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G-W Song,
S-G Lee,
S Hwang,
C-S Ahn,
D-B Moon,
K-H Kim, T-Y Ha,
D-H Jung,
G-C Park,
J-M Namgung,
C-S Park,
H-W Park,
Y-H Park
[show abstract]
[hide abstract]
ABSTRACT: ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) is a feasible therapeutic option for countries with a scarcity of deceased donors. This report presents our initial experiences in ABOi ALDLT in 10 patients between December 2008 and September 2009. The mean age of recipients was 48.5 ± 5.7 years (range, 40-54 years). The mean Model for End-stage Liver-Disease score was 13.9 ± 4.0 (range, 9-22). All patients were administered preoperative rituximab once and plasma exchanges according to the hemagglutinin titer. The spleen was preserved in all cases. For local infusion therapy, hepatic arterial infusion was performed in 9 patients and portal vein infusion in 1 subject. The 10 patients experienced no in-hospital mortality. At a mean follow-up period of 31.8 ± 2.9 months (range, 4.1-34.9 months), 1 patient has died (postoperative month 4 due to sepsis following a biliary stricture. The 3-month patient and graft survivals were 100%, and 1- and 2-year survivals, 90.0%. There was no episode of antibody-mediated rejection. The promising results of our initial experience may have been due to the use of preoperative rituximab and the good preoperative conditions of the patients.
Transplantation Proceedings 01/2013; 45(1):272-5. · 1.00 Impact Factor
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C-S Park,
S Hwang,
H-W Park,
Y-H Park,
H-J Lee,
J-M Namgoong,
S-Y Yoon,
S-W Jung,
G-C Park,
D-H Jung,
G-W Song,
D-B Moon,
C-S Ahn,
K-H Kim, T-Y Ha,
S-W Kwon,
S-G Lee
[show abstract]
[hide abstract]
ABSTRACT: Severe early graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). We have assessed the effectiveness of plasmapheresis (PP) as liver support for LDLT recipients with severe early graft dysfunction.
Of the 789 adult LDLTs performed between January 2007 and December 2009, 50 patients (6.3%) underwent PP as a supportive measure during the first month.
The mean time from LDLT to start of plasmapheresis was 11.2 ± 6.8 days (range 2-28). The 50 patients underwent 517 sessions of PP, or a mean of 10.3 ± 6.8 sessions per patient, over a mean 21.6 ± 9.4 days. Thirty-four patients (68%) required concurrent hemodiafiltration. Mean serum total bilirubin concentration before PP was 16.2 ± 6.7 mg/dL, peaking at 20.3 ± 7.9 mg/dL during PP, and decreasing to 13.4 ± 5.4 mg/dL 1 week after completion of PP (P < .001 compared with before PP). Except for prothrombin time, no other biochemical parameter was significantly altered by PP. There were no serious complications related to PP. Of the 50 patients, 17 (34%) died soon or a few months after PP. The 6-month graft survival rate after completion of PP was 66%; the overall 1-year patient survival rate was 64.0%.
PP appeared to have beneficial effects for LDLT recipients with severe early graft dysfunction, namely total bilirubin concentrations greater than 10 mg/dL.
Transplantation Proceedings 04/2012; 44(3):749-51. · 1.00 Impact Factor
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H W Park,
S Hwang,
C S Ahn,
K H Kim,
D B Moon, T Y Ha,
G W Song,
D H Jung,
G C Park,
J M Namgoong,
S Y Yoon,
C S Park,
Y H Park,
H J Lee,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: De novo malignancy is not uncommon after liver transplantation (OLT). We have compared the incidence of novo malignancy following OLT with those among the general Korean population.
Between January 1998 and December 2008, 1952 adult OLT were performed, including 1714 living donor and 238 deceased donor grafts whose medical records were retrospectively reviewed.
Among the 1952 patients, 44 (2.3%) showed de novo malignancies after a mean posttransplant period of 41 months. Among the 14 types of malignancy the most frequent was stomach cancer (n = 11; 25.0%), colorectal cancer (n = 9; 20.5%), breast cancer (n = 4; 9.1%), and thyroid cancer (n = 3; 6.8%). These patients underwent aggressive treatment, including surgery, chemotherapy, and radiotherapy, except for one patient with an aggressive primary liver cancer. Over a mean follow-up of 45 months after diagnosis of de novo malignancy, 13 patients (29.5%) died; the overall 3-year patient survival rate was 67.5%. The relative risk of malignancy following OLT was 7.7-fold higher in men and 7.3-fold higher in women than the Korean general population.
OLT recipients must be checked periodically for de novo malignancy throughout their lives, especially for cancers common in the general population.
Transplantation Proceedings 04/2012; 44(3):802-5. · 1.00 Impact Factor
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Y-H Park,
S Hwang,
H-W Park,
C-S Park,
H-J Lee,
J-M Namgoong,
S-Y Yoon,
S-W Jung,
G-W Song,
G-C Park,
D-H Jung,
C-S Ahn,
K-H Kim,
D-B Moon, T-Y Ha,
S-G Lee
[show abstract]
[hide abstract]
ABSTRACT: Adult liver transplantation (OLT) recipients occasionally show serious acute cardiopulmonary dysfunction, requiring intensive care. We assessed the role of extracorporeal membrane oxygenation (ECMO) support in adult recipients facing acute pulmonary failure and refractory to conventional mechanical ventilation and concurrent nitric oxide gas inhalation.
From January 2008 to March 2011, 18 adult OLT recipients at our institution required ECMO support: 12 due to pneumonia and 6 to adult respiratory distress syndrome. Their mean age was 55.7 ± 6.9 years and mean Model for End-stage Liver Disease score, 24.8 ± 8.5. Twelve patients had undergone living donor and six deceased donor OLT.
A venovenous access mode and concurrent continuous venovenous hemodiafiltration were used in all patients. There were no procedure-related complications. Eight patients (44.4%) were successfully weaned from ECMO upon the first attempt after a mean support of 11.9 ± 6.1 days, but the other 10 died due to overwhelming infection. Univariate analysis revealed no significant pre-ECMO risk factor for treatment failure but C-reactive protein concentration at the time of ECMO differed significantly among patients who did versus did not survive after ECMO.
ECMO as rescue therapy may be a final therapeutic option for OLT recipients with refractory pulmonary dysfunction who would otherwise die due to hypoxemia from severe pneumonia or adult respiratory distress syndrome.
Transplantation Proceedings 04/2012; 44(3):757-61. · 1.00 Impact Factor
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J W Jung,
S Hwang,
J M Namgoong,
S Y Yoon,
C S Park,
Y H Park,
H J Lee,
H W Park,
G C Park,
D H Jung,
G W Song, T Y Ha,
C S Ahn,
K H Kim,
D B Moon,
G Y Ko,
K B Sung,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: To assess the incidence and management of postoperative abdominal bleeding after orthotopic liver transplantation (OLT) and to identify risk factors for abdominal bleeding.
We retrospectively reviewed the medical records of 1039 patients who underwent OLT at our institution from January 2008 to December 2010 seeking to identify subjects with posttransplantation abdominal bleeding, defined as any hemorrhage requiring radiologic intervention or laparotomy within the first month.
Among the 1039 patients, 94 (9%) showed abdominal bleeding, occurring at a mean of 6.1 days (range, day 1 to 21 days). Active bleeding was controlled by endovascular interventional techniques (n = 37; 39%), by surgical ligation or vascular reconstruction (n = 43; 46%), or by sequential combinations of endovascular intervention and surgery (n = 14; 15%). The most frequent bleeding sites for radiologic intervention were the right inferior phrenic artery (n = 14), right and left epigastric arteries (n = 7), intercostal artery (n = 5) and right renal capsular artery (n = 4). The most frequent bleeding sites requiring laparotomy were the hepatic artery (n = 9), diaphragm (n = 8), inferior vena cava (n = 5), abdominal drain insertion site (n = 4), portal vein anastomosis site (n = 4), abdominal wall (n = 3), liver graft cut surface (n = 3), hilar plate (n = 3), and greater omentum (n = 3). Bleeding episodes were associated with greater patient age and increased intraoperative blood loss.
The risk of bleeding from coagulopathy and iatrogenic injury is high during the early posttransplantation period. This risk of bleeding can be minimized by meticulous surgical dissection and bleeding control.
Transplantation Proceedings 04/2012; 44(3):765-8. · 1.00 Impact Factor
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Transplantation Proceedings 03/2012; 44(2):520-2. · 1.00 Impact Factor
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C-S Ahn,
S Hwang,
D-B Moon,
G-W Song, T-Y Ha,
G-C Park,
J-M Namgoong,
S-Y Yoon,
S-W Jung,
D-H Jung,
K-H Kim,
Y-H Park,
H-W Park,
H-J Lee,
C-S Park,
S-G Lee
[show abstract]
[hide abstract]
ABSTRACT: Sufficient arterial flow after living donor liver transplantation (LDLT) is closely related to graft survival and prevention of postoperative complications. However, some unfavorable hepatic arterial conditions in recipients preclude reconstruction, requiring alternative stumps. We have used the right gastroepiploic artery (RGEA) as a first alternative for hepatic inflow.
From January 2006 to December 2008, we performed 754 LDLTs including 28 cases of RGEA among hepatic arterial anastomoses. The arterial anastomosis was performed by an single surgeon under 859 a microscope using an end-to-end interrupted suture technique. RGEA was mobilized over 15 cm from the greater curvature of stomach and greater omentum.
The indications for RGEA use included severe hepatic arterial injury from previous transarterial chemoembolization (n=14), need for additional arterial flow in dual-grafts LDLT (n=13), poor blood flow from the recipient hepatic artery (n=3), and arterial injury during hilar dissection (n=3). The mean diameter of the isolated RGEA was 2.0±0.2 mm (range: 1.0-2.5). Most hepatic arterial anastomoses were performed with a significant size discrepancy of more than twofold. All reconstructed hepatic arterial flowes showed good; no complication was identified during the mean follow-up period of 56 months to date.
Using RGEA as an alternative arterial inflow is a simple, reliable procedure for situations of inadequate recipient hepatic or multiple graft arteries.
Transplantation Proceedings 03/2012; 44(2):451-3. · 1.00 Impact Factor
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H-J Lee,
S Hwang,
C-S Ahn,
K-H Kim,
D-B Moon, T-Y Ha,
G-W Song,
D-H Jung,
G-C Park,
J-M Namgoong,
S-Y Yoon,
S-W Jung,
H-W Park,
C-S Park,
Y-H Park,
S-G Lee
[show abstract]
[hide abstract]
ABSTRACT: Anomalous portal vein (PV) branching in living donor livers is not uncommon and usually leads to double PV orifices of the right lobe grafts. We have assessed the long-term outcomes of portal Y-graft interposition for adult living donor liver transplantation (LDLT).
We retrospectively assessed the outcomes of 79 right-lobe LDLTs using portal Y-graft interposition among the 2001 adult LDLTs performed at our institution from January 2002 to December 2010.
Donor PV types were type III except for one case of type II. Sources of Y-grafts were recipient autologous PV in 76 LDLTs, fresh iliac vein allografts in two, and patch plasty using recipient greater saphenous vein in one. Detailed procedures included a portal Y-graft resection with Y-limbs, corner stay sutures, tying of suture materials under direct mechanical dilatation, and direct edge-to-edge anastomosis to the recipient remnant main PV. Early PV stenting was necessary in five patients (6.3%) due to stenosis or buckling deformity. During a mean follow-up of 42 months, all PVs remained patent until patient death or censoring. Overall 1-, 3-, and 5-year patient survival rates were 93.6%, 88.3%, and 85.5%, respectively. None of the 79 donors experienced major complications requiring reoperation or therapeutic intervention.
Due to their technical feasibility and excellent long-term outcome, portal Y-graft interposition should be considered a standard procedure for reconstruction of right-lobe grafts with double PV orifices.
Transplantation Proceedings 03/2012; 44(2):454-6. · 1.00 Impact Factor
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S Hwang,
C S Ahn,
K H Kim,
D B Moon, T Y Ha,
G W Song,
D H Jung,
G C Park,
J M Namgoong,
S Y Yoon,
S W Jung,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: After >2000 adult living donor liver transplants (LDLTs), we observed minimization of the complication rate using case-by-case modification of venous outflow reconstruction in right liver graft (RLG), standardization seeking intend to provide a hemodynamic- based, regeneration-compliant hepatic outflow reconstruction.
We retrospectively examined 100 consecutive adult LDLT using modified RLG before and after application of RLG standardization to compare the 6-month incidences of vascular outflow complications.
The right hepatic vein stenting rate for first 6 months was 5% in the customized group and 1% in the standardized group (P=.212). The middle hepatic vein stenting rate for first 6 months was 9% in the customized group and 4% in the standardized group (P=.373). The inferior right hepatic vein stenting rate for first 6 months was 12.8% in the customized group and 7.1% in the standardized group (P=.472). The overall 6-month patient survival rate was 94% in the customized group and 95% in the standardized group (P=.867). The overall incidence of significant RLG venous outflow complications was 19% in the customized group and 8% in the standardized group (P=.023).
Standardization as a universal graft model seemed to be more effective and feasible than conventional graft customization requiring individualized case-by-case modification.
Transplantation Proceedings 03/2012; 44(2):457-9. · 1.00 Impact Factor
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S Hwang,
Y D Yu,
G C Park,
Y I Choi,
P J Park,
S W Jung,
J M Namgoong,
S Y Yoon,
H S Ha,
J J Hong, [......],
J E Ma,
S Y Choi,
J S Yun,
D H Jung,
G W Song, T Y Ha,
D B Moon,
K H Kimy,
C S Ahn,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the safety of institutional protocol for ultra-rapid hepatitis B immunoglobulin (HBIG) infusion (10,000 IU in 30 minutes) for hepatitis B virus prophylaxis in adult liver transplant recipients.
In this case-controlled study, prospectively recruited liver transplant recipients received ultra-rapid infusions of HBIG (10,000 units in 30 minutes) for 6 months. The historical control group consisted of patients who had received 1-hour HBIG infusions (conventional rapid infusion) for the precedent 6 months.
We found that 1472 patients had received 5744 ultra-rapid HBIG infusions, whereas 1343 patients had received 5200 conventional rapid HBIG infusions. Adverse side-effects were observed after 7 (0.13%) and 9 (0.16%) infusions, respectively (P = .763). The number of infusions per month increased significantly, from 878 ± 34 before the introduction of ultra-rapid infusion to 957 ± 29 afterwards (P < .001), an increase of 10.5%. The maximal capacity of HBIG infusions per day in the outpatient clinic increased from 53 for conventional rapid infusion to 65 for ultra-rapid infusion, without expansion of the outpatient facility or equipment.
Nearly all adult liver recipients able to tolerate 1-hour infusions of HBIG can also tolerate ultra-rapid infusions well. Thus, it seems to be reasonable to perform ultra-rapid infusion protocol widely for patient convenience.
Transplantation Proceedings 06/2011; 43(5):1780-2. · 1.00 Impact Factor
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G C Park,
S Hwang,
Y D Yu,
P J Park,
Y I Choi,
G W Song,
D H Jung,
C S Ahn,
K H Kim,
D B Moon, T Y Ha,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: Although hepatitis A virus (HAV) infection is usually self-limited, it may induce fulminant hepatitis. We present an unusual case of a 40-year-old, otherwise healthy man with intractable recurrent HAV infection requiring retransplantation after primary liver transplantation for HAV-associated fulminant liver failure. After the first living-donor liver transplantation, allograft function recovered uneventfully; however, beginning at 35 days, his serum total bilirubin concentration increased, reaching 40 mg/dL, with a slight increase in liver enzymes. Detection of genomic HAV RNA in serum at the time of graft dysfunction led to a diagnosis of recurrent HAV infection. Fifty-one days after the first transplant, he underwent a deceased donor retransplantation. His allograft function recovered; the patient was discharged from the hospital. Sixty-five days later, however, he was readmitted for colitis-like symptoms and was again treated for acute rejection, but died owing to overwhelming sepsis and persistence of HAV infection. These findings indicate that patients who undergo liver transplantation for HAV-associated liver disease may be at risk of HAV reinfection, particularly if they require anti-rejection therapy. Routine measurements of anti-HAV immunoglobulin M and HAV RNA during the early posttransplant period in HAV-associated liver transplant recipients may differentiate reinfection from an acute cellular rejection episode.
Transplantation Proceedings 12/2010; 42(10):4658-60. · 1.00 Impact Factor
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S Hwang,
K H Kim,
G W Song,
Y D Yu,
G C Park,
K W Kim,
N K Choi,
P J Park,
Y I Choi,
D H Jung,
C S Ahn,
D B Moon, T Y Ha,
S G Lee
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the clinical utility of peritransplant in vitro assays of immune cell function in adult living donor liver transplant (LDLT) recipients.
In particular, we measured immune cell function, using the ImmuKnow assay, in 107 adult LDLT recipients and 200 potential living liver donors (control group) admitted to our center between July 2008 and January 2009.
In the control group, the mean proportion of T-helper/inducer cells was 36.8% ± 8.2%. The degree of immune response was strong in 12%, moderate in 77%, and low in 11%. In the study group, the degree of immune response within the first month was strong in 4.6%, moderate in 38.2%, and low in 57.2%, thus significantly lower than in the control group (P < .001). ImmuKnow results and tacrolimus levels did not show a significant correlation (r(2) = .002, P = .392). Although six patients showed biopsy-proven acute cellular rejection, none showed a strong immune response. Patients with overt infection showed a lower immune response.
These results indicate that peritransplant assessment of immune response using the ImmuKnow assay does not reliably predict the occurrence of acute rejection. Additional studies are necessary to accurately assess the clinical utility of immune response monitoring.
Transplantation Proceedings 09/2010; 42(7):2567-71. · 1.00 Impact Factor
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S Hwang,
S G Lee,
C S Ahn,
K H Kim,
D B Moon, T Y Ha,
G W Song,
D H Jung,
K W Kim,
N K Choi,
G C Park,
Y D Yu,
Y I Choi,
P J Park
[show abstract]
[hide abstract]
ABSTRACT: This study analyzed the effects of a recent increase in deceased donors on the pattern of adult liver transplantation (OLT) in a high-volume center in Korea.
OLT patterns relative to pretransplant recipient status were analyzed for 112 deceased donor LTs (DDLT) and 743 living donor OLT (LDLT) in a single center as compared to nationwide Korean data over 3 years from 2006 to 2008.
During the study period, the annual proportion of institutional urgent OLT was relatively invariable (20% to 25.2%), but the annual proportion of DDLTs to all OLT increased from 8.9% to 19.9%, as did the annual rate of DDLTs among those undergoing urgent OLT, from 18.6% to 65.8%, with a reciprocal decrease in the proportion of urgent LDLTs. Korean nationwide data also showed a noticeable increase in deceased liver graft allocation for urgency from 39.8% to 62.2% over the same time period.
An increase in deceased donors up to 5 per million enabled an increase in urgent adult DDLTs, alleviating the need for urgent adult LDLTs in Korea.
Transplantation Proceedings 06/2010; 42(5):1497-501. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: The purpose of this study was to explore the best parameter of hepatic vein (HV) Doppler ultrasounds (DUS) that correlated with echocardiographic findings of and particularly the optimal cutoff value for tricuspid regurgitation (TR) following liver transplantation (LT). Thirty-six patients underwent echocardiography and DUS after LT from January 2006 to July 2007. Echocardiographic records were searched for TR grade and peak velocity of TR flow. The HV DUS parameters included peak velocity of retrograde flow (R), peak velocity of antegrade flow (A), the difference between R and A (R-A), the ratio of R to A (R/A ratio), and a modified R/A ratio, namely, the product of the R/A ratio and the R/A duration ratio. Correlation tests and receiver-operator characteristic analyses explored their interrelations and to obtained cutoff values to diagnose moderate and severe TR. TR grade best correlated with the modified R/A ratio (rho = 0.585), followed by the R/A ratio (rho = 0.503) and R (rho = 0.455). The modified R/A ratio was the most accurate parameter for the diagnosis of moderate and severe TR (Az = 0.825 and 0.895, respectively); its cutoff value was > or =0.11 for moderate TR (sensitivity and specificity both 77.78%) and 0.13 for severe TR (sensitivity, 100%; specificity, 81.2%). The modified R/A ratio best correlated with echocardiographic results of TR, although the strength of correlation was only moderate. Additionally, the modified R/A ratio was an accurate DUS parameter to diagnose moderate and severe TR among patients following LT.
Transplantation Proceedings 12/2009; 41(10):4238-42. · 1.00 Impact Factor
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S Hwang,
S G Lee,
C S Ahn,
K H Kim,
D B Moon, T Y Ha,
K M Park,
G W Song,
D H Jung,
B S Kim,
K M Moon
[show abstract]
[hide abstract]
ABSTRACT: Following implantation into adult recipients, living donor liver grafts usually undergo liver regeneration. This regeneration process may provoke the growth of occult hepatocellular carcinoma (HCC) cells in the recipient body. To assess the risk of HCC recurrence, we analyzed the influence of graft-recipient weight ratio (GRWR).
The 181 recipients with HCC within the University of California at San Francisco (UCSF) criteria were divided into four groups according to GRWR: low GRWR (<0.8; n = 30), mid GRWR (0.8-1.0; n = 65), high GRWR (>1.0; n = 64), and whole liver graft group (>1.5; n = 22).
There were no differences in overall patient survival (P = .105) and recurrence-free survival (P = .406) among these four groups. GRWR <0.8 was not a significant risk factor for HCC recurrence. Similar outcomes were obtained in HCC patients who met the Milan criteria (n = 170).
We think that small living donor liver graft and subsequent liver regeneration do not increase the risk of posttransplant HCC recurrence when HCC is within the Milan or UCSF criteria.
Transplantation Proceedings 07/2007; 39(5):1526-9. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: Pulmonary complications frequently occur after liver transplantation, but the risk factors associated with them have not been fully determined. We therefore sought to identify risk factors for pulmonary complications among adult liver transplant recipients.
We retrospectively reviewed the medical records of 128 consecutive adult patients who underwent 131 liver transplantations during 2001. We evaluated the incidence, time of onset, and outcome of radiographically determined pulmonary complications, as well as the factors predictive of infectious complications.
Postoperative chest roentgenograms detected 68 cases of pulmonary complications, including pleural effusion (n = 50), atelectasis (n = 6), pneumonia (n = 6), pulmonary edema (n = 5), and acute respiratory distress syndrome associated with pneumonia (n = 1). Of the seven patients with pneumonia, five died. On univariate analysis the risk factors predictive for pneumonia were high serum creatinine and total bilirubin, hemodialysis at the time of occurrence, and history of acute rejection and on multivariate analysis increased total bilirubin and history of acute rejection. Pulmonary complications were dependent on the medical condition at the time of occurrence rather than on the preoperative condition.
Although the incidence of pneumonia in liver recipients was relatively low, the mortality rate in patients who developed this complication was high. High-risk patients undergoing liver transplantation thus require early diagnosis and intensive treatment to diminish the morbidity and mortality associated with pulmonary complications.
Transplantation Proceedings 12/2006; 38(9):2979-81. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: Questions have been raised regarding the ethics of liver transplantation in patients with alcoholic liver disease (ALD), including the fairness of cadaveric organ allocation to individuals who abuse alcohol and the efficacy of transplantation in these patients, many of whom may relapse. Living donor liver transplantation (LDLT) for ALD patients raises the similar ethical issues. ALD candidates for cadaveric liver transplants are required to abstain from alcohol for 6 months before being listed, but the efficacy of 6 months of abstinence in ALD patients receiving LDLT is not known.
We therefore determined the efficacy of 6 months of pretransplant abstinence in 15 ALD patients who underwent LDLT from February 1997 to December 2003.
The Model for End-stage Liver Disease score was 24 +/- 10, and mean pretransplant abstinence period was 15 +/- 13 months, with 11 (73.3%) patients being abstinent for at least 6 months. Four patients received dual grafts, making the number of living donors 19: 12 children, two wives, one brother, three nephews, and one aunt. There were no unrelated donors. Three patients showed a relapse to alcohol drinking. The overall 1-, 3-, and 5-year survival rates were 100%, 100%, and 87.5%, respectively, and the cumulative 1-, 3-, and 5-year relapse rates were 6.7%, 20%, and 20%, respectively. The relapse rates in patients who did and did not maintain 6 months of abstinence were 9.1% and 50%, respectively; this difference was not significant (P = .154), likely due to the small sample size. Younger recipient age was a significant risk factor for alcohol relapse (40 +/- 8 years versus 53 +/- 6 years; P = .004).
Pretransplant abstinence of 6 months seemed to be beneficial. For ethical reasons, a 6-month abstinence rule should be strictly observed in LDLT.
Transplantation Proceedings 12/2006; 38(9):2937-40. · 1.00 Impact Factor
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[show abstract]
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ABSTRACT: Seventh-day syndrome (7DS) is characterized by sudden failure of a liver graft that had been working normally at about 1 week after transplantation, without an identifiable cause. A nonnegligible percentage of cadaveric liver transplants have shown this type of acute graft failure, whereas 7DS has not been reported after living donor liver transplantation (LDLT). Among 580 adult LDLT recipients in our institution between 1997 and 2003, 3 (0.5%) showed clinical sequences typical of 7DS. All three recipients showed similar but unique clinical sequences, consisting of initial uneventful recovery, dramatic rise of serum liver enzyme levels about 1 week later despite potent antirejection therapy, and subsequent graft loss. Liver biopsy findings were compatible with massive hemorrhagic necrosis. Sustained fever lasting for 2 days preceded deterioration of liver function. All three patients died prior to the opportunity for retransplantation. Our findings suggest that, as in cadaveric donor liver transplantation, 7DS can also occur following LDLT and that a preceding episode of sustained fever may be a prodrome of 7DS although its pathogenesis is yet poorly understood.
Transplantation Proceedings 12/2006; 38(9):2961-3. · 1.00 Impact Factor
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K H Kim,
S G Lee,
Y J Lee,
K M Park,
S Hwang,
C S Ahn,
D B Moon, T Y Ha,
K W Song,
D S Kim,
D H Jung,
B S Kim,
K M Moon,
H J Lee,
J I Park,
J H Ryu
[show abstract]
[hide abstract]
ABSTRACT: Whole blood levels 2 hours after Neoral (C2) administration were observed to correlate better with area under the curve (AUC(0-4)) than trough levels (C0), suggesting that C2 may be the best single time point predictor of Neoral absorption. Owing to concerns about drug toxicity due to excessive immunosuppression, C2 adjustments to target blood levels may represent an advance. The present study measured C2 and levels to determine which correlated more closely with AUC(0-4).
Between August 2003 and July 2004, 40 adult liver transplantations were performed in our center. All patients received Neoral twice daily. They were maintained at a C0 level of about 200 ng/mL. C0 levels were measured daily. C2 levels were estimated on postoperative days 3, 5, 7, 14, and 28. AUC(0-4) performed on postoperative days 3, 7, and 28 was calculated using the trapezoidal rule.
The mean AUC(0-4), C0, C1, C2, C3, and C4 were 1100.3 +/- 484.8 ng/mL, 197.1 +/- 84.7 ng/mL, 240.7 +/- 166.2 ng/mL, 307.8 +/- 162.6 ng/mL, 302.8 +/- 138.9 ng/mL, and 300.3 +/- 142.8 ng/mL, respectively. C2 correlated with AUC(0-4) (R2 = 0.868: P < .05) better than C0 (R2 = 0.245: P < .05), C1 (R2 = 0.604: P < .05), or C4 (R2 = 0.583: P < .05).
Neoral dose monitoring according to a mean C2 range of 307.8 +/- 162.6 ng/mL correlated better with AUC(0-4). Further studies are required to determine suitable C2 levels in liver transplant patients.
Transplantation Proceedings 11/2006; 38(9):2971-3. · 1.00 Impact Factor
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ABSTRACT: Accidental slippage of vascular clamps during living donor hepatectomy can induce brisk bleeding and even imperil the donor. After practicing more than 1000 cases of living donor hepatectomy, the investigators realized that specialized suture techniques were important to secure the vascular closure to prevent unnecessary bleeding. For secure division of intrahepatic vein branches, we devised a continuous penetration suture method in which the orders of procedures were changed to clamping-closure-cut sequence. For secure division of the main and accessory hepatic vein branches from the inferior vena cava, we applied stay sutures at each corner and midpoint of the hepatic vein stump so as not to permit its slippage. After application of these methods, we did not experience any episode of accidental clamp slippage. We are sure that these suture techniques are beneficial to prevent unnecessary bleeding during living donor hepatectomy and to make surgeons feel at ease during the living donor operation.
Transplantation Proceedings 01/2006; 37(10):4347-9. · 1.00 Impact Factor
