Browsing by Author "Mizuta, Koichi"

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    Co-occurrence of Nonanastomotic Biliary Stricture and Acute Cellular Rejection in Liver Transplant
    (Başkent Üniversitesi, 2012-04) Sanada, Yukihiro; Egami, Satoshi; Kawarasaki, Hideo; Yasuda, Yoshikazu; Okada, Noriki; Yamada, Naoya; Wakiya, Taiichi; Ihara, Yoshiyuki; Urahashi, Taizen; Mizuta, Koichi
    Background: Nonanastomotic biliary stricture is generally considered the most troublesome biliary complication after liver transplant. Nonanastomotic biliary stricture owing to immunologic cholangiopathy (such as acute cellular rejection) has not been reported. We describe 2 patients with the co-occurrence of nonanastomotic biliary stricture and acute cellular rejection after pediatric live-donor liver transplant. Case 1: A 13-month-old male infant with liver cirrhosis underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Eighty days after the live-donor liver transplant, fever with liver dysfunction and dilatation of the intrahepatic bile duct occurred. Percutaneous transhepatic biliary drainage and a liver biopsy were performed. The histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome. Case 2: A 21-month-old female infant with biliary atresia underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Twenty-six days after the live-donor liver transplant, percutaneous transhepatic biliary drainage for B3 and a liver biopsy were performed, owing to fever, with liver dysfunction, and dilatation of the intrahepatic bile duct. Histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome. Conclusions: It is important for patients with nonanastomotic biliary stricture to undergo early liver biopsy because the nonanastomotic biliary stricture may be coincident with, or caused by, acute cellular rejection.
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    Use of 3-Dimensional Computed Hepatic Venous Visualization for Graft Outflow Venoplasty in Adult Left Living-Donor Liver Transplant
    (Başkent Üniversitesi, 2012-08) Urahashi, Taizen; Sanada, Yukihiro; Mizuta, Koichi; Wakiya, Taiichi; Ihara, Yoshiyuki; Yamamoto, Masakazu; Katsuragawa, Hideo
    Objectives: A surgeon must be aware of hepatic vascular variations to safely perform living-donor liver transplant. The ramification patterns of the hepatic veins with tributaries for left lobe graft outflow venoplasty should be evaluated preoperatively with 3-dimensional computed tomography of the donor. Materials and Methods: Twenty-four potential donors were examined between October 1999 and July 2006 for living-donor liver transplant using the left lobe. They underwent triphasic helical computed tomography of the liver on a multidetector helical computed tomographic scanner. All images, including 2-dimensional reformation and 3-dimensional reconstructed models with maximum intensity projection and volume rendering, were sent to a workstation for postprocessing. Results: The ramification patterns of the left and middle hepatic vein were classified into 2 groups; they formed a common trunk (type 1), which had 3 variations; type 1A (13 cases): in which the left hepatic vein and the middle hepatic vein without any tributaries on their confluence; type 1B (8 cases): in which there was venous confluence in the left hepatic vein with the left superficial vein and middle hepatic vein; type 1C (2 cases): in which the hepatic venous confluence in the left hepatic vein and middle hepatic vein and the left superficial vein directly joining into the inferior vena cava; type 2 (1 case) had the left hepatic vein and middle hepatic vein joining into the inferior vena cava separately; type 1B underwent 2 venoplasty procedures, but the others underwent only a single venoplasty. Conclusions: We demonstrated the anatomic interrelation of the hepatic veins for hepatic outflow venoplasty of adult left lobe living-donor liver transplant with 3-dimensional computed tomography scanning to help surgeons preoperatively determine the appropriate technique or form of reconstruction.