YF Cheng

Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan

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Publications (136)240.99 Total impact

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    ABSTRACT: Portal vein (PV) steno-occlusive disease is a known vascular complication after liver transplantation. The use of portal venous stenting (PVS) is encouraging because it provides longer vessel patency. The purpose of this study is to assess the therapeutic usefulness of self-expandable PVS in pediatric living donor liver transplantation (LDLT) recipients with PV complications. Between July 2008-July 2011, twelve pediatric recipients (M/F: 2/10; mean age=3.3 years; range=9months-9.8 years) were diagnosed to have anastomotic stenosis of the portal vein (4 occlusions and 8 stenoses). PVS with self-expandable metallic stents (SEMS) were deployed where the size varied from 7.0-10.0 mm in diameter. The mean follow-up time was 26 months (0-36 months). After deployment of SEMS, the mean PV diameter was expanded to 72% of the original diameter (4.2-8.0 mm) and then increased to 85% (5.5-9.3 mm) at 6 months, 90% (6.1-9.5 mm) at 12 months, and 91% (6.5-9.1 mm) at 24 months and at almost full expansion of 94% (7.0-9.6 mm) at 36 months follow-up. The stent patency rate was 100%). In small pediatric patients, despite the continued growth of pediatric recipients, the long-term patency of the gradually self-expandable metallic stents is able to maintain enough PV flow to accommodate the physiological function of the donated liver grafts.
    No preview · Article · Mar 2015
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    ABSTRACT: Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache. Typical abnormal magnetic resonance imaging (MRI) findings have been considered to be the sine qua non of SIH, but a sizeable minority of patients has normal results using conventional MRI. The purpose of this study was to evaluate the difference in cerebrospinal fluid (CSF) flow dynamics between patients and healthy people using cine phase contrast (PC) MRI, and to assess the CSF flow dynamics in patients before and after treatment. From November of 2007 to December of 2012, twenty patients with SIH (10 men and 10 women, mean age = 40.9 ± 7.77 years) and 31 age- and gender-matched healthy subjects (15 men and 16 women, mean age = 46.3 ± 7.53 years) were enrolled in this retrospective study. Cine PC MRI was performed on the patients and on the healthy subjects to measure the CSF flow in cerebral aqueduct. Patients underwent repeated cine PC MRI at 24 hours and at one month after treatment respectively. Five parameters including peak positive and negative velocity, average flow, and average positive and negative flow were recorded to evaluate their differences. Seventeen patients (85%) received epidural blood patching (EBP) owing to the failure of conservative treatment. All patients experienced resolution of symptoms after treatment. Before treatment, the patients had a significantly lower average CSF flow than the healthy subjects (p< 0.001). The average CSF flow was elevated in patients with SIH at 24 hours after treatment and was significantly increased one month after treatment (p= 0.003). By establishment of the receiver operating characteristic (ROC) curve, the best cutoff value for the average CSF flow was determined to be 14.0μl/beat, while the sensitivity and specificity were determined to be 90.3% and 72.2%, respectively. Patients with SIH showed lower CSF flow compared to healthy subjects, but this decreased CSF flow was shown by cine PC MRI to be gradually recovered after treatment. This study provides evidence that cine PC MRI is useful for assessing the dynamic changes of CSF flow in the cerebral aqueduct noninvasively and for demonstrating the effectiveness of treatment in patients with SIH reliably.
    No preview · Article · Sep 2014
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    ABSTRACT: Adipose-derived mesenchymal stem cells (ASCs) have been considered to be attractive and readily available adult mesenchymal stem cells (MSCs) and are becoming increasingly popular for use in regenerating cell therapy. However, recent evidence attributed a fibrotic potential to MSCs which differentiated into myofibroblasts with highly increased α-smooth muscle actin (α-SMA) expression while transplanted into an injured/regenerating liver in mice. In this study, we studied the role of miR-27b in ASCs and their regenerative potential after partial liver resection in rats. ASCs transfected with control siRNA or miR-27b were intravenously injected into autologous rats undergoing 70% partial hepatectomy (PH). Our data showed that the regenerative capacities of ASCs with overexpressed miR-27b were significantly higher compared with control ASCs. However, the enhanced regeneration, hepatic differentiation, and suppressed liver inflammation, as well as fibrotic activity, were significantly reverted by ZnPP coadministration (heme oxygenase-1 [HO-1] inhibitor) indicating an important role of HO-1 in the regenerating and cytoprotective activities of miR-27b–transfected ASCs. We demonstrated that administration of autologous ASCs overexpressed with miR-27b enhances rapid and early liver regeneration and, importantly, preserves function after PH. The ASCs with miR-27b overexpression might offer a viable therapeutic option to facilitate rapid recovery after liver resection.
    No preview · Article · May 2014 · Transplantation Proceedings
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    ABSTRACT: Objective Hepatic steatosis can cause substantial problems for both donors and recipients in living donor liver transplantation (LDLT). The aim of this study is to evaluate the accuracy of the magnetic resonance IDEAL (iterative decomposition of water and fat with echo asymmetry and least squares estimation) sequence in quantifying the liver fat during LDLT. Materials and Methods A total of 63 liver donors (29 men and 34 women ranging from 18 to 47 years old with a mean age of 30) who received both magnetic resonance imaging (MRI) and intraoperative liver biopsy were enrolled in this study. MR IDEAL IQ sequences were performed by 1.5-T MRI (Discovery 450; GE Healthcare, Milwaukee, Wis, United States) to estimate the liver fatty content. Accuracy was assessed through linear regression between fat fraction image and pathology grading. Sensitivity and specificity of MR IDEAL IQ fat fractions were also calculated. Results A total of 63 LDLTs were performed and with pathology grading. No fatty content was found in 48 donors (76.2%; group 1), 5% to 10% fatty liver in 11 donors (17.4%; group 2), 11% to 15% fatty liver in 2 donors (3.2%; group 3), and >16% fatty change in 2 donors (3.2%; group 4). MR IDEAL fat fraction results were excellent in prediction of the normal and fatty content and with good correlation with the pathology grading (2.9 ± 0.9, 8.3 ± 4.2, P < .0001). Linear regression between IDEAL image and pathology grading indicated a high accuracy rate (R2 = 0.813, R2 = 0.9286) for all 4 groups. The sensitivity and specificity for detection of liver steatosis in MRI fat fraction image were 100% and 77.1% (P < .0001, 95% confidence interval 0.000–1.000). Conclusion MR IDEAL IQ sequencing is a highly precise and accurate method in quantifying hepatic steatosis for the living donor.
    No preview · Article · Apr 2014 · Transplantation Proceedings
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    ABSTRACT: The acoustic radiation force impulse elastography (ARFI) is a new technology of elastography integrated into B-mode ultrasonography. It has been a reliable method to evaluate liver fibrosis of chronic liver disease in recent years, but less applied in the posttransplantation liver. The aim of the study was to evaluate liver fibrosis by the ARFI with correlation of pathological stages in living donor liver transplantation (LDLT). From August 2010 to August 2012, there were 57 LDLT patients with liver biopsy (LB) due to posttransplantation dysfunction; all patients also received posttransplantation ARFI liver stiffness measurement (LSM) after transplantation for liver fibrosis staging. The ARFI elastography was performed using a Siemens Acuson S2000 ultrasound system with 4V1 transducers (Acusion, Siemens Medical Systems Co. Ltd. Erlangen, Germany). The ARFI LSM value was presented by shear wave velocity (SWV, m/s). The fibrosis staging as F0 to F4 was in accordance with the Metavir scoring system. A total of 57 patients had both posttransplantation LB and effective ARFI fibrosis staging for correlation. The ARFI LSM value increased with severity of liver fibrosis and had significant linear correlation with the results of histological fibrosis staging. The ARFI LSM sensitivities (Se), specificities (Sp), and cutoff values based on receiver-operator characteristic curve were F0: 0.75 m/s (Se: 93.8%, Sp: 4%), F1: 1.06 m/s (Se: 95.5%, Sp: 25.7%), F2: 1.81 m/s (Se: 50%, Sp: 83.6%) and F3: 2.33 m/s (Se: 100%, Sp: 92.9%). Predictive value of ARFI LSM reported a significant difference between early fibrosis stage (F0-F1) and advanced fibrosis stage (F ≧ 2) (P < .05). In this study, ARFI demonstrated a strong linear correlation and severity of liver fibrosis with LB pathologic staging. ARFI can be an alternative and compensatory method for frequent LB in the posttransplantation liver.
    No preview · Article · Apr 2014 · Transplantation Proceedings
  • P.-Y. Yu · M.-H. Chen · H.-Y. Ou · T.-L. Huang · C.-Y. Yu · C.-L. Chen · Y.-F. Cheng
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    ABSTRACT: Background The recipient's hepatic vascular anatomy is essential in living-donor liver transplantation (LDLT). Magnetic resonance angiographic inflow-sensitive inversion recovery (IFIR-MRA) is a new noncontrast technology for vascular evaluation, particularly for those patients with renal function impairment. The purpose of this study was to improve the image quality with different blood suppression inversion time (BSP TI) settings. Methods From October 2012 to March 2013, 21 recipient candidates underwent IFIR-MRA with the use of the GE 1.5T-Discovery 450 for LDLT preoperation evaluation with different BSP TI settings. Subjective visualized image quality and depiction of hepatic arteries, portal veins, and inferior vena cava (IVC) were all evaluated on a vessel-to-vessel basis. A paired t test analysis was used to assess the difference in grading scales between the different BSP TI settings in IFIR-MRA. Results The 21 recipients (4 female, 17 male) had a mean age of 53.43 ± 11.07 years. A significant difference (P < .001) existed in the arterial depiction scores between BSP TI 1,000 ms (3.10 ± 0.70) and BSP TI 1,400 ms (3.57 ± 0.7). There were no significant differences of quality scores in artery (3.71 ± 0.56 vs 3.48 ± 0.60), portal vein (3.57 ± 0.60 vs 3.48 ± 0.51), and IVC (2.71 ± 1.19 vs 2.76 ± 1.09), and no significant differences of depiction scores in portal vein (2.29 ± 0.46 vs 2.48 ± 0.51) and IVC (1.57 ± 0.68 vs 1.62 ± 0.15). Conclusions The images with BSP TI 1,400 ms were the most optimal for IFIR noncontrast MRA imaging in LDLT. This new technology can replace traditional contrast-enhanced MRA, especially for patients with renal function impairment.
    No preview · Article · Apr 2014 · Transplantation Proceedings
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    ABSTRACT: Objective The relationship between portal pressure and small-for-size syndrome (SFSS) is unsettled. The purpose of this study was to evaluate the role of portal pressure in predicting SFSS. Methods Thirty-four patients with end-stage liver disease who received adult-to-adult living-donor liver transplantation (ALDLT) were included. Recipients were grouped based on whether they received portal flow modulation or not. The intraoperative portal vein flow volume (PVFV) and portal venous pressure (PVP) between the 2 groups were compared. The relationship of PVP to PVFV, graft weight-to-recipient weight ratio (GRWR), and graft weight-to-recipient spleen size ratio (GRSSR) were analyzed. Results Persistent portal hypertension was found after ALDLT. The PVP was linearly correlated with PVFV but not with GRWR or GRSSR. With the use of the following criteria, (1) PVFV >250 mL/min/100 g graft weight, (2) GRWR <0.8%, and (3) GRSSR <0.6, modulation of the portal flow was performed in 3 cases. The receiver operating characteristic analysis showed that 23 mm Hg was the cutoff point for PVP, with a sensitivity of 83% and specificity of 43%. Conclusions PVP is a weak parameter to use for portal flow modulation after ALDLT. It is sensitive but not specific to predict SFSS.
    No preview · Article · Apr 2014 · Transplantation Proceedings
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    ABSTRACT: Objective This study aimed to determine whether coronary vein size can serve as a predictor of hemodynamic instability during inferior vena cava clamping in living-donor liver transplantations. Methods Fifty-two patients' hemodynamic data before and after clamping were retrospectively analyzed and compared with the use of linear regression and repeated measurement. Data included arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, stroke volume, stroke volume variation, and systemic vascular resistance. Results The values of hemodynamic parameters at 1, 3, 10, and 30 minutes after clamping were compared with baseline data. All changes were found to be significant when the presence of the coronary vein was not considered. When the coronary vein was taken into consideration, linear regression analysis showed that only the percentage changes of cardiac index; stroke volume at 1, 3, and 10 minutes; and systemic vascular resistance at 1 minute after portal and inferior vena cava clamping were significantly correlated with the presence of the coronary vein. Conclusions Coronary vein size is a weak predictor of hemodynamic tolerability and instability during portal vein and inferior vena cava clamping in this kind of surgery.
    No preview · Article · Apr 2014 · Transplantation Proceedings
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    ABSTRACT: Objective Due to the shortage of cadaver liver grafts in Asia, more than 90% of biliary atresia (BA) patients require living donor liver transplantation (LDLT), but the factors that influence liver graft regeneration in pediatric patients are still unclear. The aim of this study was to evaluate the potential predisposing factors that encourage liver graft regeneration in pediatric liver transplantation (LT). Methods Case notes and Doppler ultrasound and computed tomography studies performed before and 6 months after transplantation of 103 BA patients who underwent LDLT were reviewed. The predisposing factors that triggered liver regeneration were compiled from statistical analyses and included the following: age, gender, body weight and height, spleen size, graft weight–to–recipient weight ratio (GRWR), post-transplantation total portal flow, and vascular complications. Results Seventy-two pediatric recipients were enrolled in this study. The liver graft regeneration rate was 29.633 ± 36.61% (range, −29.53–126.27%). The size of the spleen (P = .001), post-transplantation portal flow (P = .004), and age (P = .04) were correlated lineally with the regeneration rate. The GRWR was negatively correlated with the regeneration rate (P = .001) and was the only independent factor that affected the regeneration rate. When the GRWR was >3.4, patients tended to have poor and negative graft regeneration (P = .01). Conclusion Large-for-size grafts have negative effect on regeneration rates because liver grafts that are too large can compromise total portal flow and increase vascular complications, especially when the GRWR is >3.4. Thus, optimal graft size is more essential than other factors in a pediatric LDLT patient.
    No preview · Article · Apr 2014 · Transplantation Proceedings
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    ABSTRACT: Background: Early pulmonary edema is common after orthotopic liver transplantation. Associated pathogenic mechanisms might involve increased activity of cardiac-inhibitory systems due to increased vasodilator production, mainly nitric oxide (NO). NO is primarily responsible for flow-mediated vasodilatation (FMD). We investigated the incidence of pulmonary edema in liver transplant patients and its correlation with FMD. Methods: We prospectively evaluated traditional risk factors, Doppler echocardiographic findings, derived hemodynamic data, and brachial artery nitroglycerin-induced vasodilatation (NTD) and FMD within 1 week prior to liver transplantation in 54 consecutive liver transplant patients with cirrhosis. Post-transplantation chest roentgenography was performed daily. In-hospital outcomes, transfusion volume of blood components, and hemodynamic data during surgery and at the intensive care unit were analyzed. Results: Twenty-nine patients (53.7%) developed radiological pulmonary edema within 1 week of transplantation. Diffuse-type interstitial and alveolar pulmonary edema constituted 13 cases (24.1%). Patients with pulmonary edema had higher pretransplantation Child-Turcotte-Pugh scores (p = 0.01), cardiac output (p = 0.03), FMD (p < 0.01), NTD (p = 0.01), and FMD/NTD ratio (p = 0.02). Although the total volume of intravenous fluid transfused was higher in the pulmonary edema group, the net fluid retention during surgery was statistically insignificant. The lengths of intensive care unit stay and hospitalization, as well as mortality rates, were not different in these groups. FMD is the only significant predictor associated with pulmonary edema by the step-wise multiple logistic regression analysis. Conclusions: The high incidence of pulmonary edema after living donor liver transplantation was associated with a high FMD and hyperdynamic state at pretransplantation. Cirrhotic cardiomyopathy may be a predictor for this patient population.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Background: Early pulmonary edema is common after orthotopic liver transplantation. Associated pathogenic mechanisms might involve increased activity of cardiac-inhibitory systems due to increased vasodilator production, mainly nitric oxide (NO). NO is primarily responsible for flow-mediated vasodilatation (FMD).We investigated the incidence of pulmonary edema in liver transplant patients and its correlation with FMD. Methods: We prospectively evaluated traditional risk factors, Doppler echocardiographic findings, derived hemodynamic data, and brachial artery nitroglycerin-induced vasodilatation (NTD) and FMDwithin 1week prior to liver transplantation in 54 consecutive liver transplant patients with cirrhosis. Post-transplantation chest roentgenography was performed daily. In-hospital outcomes, transfusion volume of blood components, and hemodynamic data during surgery and at the intensive care unit were analyzed. Results: Twenty-nine patients (53.7%) developed radiological pulmonary edema within 1 week of transplantation. Diffuse-type interstitial and alveolar pulmonary edema constituted 13 cases (24.1%). Patients with pulmonary edema had higher pretransplantation Child-Turcotte-Pugh scores (p = 0.01), cardiac output (p = 0.03), FMD (p < 0.01), NTD (p = 0.01), and FMD/NTD ratio (p = 0.02). Although the total volume of intravenous fluid transfused was higher in the pulmonary edema group, the net fluid retention during surgery was statistically insignificant. The lengths of intensive care unit stay and hospitalization, aswell as mortality rates,were not different in these groups. Conclusions: The high incidence of pulmonary edema after living donor liver transplantation was associated with a high FMD and FMD/NTD ratio at pretransplantation. FMD is the only significant predictor associated with pulmonary edema. However, we observed no alteration in mortality rates.
    No preview · Article · May 2013 · Acta Cardiologica Sinica
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    ABSTRACT: This is a retrospective study. The purpose of this study was to assess the diagnostic accuracy and utility of posttransplant magnetic resonance cholangiography (MRC) in detecting biliary complications and planning the treatment. From July 2006 to April 2010, 51 (19%) of these 268 adult living-donor liver transplantation (LDLT) recipients were referred to MRC due to biliary dilatation and abnormalities detected by ultrasound or abnormal liver function. The biliary complications were treated with endoscopic or percutaneous transhepatic approach. Among those 51 recipients, MRC revealed no definite biliary pathology in 34 patients. In 10 of the 34 MRC-negative cases, additional MR angiography showed vascular stenosis. 15 MRC-positive cases were correctly assessed the site of the obstruction, bile leakage or lithiasis. Under MRC guidance, biliary interventions were completed in 12 of the MRC-positive cases. MRC achieved sensitivity of 100%, specificity of 94.4%, positive predictive value of 88.2%, and negative predictive value of 100%. MRC is a reliable diagnostic modality in detecting post-transplant biliary complications with 96.1% accuracy. It is an essential diagnostic tool for assessing the necessity for interventional procedure. MR angiography can provide additional information on vascular problems that caused biliary complications. Magnetic resonance imaging (MRI) is thus indispensable before therapeutic biliary or vascular procedure in post-transplant recipients.
    No preview · Article · Mar 2013
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the second leading cause of cancer related death in Taiwan. However, HCC recurrence after living donor liver transplantation (LDLT) is an undesirable outcome, and the treatment is controversial due to different recurrent patterns. The aim of this study is to evaluate the efficacy of transarterial embolization (TAE) for HCC recurrence after LDLT. From March 2003 to February 2011, 217 patients received LDLT for HCC under Milan/UCSF criteria in Kaohsiung Chang Gung Memorial Hospital. The clinical profiles, imaging features, histopathologic diagnosis, treatment methods and outcomes of HCC recurrence after LDLT were retrospectively analyzed. TAE was performed with a microcatheter system to protect hepatic artery anastomosis. The endpoint of this study was survival from time of recurrence. Recurrences were found in 15 patients (6.9%) with LDLT for HCC, and were divided into three groups by treatment. Group 1 (n=2) was surgical resection for localized extrahepatic recurrence. Group 2 (n=4) was TAE for intrahepatic recurrence. Group 3 (n=9) was systemic chemotherapy, radiation therapy or conservative treatment for multiple intrahepatic or extrahepatic recurrence. Kaplan-Meier survival estimates showed that the 6- and 12-months survival after recurrence in groupl, 2, 3 was 100%, 75%, 55.5% and 100%, 37.5%, 0% Surgery had significant benefit on survival after recurrence for solitary or localized resectable recurrence. TAE may have an effect in the loco-regional control of intrahepatic recurrence to prolong survival, even where limited extrahepatic metastasis could be controlled by other treatment. Multiple metastasis was usually unresponsive to chemotherapy and/or radiation therapy with shorter survival after recurrence.
    No preview · Article · Sep 2012
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    ABSTRACT: The aim of this study was to evaluate portal vein stenosis (PVS) in pediatric liver transplantation (PLT) using Doppler ultrasound (DUS) before and after interventional management for hemodynamic changes. From 2000 to 2010, we encountered 11 PVS cases among 180 PLT that were evaluated using DUS and computed tomography (CT) angiography (CTA); all underwent portal stenting. DUS was used to monitor portal hemodynamics. For the diagnosis of PVS, we investigated multiple parameters including stenotic size (SS), stenotic ratio (SR) (SR [%]=PRE-SS/PRE [PRE=stenotic size]), portal flow velocity ratio (VR) (VR=VS/PRE [PRE=velocity at prestenotic site; VS=peak velocity at stenotic site]), spleen size, and platelet count. The incidence of PVS was 5.6% (11/180). The PV was 2.5 mm using DUS and 2.7 mm using CTA. The average SR was 65% fitting the criterion. Low prestenotic portal flow<12 cm/sec and high peak velocity in the stenotic segment (up to 147 cm/sec) were observed in 6 cases. The VR value was high at 7.5:1 and there was splenomegaly with thrombocytopenia. After portal vein stenting, hyperperfusion occurred might after reopening the stenosis: the flow increased to an average of 34 cm/sec and then flow decreased slowly to a stable level 2 weeks later. The size of the spleen decreased from 17 to 12 cm and the thrombocytopenia also improved with platelet counts increasing from 67×10(3) to 178×10(3)/μl at 2 months follow-up. The changes in portal flow, portal vein size, spleen size, and platelet count were significant (P<.05). PVS is diagnosed using DUS by increased intrahepatic PV dilatation, peak flow at the stenotic site, discrepant VR. Early portal stenting showed a better prognosis. DUS is essential and effective for hemodynamic monitoring and management of PVS.
    Full-text · Article · Mar 2012 · Transplantation Proceedings
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    ABSTRACT: Recent proteomic approach allows us to target on specific molecules underlying the common mechanism between experimental and clinical liver allograft tolerance. Especially, new insight has been gained from our studies since we found that post-transplant autoimmune responses with high titer of anti-nuclear antibodies against histone H1 and high mobility group box 1 (HMGB1) play an important role in the induction of liver allograft tolerance in OLT rats and clinical drug-free OLT patients. Our previous studies showed that either treatment of recipient rats with commercially available histone H1 polyclonal Ab or immunization with calf thymus histone H1 could prolong allograft survival in heterotopic heart transplantation. We have also reported that the blockade of histone H1 modulated dendritic cells toward tolerogenic status, decreased the cytotoxicity of lymphokine activated killer and natural killer cells, and induced CD4+CD25+ T-cells. For further analysis of this mechanism, we generated an immunosuppressive histone H1 monoclonal Ab (16G9 mAb) and determined one peptide (designated SSV) that binds directly to 16G9 mAb. The binding of SSV to 16G9 mAb or serum of both tolerogeneic OLT rats and clinical drug-free OLT patients, was inhibited by histone H1. Furthermore, immunization of mice with SSV induced immunosuppression in serum, suggesting that SSV was an epitope responsible for the immunosuppressive activity of 16G9 mAb. 16G9 mAb and peptide SSV will allow us to establish a novel diagnostic and therapeutic strategy in transplantation. This article reviews our work exploring how the autoimmune response against nuclear proteins is involved in liver transplantation immunology.
    No preview · Article · Jan 2011 · Current Trends in Immunology
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    ABSTRACT: To evaluate the postoperative portal vein stenosis (PVS) and the diagnostic efficiency of Doppler ultrasound (DUS) in adult living donor liver transplantation (ALDLT). From January 2007 to December 2008, 103 ALDLTs were performed and postoperatively followed by routine DUS. The morphologic narrowing at the anastomotic site (AS) of the PVS was analyzed. We calculated the PV stenotic ratio (SR) using the following formula: SR (%)=PRE-AS/PRE (PRE=pre-stenotic caliber). An SR>50% was defined as the critical point for PVS. We also calculated the velocity ratio (VR) between the AS and PRE, and set the significant VR as >3:1. Statistical analyses were carried out to determine clinical significance. Using the definition of morphologic PVS by DUS, there were total 20 cases (19.4%) in this series with SR>50%, which included 17 cases with VR>3:1. Eight cases of severe PVS had a stenotic AS>5 mm and subsequently underwent interventional management. Doppler criteria of SR and VR values were elevated up to 75.8% and 7.5:1, respectively, in these treated cases. Two cases of severe PVS subsequently developed PV thrombosis. Intervention by balloon dilation and/or stenting was performed successfully in this PVS case. DUS is the most convenient and efficient imaging modality to detect and follow postoperative PVS in ALDLT. The Doppler criteria of SR and VR are both sensitive but less specific. Cases of AS<5 mm require interventional management for good long-term graft survival.
    No preview · Article · Apr 2010 · Transplantation Proceedings
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    ABSTRACT: The study aimed to retrospectively review sonographic features of extra-articular giant cell tumor of the tendon sheath (GCTTS), and developed a grouping system for facilitating differential diagnosis. From January 2005 to December 2009, 15 pathologically proven extra-articular GCTTS in 15 patients were encountered in our hospital. According to the tumor sites and their sonographic features, we categorized the sonographic findings into three types: superficial type (tumor attaching to the tendon but no complete encasement of it), encasing type (tumor completely encasing the tendon) and juxta-fascial type (tumor without attachment to the tendon). The demographic data, clinical presentation symptom, sonographic feature and color or power Doppler flow in each type of the patients were documented. Histopathologically, the localized or diffuse form of GCTTS was also recorded. The incidences of sonographic presentation in the superficial, encasing and juxta-fascial types of GCTTS were 46.7% (n=7), 33.3% (n=5) and 20.0% (n=3), respectively. The masses in the encasing type manifested with largest average size. The most common location of GCTTS in the superficial and encasing types was the hand. The 3 juxta-fascial type GCTTS were located in the subcutis of the hand and buttock, and the subfascial region of the forearm. On sonography, all GCTTS presented as hypoechoic masses with homogeneous or heterogeneous echogenicity. The tumors in the superficial and encasing types were eccentrically located to the related tendon and their superficial components were always disproportionally predominant. Bony erosion was found in three masses. No dermal attachment, decreased or increased sound through transmission, calcified or cystic component were noted in all masses. Only 26.7% of GCTTS demonstrated hypervascularity within the tumors. The two largest tumors were in encasing type and reported to be diffuse form microscopically. Two patients underwent recurrence, one with mass in superficial type and another in encasing type. We concluded that extra-articular GCTTS typically appears as a hypoechoic mass with heterogeneous or homogeneous echogenicity and intimate contact with the abutting tendon or fascia. The diffuse form GCTTS should be considered if a characteristic mass presented with larger size, lobulated or irregular contour, complete encasement of the related tendon and hypervascularity. Besides, differential diagnosis of a well-defined and fascia-attached mass should include juxta-fascial type GCTTS.
    No preview · Article · Mar 2010
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    ABSTRACT: Placenta previa accreta, the combination of placenta previa and placenta acrreta, can cause life-threatening massive post-partum hemorrhage (PPH) and may require emergent hysterectomy. Intraoperative transcatheter arterial embolization (TAE) performed after fetal delivery and before placenta expulsion can significantly reduce blood loss and preserve the uterus. However, TAE may fail under the status of hemorrhagic shock, vasospasm of the uterine arteries, and disseminated intravascular coagulopathy (DIC) due to immediate blood loss after placental delivery. We describe two cases of pregnancy complicated by placenta previa accreta and embolization was performed via different approaches to control bleeding. Emergent TAE failed in the first patient due to impending shock, vasospasm of the uterine artery and DIC. Eventually, an emergent hysterectomy was performed in this patient. Preoperative insertion of a 5 French right femoral arterial angiosheath was done in the second patient. It was easier to perform intraoperative TAE and the blood loss was much less. In our case, insertion of a right femoral arterial sheath before cesarean section with subsequent UAE after fetal delivery is an effective method to control the post-partum hemorrhage due to placenta previa accreta. It may reduce blood loss, preserve ovary function and the patient's uterus for further fertility.
    No preview · Article · Sep 2009
  • H.-Y. Ou · T.-L. Huang · T.-Y. Chen · L.L.-C. Tsang · Y.-F. Cheng
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    ABSTRACT: Our aim is to review the imaging findings of glycogen storage disease (GSD), both pre and post liver transplantation. From March 1996-October 2006, 13 living donor liver transplantation and one split liver transplantation for GSD were performed. The transplant records were reviewed. There were 9 female and 5 male patients. All were non-responsive to medical treatment. Ten patients had GSD type I and 4 had GSD type III. All type I patients were subtype Ia. Of the 4 children with type III, 2 were subtype IIIa based on debranching enzyme deficiency in the liver and muscle tissue biopsies. In 2 GSD type III patients, only liver biopsies were done. The mean age, weight, and height were 8.2 years, 23 kg and 114 cm respectively. The mean liver volume was 1366 cm 3. The imaging findings in GSD type I were hepatomegaly (10/10), enlarged kidney (10/10), increased renal medullary echogenicity (10/10), hypervascularity of the hepatic tumor (2/10), nephrocalcinosis (1/10), and splenomegaly (1/10) before liver transplantation. Post liver transplantation, the increased renal medulla echogenicity and spleen size both return to normal. In GSD type III, the imaging findings included hepatomegaly (4/4), enlarged liver with lobulated contour (1/4), and splenomegaly (1/4). The spleen size reverted to normal size post liver transplantation. In summary, the common imaging findings in GSD type I include hepatomegaly without cirrhotic change and nephromegaly with increased echogenicity of the renal medulla. In contrast, in GSD type III, the findings revealed hepatomegaly without nephromegaly. Post liver transplantation, the increased renal medulla echogenicity and spleen size both return to normal.
    No preview · Article · Mar 2009
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    ABSTRACT: The purpose of this study was to assess factors influencing the end-tidal concentrations of isoflurane within a bispectral index (BIS) range of 45–55 among healthy live liver donors (n = 11), chronic hepatitis B patients undergoing hepatectomy hepatocellular carcinoma (n = 10), and end-stage liver disease patients undergoing liver transplantation (n = 7). Patients data collected prospectively were compared among the groups using one-way analysis of variance as well as univariate and multivariate techniques. The results showed that end-stage liver disease patients required the least end-tidal isoflurane concentration. Patients with hepatocellular carcinoma with cirrhosis required intermediate end-tidal isoflurane concentrations; healthy live liver donors required the highest end-tidal isoflurane concentrations to provide sufficient anesthetic depth, as monitored by a target BIS (range, 45–55). Upon multivariate analysis, liver function was the only significant factor influencing the likelihood of lowering the end-tidal isoflurane concentration by 4 hours after anesthesia induction (P = .026). In conclusion, we recommend a preset target BIS within the range of 45–55 to monitor the depth of anesthesia during partial hepatectomy and liver transplantation because end-tidal isoflurane concentration requirements are different for patients with various liver status. This strategy may protect the patients from intraoperative recall or anesthesia over-depth as a consequence of insufficient or overdose of anesthesia, respectively.
    No preview · Article · Nov 2008 · Transplantation Proceedings

Publication Stats

1k Citations
240.99 Total Impact Points

Institutions

  • 1998-2014
    • Chang Gung University
      • College of Medicine
      Hsin-chu-hsien, Taiwan, Taiwan
  • 1992-2014
    • Chang Gung Memorial Hospital
      • • Department of Surgery
      • • Department of Diagnostic Radiology
      T’ai-pei, Taipei, Taiwan