In regenerative medicine, cell sheet engineering has various advantages, including the retention of cells at the transplantation site for a longer period and the local delivery of growth factors and ...cytokines. Adipose-derived stem cell (ASC) is widely used owing to their various functions such as wound healing, immunomodulation, and nerve regeneration, in addition to their ability to differentiate into adipocytes, chondrocytes, and osteoblasts. ASC sheet generated using cell sheet engineering is considered effective in preventing anastomotic leakage, a serious postoperative complication in gastrointestinal surgery. However, the ASC sheet is too soft, thin, and brittle to handle with laparoscopic forceps during the operation. Therefore, we considered using the peritoneum, which is stiff and easy to collect while operating, as an alternative support. In this study, we explored the feasibility of using the peritoneum as a support for the precise transplantation of ASC sheets during surgery.
ASCs were isolated from the subcutaneous fat of the inguinal region of Sprague-Dawley (SD) transgenic rats expressing green fluorescent protein. ASCs were cultured until passage 3, seeded in temperature-responsive culture dishes, and the resulting ASC sheet was harvested at more than 80% confluency. Non-transgenic SD rats were used for transplant experiments. The wall peritoneum was harvested from SD rats following laparotomy, and hybrid adipose-derived stem cell (HASC) sheet was prepared by laminating the peritoneum with ASC sheet. The cell sheets were transplanted on the backs of SD rats following the incision. On post-transplantation days 3 and 7, the specimens were extracted. ASC and HASC sheets were then compared macroscopically and histopathologically.
HASC sheet transplantation was macroscopically and histopathologically more effective than ASC sheet transplantation. The peritoneum provided sufficient stiffness as a support for precise transplantation.
The newly developed HASC sheet, which combine the advantages of ASC sheet with those of the peritoneum, could be more useful for clinical application than the ASC sheet alone.
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•Adipose-derived stem cell (ASC) sheet is effective for wound healing.•ASC sheet is difficult to transplant with laparoscopic forceps.•The peritoneum is relatively rigid and can be used as a support.•Feasibility of hybrid adipose-derived stem cell (HASC) sheet composed of ASC sheet and peritoneum was evaluated.•HASC sheet was easier to transplant than ASC sheet alone.
Background
Curative surgery is the most effective treatment for intrahepatic cholangiocarcinoma (ICC). When an ICC involves the suprahepatic inferior vena cava (IVC), hepatectomy with suprahepatic ...IVC resection and reconstruction is challenging. For reconstruction of the suprahepatic IVC, total hepatic vascular exclusion (THVE), veno-venous bypass, and/or in situ hypothermic portal perfusion are required, but mortality and morbidity remain high.
Case presentation
We present a 73-year-old woman with mass-forming ICC which invaded the suprahepatic IVC and middle hepatic vein. Left hepatectomy, suprahepatic IVC resection, and reconstruction with an artificial graft were successfully performed during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to maintain blood pressure. While clamping the IVC diagonally, the right hepatic vein confluence could be preserved. No congestion in the right liver was seen; therefore, there was no requirement for the Pringle maneuver or THVE during reconstruction. No morbidity or mortality was seen after surgery.
Conclusions
Hepatectomy with suprahepatic IVC resection and reconstruction under V-A ECMO can be performed safely. When an ICC invades the suprahepatic IVC, V-A ECMO during resection and reconstruction of the suprahepatic IVC with an artificial graft is recommended as one of the options.
Summary
This study aimed to analyze the influences of single nucleotide polymorphisms (SNPs) in Fc gamma receptor IIA (FCGR2A) on postoperative outcomes after lung transplantation (LTx). We enrolled ...191 lung transplant recipients 80 undergoing living‐donor lobar lung transplants (LDLLTs) and 111 undergoing deceased‐donor lung transplants (DDLTs) in this study. We identified SNPs in FCGR2A (131 histidine H or arginine R; rs1801274) and reviewed the infectious complication‐free survival after ICU discharge. The SNPs in FCGR2A comprised H/H (n = 53), H/R (n = 24), and R/R (n = 3) in LDLLT and H/H (n = 67), H/R (n = 42), and R/R (n = 2) in DDLT. Recipients with H/H (H/H group) and those with H/R or R/R (R group) were compared in the analyses of infectious complications. In multivariate analyses, the R group of SNPs in FCGR2A was associated with pneumonia‐free survival {HR: 2.52 95% confidence interval (CI): 1.35–4.71, P = 0.004}, fungal infection‐free survival HR: 2.50 (95% CI: 1.07–5.84), P = 0.035, and cytomegalovirus infection‐free survival HR: 2.24 (95% CI: 1.07–4.69), P = 0.032 in LDLLT, but it was not associated with infectious complication‐free survival in DDLT. Therefore, in LDLLT, more attention to infectious complications might need to be paid for LTx recipients with H/R or R/R than for those with H/H.
Although there were no significant differences in prognoses after LTx among SNPs in FCGR2A, a SNP in FCGR2A (H/R or R/R) was detected as a significant predictive factor for pneumonia, fungal infection, and CMV infection after ICU discharge among LDLLT recipients.
University of Wisconsin solution (UW) may freeze at temperatures below -0.7 °C, damaging the graft. The present study assessed the effectiveness of the liver graft package protocol, which recommends ...filling a package with sufficient liquid to prevent grafts from sustaining freezing injury.
We filled ice cubes at two temperatures (-80 and -20 °C) around packages and performed a comparative study with four groups based on the temperature and filling of the second layer with lactated Ringer's solution (LR) (A: -80 °C, LR-; B: -80 °C, LR+; C: -20 °C, LR-; D: -20 °C, LR+). The bovine liver was used as a graft and preserved for 6 h in the first isolation bag filled with UW.
While temperatures dropped below -0.7 °C at some points for 6 h in groups A, B, C, they never dropped to -0.7 °C in group D. The macroscopic findings in groups A, B, C showed freezing of the UW and grafts, but no such results in group D. A pathological study including electron microscopy showed freezing injury in groups A, B, and C but no significant changes in group D.
The graft package protocol prevents freezing of the UW and liver grafts.
Aim
Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co‐infection from blood products for hemophilia has been a social problem in Japan, and liver transplantation (LT) for these patients ...has been a challenging procedure. However, with the advent of the direct‐acting antiviral agent for HCV and change in the policy for prioritization of deceased donor LT, the results of LT for patients co‐infected with HCV/HIV may have improved.
Methods
This study was conducted to provide updated results of our nationwide survey of LT for patients co‐infected with HCV/HIV, from January 1997 to December 2019. We collected data on 17 patients with HIV/HCV co‐infection who underwent either deceased donor LT (n = 5) or living donor LT (n = 12).
Results
All the patients were men with hemophilia, and the median age was 41 (range, 23–61) years. The median CD4 count before LT was 258 (range, 63–751). Most patients had poor liver function before surgery with Child–Pugh grade C and a Model for End‐stage Liver Disease score of 20 (range, 11–48). The right lobe was used for most grafts for living donor liver transplantation (n = 10). Overall survival was significantly better with a sustained viral response (SVR) than without an SVR, and a univariate analysis indicated that SVR after direct‐acting antiviral or interferon/ribavirin showed the highest hazard ratio for patient survival after LT. A multivariate analysis was not possible because of the limited number of cases.
Conclusion
SVR for HCV showed the highest impact on the outcome of LT for patients with hemophilia co‐infected with HIV/HCV. SVR for HCV should be achieved before or after LT for patients with hemophilia co‐infected with HIV/HCV for a better outcome.
Background
There are no previous reports of debulking of giant liver hemangioma. This report describes our experience with debulking surgery for a patient with bilateral giant liver hemangiomas with ...severe symptoms.
Case presentation
We present a case of symptomatic giant liver hemangioma in a 41-year-old woman. She presented with abdominal pain and fullness at a local hospital and underwent trans-arterial embolization (TAE). TAE was not effective, and she was not able to walk a long distance. Giant liver hemangiomas, 30 cm and 15 cm in diameter, were located in the right liver and in the left lateral section, respectively, and normal liver parenchyma with tiny liver hemangiomas was present in segment 4. The liver function was normal. However, right hemi-hepatectomy with left lateral sectionectomy was considered to be risky according to the 3DCT volumetry. Therefore, we performed right hemi-hepatectomy in order to reduce her symptoms. The postoperative course was uneventful, and she was discharged on the 14th day after surgery. The abdominal fullness and abdominal pain disappeared immediately after surgery. The hemangiomas in the remnant liver, 15 cm in diameter, showed no change, and she is well without symptoms 7 years after surgery.
Conclusions
Debulking surgery is one of the options for bilateral giant liver hemangiomas with severe symptoms.
Aim
To clarify the outcome and predictive factors in patients with acute liver failure (ALF) awaiting deceased donor liver transplantation (DDLT) in Japan.
Methods
Of the DDLT candidates in Japan ...between 2007 and 2016, 264 adult patients with ALF were retrospectively enrolled in this study. Factors associated with DDLT and waiting‐list mortality were assessed using the Cox proportional hazard model. The DDLT and transplant‐free survival probabilities were evaluated using Kaplan–Meier analysis and the log–rank test.
Results
The waiting‐list registration year after the Transplant Law revision in 2010 was a significant factor associated with DDLT. The adjusted hazard ratio indicated that DDLT probability after 2010 was four times higher than that before, and the 28‐day cumulative DDLT probability was more than 35%. The median survival time of the entire cohort was 40 days. Multivariate analysis identified the following three factors associated with waiting‐list mortality: age, coma grade, and international normalized ratio. The transplant‐free survival probabilities were significantly stratified by the number of risks, and patients with all three risks showed extremely poor short‐term prognosis (median survival time = 23 days).
Conclusions
The DDLT probability of ALF patients increased after the law revision in 2010; however, patients at high risk of short‐term waiting‐list mortality might need emergent living donor transplantation.
Background
Ring calcification in hepatocellular carcinoma is extremely rare. Untreated hepatocellular carcinoma occasionally includes calcified lesions. Here, we report a case of ring-calcified ...hepatocellular carcinoma.
Case presentation
A 60-year-old man with a hepatic tumor was referred to Tokyo Women’s Medical University Hospital. He had a history of chronic hepatitis C. Computed tomography showed a liver tumor 20 mm in diameter in segment 6 of the Couinaud classification, with ring calcification. Based on this uncommon imaging presentation and the patient’s past exposure to the definitive hosts of
Echinococcus multilocularis
, he was preoperatively diagnosed with echinococcosis. Partial hepatectomy was performed as a radical treatment for echinococcosis. A final diagnosis of hepatocellular carcinoma was confirmed based on pathological findings. The patient was discharged uneventfully.
Conclusion
The presentation of an extremely rare hepatocellular carcinoma with ring calcification may be disguised as hydatid disease.
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