Details of a Researcher - Obara, Hideaki

Papers - Obara, Hideaki

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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) 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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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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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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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) 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-hydroxytryptamine<sub>2</sub> 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

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

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

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

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

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

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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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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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)

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

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