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Adult-to-adult living donor liver transplantation (ALDLT) has been accepted as an important option for end-stage liver disease, but information regarding the risk factors remains fragmentary. We aimed to establish a predictive model for 90-day survival. In the first step, a total of 286 cases who had received primary ALDLT using a right lobe graft between 1998 and 2004 were randomly divided into 2 cohorts at a ratio of 2:1 (191 vs. 95 recipients). The larger cohort of patients was used to develop a model. The outcome was defined as 90-day survival, and a total of 39 preoperative and operative variables, including the period of surgery (1998-2001 vs. 2002-2004) (1998-2001 vs. 2002-2004) (HR ϭ 2.41; CI ϭ 1.04-5.57), and log e [serum C-reactive protein or CRP] (HR ϭ 1.64; CI ϭ 1.13-2.38) were found to be independent risk factors. In the second step, we tried to establish a realistic survival model. In this step, we created 2 models, 1 that used all 4 variables (model 1) and 1 (model 2) in which blood loss volume was replaced with the past history of upper abdominal surgery and Model for End-Stage Liver Disease (MELD) score (Ն25), both of which showed associations with blood loss volume. These models were applied to the smaller cohort of 95 patients. Receiver operating characteristic analyses demonstrated that both models showed similar significant c-statistics (0.63 and 0.62, respectively). In conclusion, model 2 can provide a rough estimation of the 90-day survival after ALDLT. Adult-to-adult living donor liver transplantation (ALDLT) has been established as a safe procedure for both donors and recipients, [1][2][3] and is now accepted as the first option for end-stage liver disease in Japan. In Western countries, a recent chronic shortage of deceased donor livers has caused a bottleneck in liver transplants, which in turn has fueled the spread of ALDLT. [4][5][6] For effective use of donated liver grafts, it is important to detect the preoperative risks associated with survival after liver transplantation. A number of prior studies have attempted to determine risk factors that can predict patient survival after deceased donor liver transplantation. We have experience with 286 cases of ALDLT using a right lobe graft in our institution since February 1998. At the present time, 78 cases have died, resulting in a mortality rate of 27.3%. The observation that the majority of mortality or graft failure (53.8%) occurs within the initial 90-day period strongly suggests that there are unexplored risk factors for shortterm survival after ALDLT.The major aim of the present study was to build a quantitative predictive model for ALDLT focusing on the 90-day survival. This goal was achieved via 2 steps.Abbreviations: ALDLT, adult-to-adult living donor liver transplantation; HLA, human leukocyte antigen; CRP, C-reactive protein; HR, hazard ratio; CI, confidence interval; MELD, Model for End-Stage Liver Disease. Address reprint requests to Ichiro Tsunematsu, M.D.,

The aim of this study was to evaluate the utility of immediate repair of a contralateral occult hernia at the same time as incipient hernia repair. A total of 693 patients were diagnosed preoperatively with a unilateral groin hernia from January 2006 to December 2017. The open technique was used for 541 patients, and the laparo-endoscopic technique was used for 152 patients. The incidences of occult contralateral hernia confirmed during surgery under laparo-endoscopic techniques and those of contralateral metachronous hernia after a unilateral groin hernia repair with open technique were compared. Fifty-one (9.4%) of 541 patients underwent a contralateral metachronous hernia repair after unilateral groin hernia repair. Twenty-three (15.1%) of 152 patients had occult contralateral hernias using laparo-endoscopic techniques. There was a significant difference in the incidence of contralateral metachronous hernia and that of occult contralateral hernia (P = 0.02). It is concluded that finding and repairing an occult contralateral hernia at the time of laparoendoscopic technique has the advantage of avoiding a second operation. However, it has been considered overtreatment to repair all patients with an occult contralateral hernia.

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract; most of them have gain-of-function mutations of the KIT gene. There have been rare cases of families with multiple GISTs, that had autosomal dominant germline KIT mutations. Here, we present a case of multiple GISTs caused by a novel germline KIT mutation. Intraoperatively, the main tumor was present in the body of the stomach, and multiple small nodules were detected mainly in the upper and middle part of the gastric wall; several nodules were also present in the small bowel wall. The main tumor and surrounding nodules were resected. DNA sequencing of the tumor tissue, adjacent normal mucosal tissue, and peripheral blood leukocytes revealed that the patient had germline Asp820Gly mutation in exon 17 of the KIT gene. This is the first case with germline Asp820Gly mutation in exon 17 of the KIT gene.