To prevent small-for-size syndrome in adult-to-adult living donor liver transplantation (A-LDLT), larger grafts (ie, right lobe grafts) have been selected in many transplant centers. However, some centers are investigating the benefits of portal pressure modulation. Five hundred sixty-six A-LDLT procedures using right or left lobe grafts were performed between 1998 and 2008. In 2006, we introduced intentional portal pressure control, and we changed the graft selection criteria to include a graft/recipient weight ratio >0.7% instead of the original value of >0.8%. All recipients were divided into period I (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), the era of unintentional portal pressure control; n ¼ 432) and period II (2006II ( -2008, the era of intentional portal pressure control; n ¼ 134). The selection of small-for-size grafts increased from 7.8% to 23.9%, and the selection of left lobe grafts increased from 4.9% to 32.1%. Despite the increase in the number of smaller grafts in period II, 1-year patient survival was significantly improved (87.9% versus 76.2%). In 129 recipients in period II, portal pressure was monitored. Patients with a portal pressure <15 mm Hg demonstrated better 2-year survival (n ¼ 86, 93.0%) than patients with a portal pressure !15 mm Hg (n ¼ 43, 66.3%). The recovery from hyperbilirubinemia and coagulopathy after transplantation was significantly better in patients with a portal pressure <15 mm Hg. In conclusion, our strategy for A-LDLT has changed from larger graft-based A-LDLT to controlled portal pressure-based A-LDLT with smaller grafts. A portal pressure <15 mm Hg seems to be a key for successful A-LDLT. Liver Transpl 16:718-728,

Operational tolerance (graft acceptance in an immunosuppression (IS)-free environment) after living-donor liver transplantation (LDLT) could occur by our elective protocol in some patients. There is, nevertheless, no reliable parameter to monitor patients who may discontinue IS without a risk of rejection. To identify such parameters, we systemically phenotyped peripheral blood mononuclear cells from operationally tolerant patients. An increase was observed in the frequency of CD4 + CD25 high+ cells, B cells and Vd1/Vd2 cdT-cells ratio in operationally tolerant patients (Gr-tol; n = 12), compared with those from age-matched volunteers (Gr-vol; n = 24) or patients on IS (Gr-IS; n = 19). The frequency of NK cells was decreased in Gr-tol, compared with those in Gr-IS or Gr-vol. The frequency of NKT cells was decreased after LDLT, compared with that in Gr-vol. Although the contribution of those subsets to the tolerant state remains elusive, the results may provide important clues for reliable indicators of tolerance after LDLT.

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A statistical theory for compressible turbulent shear flows subject to buoyancy effects is developed. Important correlation functions in compressible shear flows are calculated with the aid of a multiscale direct-interaction approximation. They are expressed in the gradient-diffusion form similar to the eddy-viscosity representation for the Reynolds stress in incompressible flows. The results obtained are applicable to subgrid modeling, and a Smagorinsky-type model in compressible flows is constructed.

An improvement of the eddy-viscosity representation for Reynolds stress is made from the statistical viewpoint. The Reynolds stress is calculated with the aid of the two-scale direct-interaction formalism, and its deviation from the eddy-viscosity representation is found under general mean flows. This result theoretically elucidates the noncoincidence of the zeros of Reynolds stress and mean strain, which is frequently observed in asymmetric turbulent shear flows.

A previous study (Langmuir2011, 27, 5772) found the fluorinated double-tail sulfogulutarate 8FG(EO)(2) to act as a superefficient solubilizer for water in supercritical CO(2) (W/CO(2)) microemulsions. To explore more economic CO(2)-philic surfactants with high solubilizing power as well as rapid solubilization rates, the effects of fluorocarbon chain length and linking group were examined with sodium 1,5-bis(1H,1H,2H,2H-perfluoroalkyloxy)-1,5-dioxopentane-2-sulfonates (nFG(EO)(2), fluorocarbon chain length n = 4, 6, 8) and sodium 1,4-bis(1H,1H,2H,2H-perfluoroalkyloxy)-1,4-dioxobutane-2-sulfonate (nFS(EO)(2), n = 4, 8). Visual observation and UV-vis spectral measurements with methyl orange as a reporter dye indicated a maximum water-to-surfactant molar ratio (W(0)) in the microemulsions, which was 60-80 for nFG(EO)(2) and 40-50 for nFG(EO)(2). Although it is normally expected that high solubilizing power requires long fluorocarbon surfactant chains, the shortest fluorocarbon 4FG(EO)(2) interestingly achieved the highest W(0) (80) transparent single-phase W/CO(2) microemulsion. In addition, a very rapid solubilization of loaded water into CO(2) was observed for 4FG(EO)(2) even at a high W(0) of ~80.

High-pressure small-angle neutron scattering (HP-SANS) studies were conducted to investigate nanostructures and interfacial properties of water-in-supercritical CO2 (W/CO2) microemulsions with double-fluorocarbon-tail anionic surfactants, having different fluorocarbon chain lengths and linking groups (glutarate or succinate). At constant pressure and temperature, the microemulsion aqueous cores were found to swell with an increase in water-to-surfactant ratio, W0, until their solubilizing capacities were reached. Surfactants with fluorocarbon chain lengths of n = 4, 6, and 8 formed spherical reversed micelles in supercritical CO2 even at W0 over the solubilizing powers as determined by phase behavior studies, suggesting formation of Winsor-IV W/CO2 microemulsions and then Winsor-II W/CO2 microemulsions. On the other hand, a short C2 chain fluorocarbon surfactant analogue displayed a transition from Winsor-IV microemulsions to lamellar liquid crystals at W0 =25. Critical packing parameters and aggregation numbers were calculated by using area per head group, shell thickness, the core/shell radii determined from SANS data analysis: these parameters were used to help understand differences in aggregation behavior and solubilizing power in CO2. Increasing the microemulsion water loading led the critical packing parameter to decrease to ~1.3 and the aggregation number to increase to > 90. Although these parameters were comparable between glutarate and succinate surfactants with the same fluorocarbon chain, decreasing the fluorocarbon chain length n reduced the critical packing parameter. At the same time, reducing chain length to 2 reduced negative interfacial curvature, favoring planar structures, as demonstrated by generation of lamellar liquid crystal phases.

Forty-six pediatric patients who underwent living donor liver transplantation (LDLT) using parental liver grafts for inheritable metabolic disorders (IMD) were evaluated to determine the outcomes of the surgery, decisive factors for post-transplant patient survival and the impact of using donors who were heterozygous for the particular disorder. Disorders included Wilson disease (WD, n = 21), ornithine transcarbamylase deficiency (OTCD, n = 6), tyrosinemia type I (TTI, n = 6), glycogen storage disease (GSD, n = 4), propionic acidemia (PPA, n = 3), methylmalonic acidemia (MMA, n = 2), Crigler-Najjar syndrome type I (CNSI, n = 2), bile acid synthetic defect (BASD, n = 1) and erythropoietic protoporphyria (EPP, n = 1). The post-transplant cumulative patient survival rates were 86.8 and 81.2% at 1 and 5 years, respectively. Posttransplant patient survival and recovery of the growth retardation were significantly better in the liveroriented diseases (WD, OTCD, TTI, CNSI and BASD) than in the non-liver-oriented diseases (GSD, PPA, MMA and EPP) and pre-transplant growth retardation disadvantageously affected post-transplant outcomes. Although 40 of 46 donors were considered heterozygous for each disorder, neither mortality nor morbidity related to the heterozygosis has been observed. LDLT using parental donors can be recommended as an effective treatment for pediatric patients with IMD. In the non-liver-oriented diseases, however, satisfactory outcomes were not obtained by hepatic replacement alone.