 2008.05

Research paper (scientific journal), ISSN 1600-6135

Donor age has a major impact on graft survival in living donor liver transplantation

Handa, Kan, Kawachi, Shigeyuki, Tanabe, Minoru, Obara, Hideaki, Shinoda, Masahiro, Hibi, Taizo, Kojima, Masayuki, Hattori, Toshiaki, Kitagawa, Yuko

AMERICAN JOURNAL OF TRANSPLANTATION 8 614 - 614 2008.05

Research paper (scientific journal), ISSN 1600-6135

An increased serum level of high-mobility group box 1 in the pig fulminant hepatic failure model

Takano, Kiminon, Shinoda, Masahiro, Tanabe, Minoru, Fuchimoto, Yasushi, Miyasho, Taku, Yamada, Shingo, Suda, Koichi, Fukunaga, Koichi, Obara, Hideaki, Kawachi, Shigeyuki, Okamoto, Minoru, Yokota, Hiroshi, Mukai, Makio, Hoshino, Ken, Morikawa, Yasuhide, Maruyama, Ikuro, Ishizaka, Aldtoshi, Kitagawa, Yuko

GASTROENTEROLOGY 134 ( 4 ) A772 - A772 2008.04

Research paper (scientific journal), ISSN 0016-5085

Neutralization of blood group A-antigen by a novel anti-A antibody: Overcoming ABO-incompatible solid-organ transplantation

Yasushi Hasegawa; Yukinari Kato; Mika Kato Kaneko; Satoshi Ogasawara; Motohide Shimazu; Minoru Tanabe; Shigeyuki Kawachi; Hideki Obara; Masahiro Shinoda; Yuko Kitagawa; Hisashi Narimatsu; Masaki Kitajima

Transplantation 85 ( 3 ) 378 - 385 2008.02

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Inoue stentgraft placement in high-risk patients unfit for open surgical repair of aorto-iliac diseases

Subaru Hashimoto; S. Kuribayashi; H. Shimizu; R. Yozu; H. Obara; Y. Kitagawa; K. Inoue

Japanese Journal of Clinical Radiology 53 ( 12 ) 1681 - 1686 2008.01

Research paper (scientific journal)

The role of graft and host accommodation in a hamster-to-rat cardiac transplantation model

Koji Komori; Yasushi Fuchimoto; Yasuhide Morikawa; Hideaki Obara; Shigeyuki Kawachi; Minoru Tanabe; Ken Hoshino; Motohide Shimazu; Yumi Matsuzaki; Masaki Kitajima

Transplantation 85 ( 1 ) 112 - 117 2008.01

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Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children

Ryo Hotta; Ken Hoshino; Seishi Nakatsuka; Shioko Nakao; Jun Okamura; Yohei Yamada; Koji Komori; Yasushi Fuchimoto; Hideaki Obara; Shigeyuki Kawachi; Minoru Tanabe; Yasuhide Morikawa; Subaru Hashimoto; Masaki Kitajima

Pediatric Surgery International 23 ( 10 ) 939 - 945 2007.10

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Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children

Hotta, Ryo, Hoshino, Ken, Nakatsuka, Seishi, Nakao, Shioko, Okamura, Jun, Yamada, Yohei, Komori, Koji, Fuchimoto, Yasushi, Obara, Hideaki, Kawachi, Shigeyuki, Tanabe, Minoru, Morikawa, Yasuhide, Hashimoto, Subaru, Kitajima, Masaki

PEDIATRIC SURGERY INTERNATIONAL 23 ( 10 ) 939 - 945 2007.10

Research paper (scientific journal), ISSN 0179-0358

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Liver allografts are toleragenic in rats conditioned with posttransplant total lymphoid irradiation

Kazuhito Nagasaki; Hideaki Obara; Anming Xiong; Neeraja Kambham; Samuel Strober; Carlos O. Esquivel; Maria T. Millan

Transplantation 84 ( 5 ) 619 - 628 2007.09

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Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy

Y. Hasegawa; S. Kawachi; M. Shimazu; K. Hoshino; M. Tanabe; Y. Fuchimoto; H. Obara; M. Shinoda; H. Shimizu; Y. Yamada; T. Akatsu; R. Irie; M. Sakamoto; Y. Morikawa; M. Kitajima

American Journal of Transplantation 7 ( 9 ) 2204 - 2207 2007.09

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Living donor liver transplantation for fulminant hepatic failure in children - Focusing on undetermined cause in infants

Hoshino, Ken, Yamada, Yohei, Okamura, Jun, Hotta, Ryo, Komori, Koji, Obara, Hideaki, Kawachi, Shigeyuki, Fuchimoto, Yasushi, Tanabe, Minoru, Morikawa, Yasuhide, Kitajima, Masaki, Irie, Rie, Sakamoto, Michiie

TRANSPLANT INTERNATIONAL 20 313 - 313 2007.09

Research paper (scientific journal), ISSN 0934-0874

A Bioartificial Liver Device Secreting Interleukin-1 Receptor Antagonist for the Treatment of Hepatic Failure in Rats

Masahiro Shinoda; Arno W. Tilles; Naoya Kobayashi; Go Wakabayashi; Atsushi Takayanagi; Toshinori Totsugawa; Hirohisa Harada; Hideaki Obara; Kazuhiro Suganuma; François Berthiaume; Motohide Shimazu; Nobuyoshi Shimizu; Noriaki Tanaka; Masaki Kitajima; Ronald G. Tompkins; Mehmet Toner; Martin L. Yarmush

Journal of Surgical Research 137 ( 1 ) 130 - 140 2007.01

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Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia

Yohei Yamada; Ken Hoshino; Yasuhide Morikawa; Jun Okamura; Ryo Hotta; Koji Komori; Shioko Nakao; Hideaki Obara; Shigeyuki Kawachi; Yasushi Fuchimoto; Minoru Tanabe; Motohide Shimazu; Masaki Kitajima

Journal of Pediatric Surgery 41 ( 12 ) 1976 - 1979 2006.12

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Large renal artery aneurysm in Takayasu arteritis

Kentaro Matsubara; Kenji Matsumoto; Kaori Kameyama; Hideaki Obara; Masaki Kitajima

Journal of Vascular Surgery 44 ( 5 ) 1107 - 1109 2006.11

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Treatment of fulminant hepatic failure in rats using a bioartificial liver device containing porcine hepatocytes producing interleukin-1 receptor antagonist

Masahiro Shinoda; Arno W. Tilles; Go Wakabayashi; Atsushi Takayanagi; Hirohisa Harada; Hideaki Obara; Kazuhiro Suganuma; François Berthiaume; Motohide Shimazu; Nobuyoshi Shimizu; Masaki Kitajima; Ronald G. Tompkins; Mehmet Toner; Martin L. Yarmush

Tissue Engineering 12 ( 5 ) 1313 - 1323 2006.05

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Reconstructive surgery for segmental arterial mediolysis involving both the internal carotid artery and visceral arteries

Hideaki Obara; Kenji Matsumoto; Yoshiaki Narimatsu; Hitoshi Sugiura; Masaki Kitajima; Toshihiro Kakefuda

Journal of Vascular Surgery 43 ( 3 ) 623 - 626 2006.03

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IFN-γ, produced by NK cells that infiltrate liver allografts early after transplantation, links the innate and adaptive immune responses

Hideaki Obara; Kazuhito Nagasaki; Christine L. Hsieh; Yasuhiro Ogura; Carlos O. Esquivel; Olivia M. Martinez; Sheri M. Krams

American Journal of Transplantation 5 ( 9 ) 2094 - 2103 2005.09

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Identification, cloning, and characterization of a novel rat natural killer receptor, RNKp30: A molecule expressed in liver allografts

Christine L. Hsieh; Yasuhiro Ogura; Hideaki Obara; Unzila A. Ali; Guadalupe M. Rodriguez; Ronald R. Nepomuceno; Olivia M. Martinez; Sheri M. Krams

Transplantation 77 ( 1 ) 121 - 128 2004.01

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Transfer of the interleukin-1 receptor antagonist gene into rat liver abrogates hepatic ischemia-reperfusion injury

Hirohisa Harada; Go Wakabayashi; Atsushi Takayanagi; Motohide Shimazu; Kenji Matsumoto; Hideaki Obara; Nobuyoshi Shimizu; Masaki Kitajima

Transplantation 74 ( 10 ) 1434 - 1441 2002.11

Research paper (scientific journal)

Technique for iliac artery reconstruction in abdominal aortic aneurysm repair

K. Matsumoto; M. Nakamaru; H. Obara; S. Hayashi; H. Harada; M. Kitajima

Vascular Surgery 35 ( 1 ) 19 - 22 2001.01

Research paper (scientific journal)

NK cells and transplantation

Christine L Hsieh; Hideaki Obara; Yasuhiro Ogura; Olivia M Martinez; Sheri M Krams

Transplant Immunology 9 ( 2-4 ) 111 - 114 2001.01

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Significance of portal venous flow in graft regeneration after living related liver transplantation

Y. Kato; M. Shimazu; G. Wakabayashi; M. Tanabe; Y. Morikawa; K. Hoshino; H. Harada; T. Kadomura; H. Obara; H. Urakami; M. Shinoda; M. Kitajima

Transplantation Proceedings 33 ( 1-2 ) 1484 - 1485 2001.01

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Role of pararectal retroperitoneal approach in abdominal aortic aneurysm repair

Kenji Matsumoto; Katsunori Tanaka; Kouji Ohsumi; Makoto Nakamaru; Hideaki Obara; Shinobu Hayashi; Masaki Kitajima

International Journal of Angiology 9 ( 1 ) 20 - 22 2000.01

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Overexpression of truncated IκBα induces TNF-α-dependent apoptosis in human vascular smooth muscle cells

Hideaki Obara; Atsushi Takayanagi; Junichi Hirahashi; Katsunori Tanaka; Go Wakabayashi; Kenji Matsumoto; Motohide Shimazu; Nobuyoshi Shimizu; Masaki Kitajima

Arteriosclerosis, Thrombosis, and Vascular Biology 20 ( 10 ) 2198 - 2204 2000.01

Research paper (scientific journal)

A clip system for vascular anastomoses

Kenji Matsumoto; Makoto Nakamaru; Hideaki Obara; Shinobu Hayashi; Hirohisa Harada; Atsushi Morisue; Masaki Kitajima

Vascular Surgery 33 ( 4 ) 367 - 372 1999.07

Research paper (scientific journal)

Surgical strategy for abdominal aortic aneurysm with concurrent symptomatic malignancy

Kenji Matsumoto; Makoto Nakamaru; Hideaki Obara; Shinobu Hayashi; Hirohisa Harada; Masaki Kitajima; Nozomu Shirasugi; Katsuhiko Nouga

World Journal of Surgery 23 ( 3 ) 248 - 251 1999.03

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Role of dipyridamole myocardial scintigraphy in abdominal aortic aneurysm repair

K. Matsumoto; M. Nakamaru; H. Obara; S. Hayashi; H. Harada; M. Kitajima

International Angiology 18 ( 2 ) 158 - 162 1999.01

Research paper (scientific journal)

Celiomesenteric anomaly with concurrent aneurysm

K. Matsumoto; K. Tanaka; K. Ohsumi; M. Nakamaru; H. Obara; S. Hayashi; M. Kitajima

Journal of Vascular Surgery 29 ( 4 ) 711 - 714 1999.01

Research paper (scientific journal)

Indication and prospect of a newly devised ePTFE prosthesis (DTASTAT®) for hemodialysis

K. Matsumoto; H. Obara; S. Hayashi; H. Harada; A. Morisue; M. Kitajima; N. Shirasugi; T. Kakefuda

Japanese Journal of Artificial Organs 26 ( 2 ) 545 - 548 1997.01

Research paper (scientific journal)

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