1
|
Sohn W, Paik YH, Cho JY, Ahn JM, Choi GS, Kim JM, Kwon CH, Joh JW, Sinn DH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. Influence of hepatitis B virus reactivation on the recurrence of HBV-related hepatocellular carcinoma after curative resection in patients with low viral load. J Viral Hepat 2015; 22:539-50. [PMID: 25377516 DOI: 10.1111/jvh.12356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 09/21/2014] [Indexed: 12/12/2022]
Abstract
It is unclear whether the reactivation of hepatitis B virus (HBV) influences the prognosis of hepatocellular carcinoma (HCC) after resection in patients with chronic hepatitis B. The aim of this study was to identify the influence of HBV reactivation on the recurrence of hepatitis B-related HCC after curative resection in patients with low viral load (HBV DNA <2000 IU/mL). We retrospectively analysed a total of 130 patients who underwent curative resection for HBV-related early stage HCC (single nodule; <5 cm/two or three nodules; <3 cm) with pre-operative HBV DNA levels <2000 IU/mL with serial HBV DNA tests. The predictive factors including HBV reactivation for the recurrence of HBV-related HCC after curative resection were investigated. Fifty-three patients (41%) had HBV reactivation after resection among 130 patients. HBV reactivation was observed in 22 of 53 patients with undetectable baseline HBV DNA and in 31 of 77 patients with detectable baseline HBV DNA. Cumulative recurrence rates after resection at 1, 2 and 3 years were 17.0%, 23.3% and 31.4%, respectively. The multivariable analysis demonstrated that the risk factors for the recurrence were the presence of microvascular invasion (hazard ratio (HR) 2.62, P = 0.003), multinodularity (HR 4.61, P = 0.005), HBV reactivation after resection (HR 2.03, P = 0.032) and HBeAg positivity (HR 2.06, P = 0.044). HBV reactivation after curative resection is associated with the recurrence of HBV-related HCC in patients with low viral load.
Collapse
Affiliation(s)
- W Sohn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Moon JI, Kwon CHD, Joh JW, Choi GS, Jung GO, Kim JM, Shin M, Choi SJ, Kim SJ, Lee SK. Primary versus salvage living donor liver transplantation for patients with hepatocellular carcinoma: impact of microvascular invasion on survival. Transplant Proc 2012; 44:487-93. [PMID: 22410053 DOI: 10.1016/j.transproceed.2011.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Salvage liver transplantation (LT) has been proposed for patients with a small hepatocellular carcinoma (HCC) and preserved liver function. Few reports have been issued on salvage LT in a living-donor (LD) LT setting. Therefore, we performed this study to evaluate differences in tumor invasiveness and other risk factors on survival after salvage versus primary LDLT. METHODS Between September 1996 and December 2008, 324 patients with HCC underwent LT. We excluded 138 patient from the analysis, leaving 186 HCC patients for analysis, including 17 (9.1%) who had undergone earlier resection, the salvage LDLT cohort. The other 169 patients underwent primary LDLT. RESULTS Intrahepatic metastasis, Edmonson-Steiner histologic grade, microscopic vascular invasion, and preoperative serum alpha-fetoprotein levels significantly influenced tumor recurrence. Microscopic vascular invasion, intrahepatic metastasis, Edmonson-Steiner histologic grade, and treatment by salvage LDLT were significantly associated with poor patient survival univariate analysis. However, only microscopic vascular invasion was significant on multivariate analysis. The treatment modality (primary or salvage LDLT) was not observed to affect overall or disease-free survival significantly on multivariate analysis. Disease-free survival was significantly better in the primary than in the salvage LDLT group. Furthermore, patients in the primary LDLT group tended to show better survival. However, when stratified by the presence or absence of microscopic vascular invasion, no significant group difference was found for overall or disease-free survival among those without versus with microscopic vascular invasion. CONCLUSIONS Five-year overall survival after primary versus salvage LDLT were similar when differences in tumor pathologic features, such as microscopic vascular invasion, were taken into account. Multivariate analysis showed that the treatment itself was not a significant prognostic factor for survival.
Collapse
Affiliation(s)
- J I Moon
- Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Lee S, Park JB, Kim EY, Joo SY, Shin EC, Kwon CH, Joh JW, Kim SJ. Monitoring of cytomegalovirus-specific CD8+ T-cell response with major histocompatibility complex pentamers in kidney transplant recipients. Transplant Proc 2012; 43:2636-40. [PMID: 21911137 DOI: 10.1016/j.transproceed.2011.05.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/09/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) can reactivate causing serious clinical problems during immunosuppression. CMV-specific CD8(+) T cells play an important role in the control of CMV reactivation. Using pentameric major histocompatibility complex (MHC) peptide complexes, we investigated cellular immune responses to CMV among healthy individuals and kidney transplantation recipients in Korea, which is an endemic area of CMV infection. MATERIALS AND METHODS Analysis of CMV-specific T cells was performed on 28 healthy individuals and 40 recipients who bore human leukocyte antigen (HLA)-A2 or -A24. CMV pp65 pentamer-binding cells incubated with various monoclonal antibodies were measured by four-color flow cytometry. RESULTS Detectable levels of pentamer(+) CD8(+) T cells were present in 109/139 samples (78.4%) that stained with the A*02NLV-pentamer, while 15/67 samples (22.4%) stained with the A*24QYD-pentamer (P < .01). Among patients with HLA-A2, 22/24 (91.7%) samples showing positive CMV antigenemia revealed detectable pentamer(+) CD8(+) T cells, while 87/115 (75.7%) displaying negative CMV antigenemia had detectable pentamer(+) CD8(+) T cells (P = .04). There was no significant difference in percentages of pentamer(+) CD8(+) T cells between patients who did versus who did not experience episodes of CMV infection. The subpopulation of CMV-specific CD8(+) T cells in transplantation recipients was evaluated using phenotypic markers; memory cells comprised the majority of the CMV-specific CD8(+) T-cell population. CONCLUSION The A*02NLV-pentamer complex was useful to monitor CMV-specific T cells. However, MHC pentamer-based techniques did not provide a clear distinction between patients who are or are not at risk for CMV infection.
Collapse
Affiliation(s)
- S Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Abstract
PURPOSE Alemtuzumab (Campath-1H), a humanized monoclonal antibody directed against CD52, is a lymphocyte-depleting agent currently being evaluated as an induction agent in solid organ transplantation. This study analyzed the clinical outcomes and effects on peripheral blood lymphocyte subset counts in adult deceased donor renal transplant recipients who received an alemtuzumab-based induction protocol. METHODS Eleven kidney alone or simultaneous pancreas-kidney transplant recipients received 20 mg alemtuzumab on postoperative days 0 and 1, followed by calcineurin inhibitor-based maintenance immunosuppression after postoperative day 5. We collected 1-year data including recipient and donor demographic features, renal function and adverse events including endocrine impact, incidence of acute rejection episodes, infections or malignancies as well as hematologic and late immunologic parameters for correlation with patient or graft survival. RESULTS Mean HLA mismatch was 3.6 and 8/11 deceased donors were of the extended criteria type. Only 2 (18%) recipients displayed delayed graft function with a failure of the serum creatinine to decrease by 25% on the first day; however, their long-term outcomes were similar to other nonaffected patients. Serious adverse events were absent; there was no hyperlipidemia or new-onset diabetes. We failed to observe an acute rejection. The 3 (27%) recipients with infectious complications experienced pericardial tuberculosis, urinary tract infection, or invasive pulmonary aspergillosis. Two (18%) cases of posttransplantation lymphoproliferative disease were diagnosed in this study during the follow-up. Overall patient and graft survival rates were both 91%. CONCLUSION This study demonstrated that preconditioning with antibody-depletion using alemtuzumab was efficient with satisfactory patient and graft survivals at 1 year. Alemtuzumab induction was safe even for recipients of extended criteria donor renal transplantation.
Collapse
Affiliation(s)
- M Shin
- Department of Surgery, Division of Transplant Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
5
|
Jung GO, Kim SJ, Choi GS, Moon JI, Kim JM, Sin MJ, Kim EY, Kwon CHD, Joh JW, Lee SK. The effect of cytomegalovirus antigenemia titer on the efficacy of preemptive therapy for the prevention of cytomegalovirus disease after kidney transplantation. Transplant Proc 2010; 42:804-10. [PMID: 20430177 DOI: 10.1016/j.transproceed.2010.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is some controversy regarding the exact cytomegalovirus (CMV) antigenemia titer that should be used as a guideline for preemptive anti-CMV therapy. We performed 634 consecutive kidney transplantations between January 2000 and June 2007. Preemptive therapy employed intravenous gancyclovir treatment when the CMV antigenemia titer was >or=50/4x10(5) leukocytes after kidney transplantation. The 634 recipients were allocated into 2 groups according to the peak CMV antegenemia: group A, CMV antigenemia titer<50/4x10(5) (n=550); and group B, >or=50/40x10(5) (n=84). Among the 634 recipients, 264 were positive for CMV antigenemia, and 61 developed symptomatic CMV infections. The incidence of symptomatic CMV infections in group B was significantly higher than in group A. Two cases in both groups developed tissue-proven CMV disease: group A CMV colitis and CMV nephritis, and group B, 2 cases of CMV colitis. Graft and patient survival rates in groups A and B at 5 years posttransplantation were not different. The authors concluded that a CMV antigenemia titer of >or=50/4x10(5) leukocytes can be considered an appropriate guideline for preemptive anti-CMV therapy.
Collapse
Affiliation(s)
- G O Jung
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Choi GS, Park JB, Jung GO, Chun JM, Kim JM, Moon JI, Kwon CHD, Kim SJ, Joh JW, Lee SK. Living donor liver transplantation in Budd-Chiari syndrome: a single-center experience. Transplant Proc 2010; 42:839-42. [PMID: 20430186 DOI: 10.1016/j.transproceed.2010.02.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Budd-Chiari syndrome (BCS), which is characterized by hepatic venous outflow obstruction due to occlusion of the major hepatic vein and/or the inferior vena cava (IVC), is rare. Traditionally, a caval resection is advocated for these patients; however, such a maneuver renders living donor liver transplantation (LDLT) impossible. We encountered BCS in 4/377 LDLT patients during a 5-year period (January 2003 to December 2007). This report examine the various surgical modifications in these 4 patients, who underwent to LDLT for BCS. Resection of right hepatic vein (RHV) with an adjacent fibrotic part of the IVC with direct anastomosis of the graft RHV to the IVC was performed in 2 patients. One patient underwent retrohepatic IVC excision and reconstruction with a cryopreserved autologous IVC graft. The fourth patient, with a preexisting mesoatrial shunt for BCS, underwent conversion of this to a RHV atrial shunt. Graft and patient survivals were 100%. There were few complications in either donors or recipients. LDLT for BCS can be performed safely with adequate venous drainage techniques and with anticoagulant therapy and good follow-up for early diagnosis and treatment of recurrence leading to excellent long-term results.
Collapse
Affiliation(s)
- G S Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Park KS, Kim YS, Kim JH, Choi BK, Kim SH, Oh SH, Ahn YR, Lee MS, Lee MK, Park JB, Kwon CH, Joh JW, Kim KW, Kim SJ. Influence of human allogenic bone marrow and cord blood-derived mesenchymal stem cell secreting trophic factors on ATP (adenosine-5'-triphosphate)/ADP (adenosine-5'-diphosphate) ratio and insulin secretory function of isolated human islets from cadaveric donor. Transplant Proc 2010; 41:3813-8. [PMID: 19917393 DOI: 10.1016/j.transproceed.2009.06.193] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
Successful islet transplantation (ITx) is not only dependent on the number of islets, but also their quality, including viability, metabolic activity, and function. Islet quality decreases during cultivation after the isolation procedure. To overcome this obstacle, we established the practice of islet and mesenchymal stem cells (MSCs) coculture. This coculture condition improved the ATP (adenosine-5'-triphosphate)/ADP (adenosine-5'-diphosphate) ratio and insulin secretory function in vitro. It is believed that the enhancement of islet quality in islet-MSCs cocultures may be caused by the secretion of active agents by MSCs. Herein we have shown that interleukin-6 (IL-6), vascular endothelial growth factor-A (VEGF-A), hepatocyte growth factor (HGF), and transforming growth factor-beta (TGF-beta) were significantly increased as measured by enzyme-linked immunosorbent assay (ELISA) in MSCs-cultured medium, factors that have been shown to improve the survival, function, and angiogenesis/revascularization of islets. These results indicated that the quality of human islets was enhanced by trophic molecules secreted by MSCs, which influence the intracellular islet ATP content and insulin secretory function.
Collapse
Affiliation(s)
- K S Park
- Department of Molecular Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
INTRODUCTION The incidence of peroneal neuropathy (PN), occurring predominantly in the left leg, increases after the incorporation of intermittent pneumatic compression (IPC) devices among adult liver transplantation (OLT) recipients in our hospital. The aim of this study was to investigate the possible risk factors for PN and the reason for the left-leg predominance. METHODS We retrospectively reviewed the medical records of 501 OLT recipients. The patients were first divided into 2 groups, PN (n = 33) and non-PN (n = 468), to assess possible risk factors. The patients were then categorized into IPC (n = 262) and non-IPC (n = 239) groups according to the use of IPC devices. In a subsequent prospective study, we measured the degree and duration of the tilt of the operating table during OLT to investigate their relationship to the predominant left-leg PN. RESULTS The rate of IPC device use was significantly greater among the PN than non-PN group (78.8% vs 50.4%, P < .01). The incidence of PN was significantly higher among the IPC than non-IPC group (9.9% vs 2.9%, P < .01). The degree and duration of left tilt of the operating table were greater and longer than the right tilt. CONCLUSIONS The use of IPC devices during OLT increased the occurrence of PN and the left tilt of the operating table was strongly related to the predominant left-leg PN. Careful protection of the vulnerable point and minimization of the tilting of the operating table is advised during OLT, especially when IPC devices are used.
Collapse
Affiliation(s)
- J S Yoon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Lee SK, Park JB, Kim SJ, Choi GS, Kim DJ, Kwon CHD, Lee SK, Joh JW. Early Postoperative Renal Dysfunction in the Adult Living Donor Liver Transplantation. Transplant Proc 2007; 39:1517-9. [PMID: 17580177 DOI: 10.1016/j.transproceed.2006.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 11/16/2006] [Indexed: 12/16/2022]
Abstract
Living donor liver transplantation (LDLT) is a widely accepted treatment for end-stage liver diseases. Renal dysfunction, a frequent complication after liver transplantation, has an unfavorable effect on the prognosis. Despite special characteristics of LDLT, such as small-for-size graft syndrome (SFS), the relations between graft size and postoperative renal dysfunction have not been evaluated. So we described the relevance of previously known risk factors with SFS (graft-recipient body weight ratio [GRWR] < 0.8%) and early postoperative renal dysfunction in LDLT. The study population consisted of adults who received LDLT from May 1996 to November 2005. The 284 patients who were followed to 3 months after LDLT were classified as group I (n = 201, creatinine < 1.5 mg/dL) versus group II (n = 83, creatinine > or = 1.5 mg/dL). Univariate analysis showed renal dysfunction in the early postoperative period was related to preoperative total bilirubin, blood urea nitrogen, creatinine, prothrombin time level, model for end-stage liver disease (MELD) score, GRWR, presence of preoperative renal dysfunction, transfusion of packed red blood cell, fresh frozen plasma, cryoprecipitate, reoperation, and the need for renal replacement therapy (RRT). Upon multivariate analysis, MELD score, GRWR, preoperative renal dysfunction, and need for RRT were related to early postoperative renal dysfunction. In conclusion, there was a significant relationship between SFS (GRWR < 0.8) and early postoperative renal dysfunction.
Collapse
Affiliation(s)
- S K Lee
- Department of Surgery, Transplantation Division, Sungkyunkwan University, #50 Ilwon Dong, Kangnam Ku, Samsung Medical Center, Seoul 135-710, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
10
|
An JY, Heo JS, Noh JH, Sohn TS, Nam SJ, Choi SH, Joh JW, Kim SJ. Primary malignant retroperitoneal tumors: Analysis of a single institutional experience. Eur J Surg Oncol 2007; 33:376-82. [PMID: 17129700 DOI: 10.1016/j.ejso.2006.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 10/11/2006] [Indexed: 11/15/2022] Open
Abstract
AIMS In order to achieve complete resection in the surgical management of retroperitoneal tumors, it is crucial to know the tumor's anatomical location relative to neighboring organs. METHODS Forty-nine patients with primary malignant retroperitoneal tumors were divided by tumor location into two groups [upper abdomen (group 1) or lower abdomen (group 2)], and clinicopathological features, tumor recurrence, and patient survival were assessed. RESULTS No significant differences in preoperative clinical characteristics existed between two groups, and liposarcoma was the most frequently observed tumor type. The difference in the rates of complete resection between the two groups was not statistically significant (75.9% for group 1 and 85% for group 2). En-bloc combined resection was performed in 52% and 30% of patients in groups 1 and 2, respectively. The local recurrence rate in group 2 (31.3%) was higher than that in group 1 (9.5%), despite the fact that the differences in rates of complete resection and distant recurrence rates (14.3% in group 1 and 12.5% in group 2) between the two groups were not statistically significant. The overall 5-year survival rates were 67.9% for group 1 and 43.2% for group 2 (p=0.038). The 5-year survival rate of patients with tumors smaller than 10 cm was 78.4%, while that of patients with tumors larger than 10 cm was 38.1% (p=0.017). The 5-year survival rate after complete excision was 61%, whereas that after incomplete resection or biopsy only was 40.0% (p<0.0001). CONCLUSIONS An upper abdominal tumor location is a positive prognostic factor even if small tumor size (<10 cm) and complete resection of the tumor are still more important factors to improve outcome in patients with malignant primary retroperitoneal tumors. Because complete resection was shown to be the most important prognostic factor, an aggressive and careful surgical approach is recommended for the treatment of such tumors.
Collapse
Affiliation(s)
- J Y An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Lee KW, Park JW, Park JB, Kim SJ, Choi SH, Heo JS, Kwon CHD, Kim DJ, Han YS, Lee SK, Joh JW. Liver transplantation for hepatocellular carcinoma with bile duct thrombi. Transplant Proc 2006; 38:2093-4. [PMID: 16980009 DOI: 10.1016/j.transproceed.2006.06.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In a few cases of hepatocellular carcinoma (HCC), jaundice results from obstructive causes, including tumor invasion or thrombi in the bile duct. We have reported herein our experience with liver transplantation (OLT) for HCC cares showing bile duct thrombi (BDT). From September 1996 to August 2004, 140 adult patients underwent OLT for HCC at our center. Four patients (2.9%) who had OLT performed for HCC had BDT and were included in this study. The patients were all men of mean age 57.0 years. The initial total bilirubin levels were in the range of 2.0 to 30.5 mg/dL. The sizes of the tumors ranged from 2.0 cm to 3.0 cm in diameter, all were single lesions. The median follow-up period was 20.6 months (range: 17.6 to 28.1 months). The only case in which the BDT was identified intraoperatively died 20 months after OLT due to multiple intrahepatic recurrences. The other three patients were alive, showing no evidence of recurrence at the end of follow-up. Although a series of four is too small to reach any conclusion, we suggest that OLT may be a treatment option for HCC with BDT in selected cases.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Korea 135-710
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Steatotic liver graft transplantation affect donor safety as well as recipient survival. We investigated safety of donors according to the extent of fatty change. We retrospectively reviewed donors who underwent right hepatectomy from September 1999 to April 2005, dividing them into three groups according to degree of macrovesicular fatty change upon intraoperative liver biopsy. Group 1 included patients with macrovesicular steatosis of 0 approximately 9%: group 2, 10 approximately 19% and group 3, at least 20%. Two hundred forty-five donors were enrolled with a male to female ratio of 2.02:1 and mean age of 31.8 years. There were 163 donors in group 1, 75 in group 2, and seven in group 3. There was no statistically significant difference in body mass index, operative time, blood loss, postoperative peak serum bilirubin, and aspartate transaminase levels among groups 1, 2, and 3. Overall complication rate, including reoperation, biliary stricture, wound infection, ileus, transfusion, bile leak and fluid collection were not different between the groups. Postoperative hospital stay was also not different. Peak alanine transaminase level was different between each group, and prothrombin time between group 1 and 3, but days until return to normal levels in all measured laboratory parameters were not different. Residual liver volume percent was significantly smaller among group 1 compared to others. In conclusion, fatty livers with less than 30% macrovesicular steatosis may be good donor candidates without significant complications as long as sufficient residual liver volume is left for the donor.
Collapse
Affiliation(s)
- C H D Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Korea 135-710
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Park JW, Lee KW, Kim SJ, Choi SH, Heo JS, Kwon CHD, Kim DJ, Han YS, Lee SK, Joh JW. Outcome of Patients With Recurrent Hepatocellular Carcinoma in Liver Transplantation. Transplant Proc 2006; 38:2121-2. [PMID: 16980018 DOI: 10.1016/j.transproceed.2006.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Liver transplantation (OLT) is the treatment of choice for patients with hepatic cirrhosis related hepatocellular carcinoma (HCC). Among 156 liver transplant patients for HCC from June 1996 to February 2005, 23 had recurrent HCC. To evaluate risk factors that affect early recurrence of HCC after OLT, we divided the 23 patients into two groups: early (< or =12 months) and late (>12 months) recurrences. Among them, 15 patients were dead and eight alive patients had been followed to 31 July 2005. The most common recurrence site was the grafted liver (n = 15), next was bone (n = 11), lung (n = 8), lymph node (n = 6), brain (n = 4), skin (n = 2), adrenal gland (n = 1). There were no significant differences between the two groups in age or tumor size, number of tumors, cell differentiation, alpha-feto protein levels, tumor staging, number of patients within Milan criteria, steroid pulse therapy, infectious diseases, and immunostaining of tumor. In our study, there were no risk factors that predict early tumor recurrence. We noticed that more patients in the early recurrence group were excluded by Milan criteria due to a more progressed tumor staging with higher mean levels of serum alpha-feto protein.
Collapse
Affiliation(s)
- J W Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Korea 135-710
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
The introduction of high doses of hepatitis B immune globulin (HBIG) and lamivudine for liver transplantation (OLT) prophylaxis has reduced the risk of hepatitis B recurrence and improved the survival of patients transplanted for hepatitis B virus (HBV)-related liver disease. But, posttransplant prophylaxis strategies to treat the recurrence of HBV have not yet been standardized. We analyzed 23 patients with HBV recurrence among 340 HBV-associated liver transplants performed from September 1996 to April 2004 (6.7%). Nine patients underwent deceased donor OLT and 14, living donor OLT. Mean follow-up was 37 months. Seroconversion after recurrence was observed in 6 of 23 patients (26%). Mean time to HBV recurrence tended to be shorter among the seroconversion (+) patients compared to seroconversion (-) patients (10 months vs 19.7 months; P = .062). Seroconversion rate after HBIG and lamivudine combination therapy for patients with HBV recurrence was 37.5% and time to seroconversion after HBV recurrence was 1.7 months. Seroconversion was best achieved when the pretransplant HBV DNA level was high and HBeAg was positive. Also, seroconversion rate was increased when HBV DNA level was low and the alanine transferase level high at the time of recurrence and when the time to recurrence after transplantation was short. Seroconversion after HBV recurrence, which was observed in 26%, may be increased in selected cases. Accordingly, aggressive treatment should be undertaken after HBV recurrence.
Collapse
Affiliation(s)
- Y S Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Korea 135-710
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Renal recipients with hepatitis B virus (HBV) should be treated with prolonged lamivudine. However, lamivudine resistance usually results after YMDD mutation within the HBV polymerase gene. Thereupon, the aim of this study was to investigate the genotypic resistance to lamivudine among renal transplant recipients to identify its effect on the clinical course of HBV in these patients. Between March 1997 and September 2003, eight of 17 renal transplant patients with hepatitis B virus were enrolled into this study and treated with 100 mg of lamivudine once each day. We amplified a selected region of the polymerase gene of HBV in order to confirm mutations in the YMDD motif. Mutations of YMDD region were observed in five of eight patients (62.5%). Out of five patients positive for HBV DNA, three (60%) showed genotypic resistance (YMDD mutation) with a normal ALT level. Two patients converted to HBV DNA negative. But, they were not associated with HBeAg seroconversion. Out of three patients who were pretransplant HBV DNA negative, genotypic resistance was observed in two patients (67%) revealing both positivity of HBe antibody and negativity of HBV DNA. In conclusion, although a normal ALT level and HBV DNA negative are maintained, the mutation of the YMDD locus may develop. Accordingly, we suggest that if the YMDD mutation is not involved in the progression of hepatitis B, lamivudine therapy should be continued despite genotypic resistance.
Collapse
Affiliation(s)
- J W Joh
- Digestive Disease Research Center, and Department of Internal Medicine and Surgery, Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
16
|
Lee KW, Park JW, Joh JW, Kim SJ, Choi SH, Heo JS, Lee HH, Lee DS, Park JH, Yoo BC, Paik SW, Koh KC, Lee JH, Choi MS, Lee SK. Can we expand the Milan criteria for hepatocellular carcinoma in living donor liver transplantation? Transplant Proc 2005; 36:2289-90. [PMID: 15561222 DOI: 10.1016/j.transproceed.2004.08.144] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Milan criteria, namely, tumors 5 cm or less in diameter in patients with single hepatocellular carcinoma (HCC), no more than 3 tumor nodules, and each 3 cm or less in diameter in patients with multiple tumors, are accepted for cadaveric liver allocation. However, in living donor liver transplantation (LDLT), graft donation may only depend on the donor's intention. The aim of this study was to elucidate the feasibility of Milan criteria in LDLT. MATERIALS AND METHODS From January 2001 to December 2002, 46 cases of liver transplantation (LT) for HCC included 5 hospital mortalities and 3 cadaveric transplantations, all of which were excluded. We classified the patients into Group I cases that met the Milan criteria and Group II cases that did not meet the Milan criteria. The analyses examined tumor-related risk factors affecting recurrence and survival, such as tumor size, number of tumor nodules, and presence of microvascular and macrovascular invasion. RESULTS Twenty-one cases belonged to Group I and 17 to Group II. There was no significant difference in the recurrence or survival rates between Groups I and II. The risk factors affecting recurrence were macrovascular invasion and tumor size (5 cm). The number of tumor nodules and microvascular invasion did not appear to affect recurrence. The risk factor affecting survival was macrovascular invasion. CONCLUSION We suggest that in selected cases the Milan criteria could be extended to increase the number of tumor nodules as long as the HCC were small and did not macrovascular invasion.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Lee DS, Gil WH, Lee HH, Lee KW, Lee SK, Kim SJ, Choi SH, Heo JS, Hyon WS, Kim GS, Paik SW, Koh KC, Joh JW. Factors affecting graft survival after living donor liver transplantation. Transplant Proc 2005; 36:2255-6. [PMID: 15561210 DOI: 10.1016/j.transproceed.2004.08.073] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Living donor liver transplantation (LDLT) has been considered as an alternative option to resolve the shortage of cadaveric donor organs, despite the ethical aspects of the donor procedure. The objective of this study was to analyze the risk factors affecting graft survival in LDLT. From June 1996 to December 2002, 141 patients who underwent LDLT were retrospectively analyzed. Graft survival rates were 82.5%, 80%, 77.3%, and 77.3% at 6 months, 1 year, 3 years, and 5 years, respectively. The factors influencing graft survival in univariate analysis were graft-to-recipient body weight ratio (GRWR) less than 0.8% (P = .0009), intraoperative transfusion of more than six packed RBC units in addition to the use of cell saver amounts (P = .0001), left lobe grafts in adults causing small-for-size situations (P = .0135), and donor age (P = .0472). The multivariate analysis demonstrated that GRWR less than 0.8% (P = .002) and intraoperative transfusion of more than six packed RBC units (P = .014) were independent factors that decreased graft survival rates. The graft selection of greater than 0.8% of GRWR and reduction of intraoperative RBC transfusion improve graft survival.
Collapse
Affiliation(s)
- D S Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Heo JS, Park JW, Lee KW, Lee SK, Joh JW, Kim SJ, Lee HH, Lee DS, Choi SH, Seo JM, Choe YH. Posttransplantation lymphoproliferative disorder in pediatric liver transplantation. Transplant Proc 2005; 36:2307-8. [PMID: 15561231 DOI: 10.1016/j.transproceed.2004.08.138] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the clinical features of risk factors for posttransplantation lymphoproliferative disorder (PTLD) in pediatric liver transplantation. MATERIALS AND METHODS Between June 1996 and June 2002, among 41 pediatric patients who underwent liver transplantation, 7 died in the postoperative period. Thirty-five patients, including 1 patient who died of PTLD, were reviewed. Based on the serology results, patients were divided into a high-risk group (EBV-naive recipients of EBV-positive grafts) and a low-risk group (patients other than those in the high-risk group). RESULTS Five of 41 patients (12.2%) developed PTLD. All of them belonged to the high-risk group. The incidence of PTLD in the high-risk group was 31.3% (5 of 16). The mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed at a median of 6 months after transplantation. Three of 5 patients developed rejection before the diagnosis of PTLD. One patient was diagnosed with laryngeal and gastrointestinal PTLD, whereas the other 4 had gastrointestinal PTLD. They experienced the following symptoms and signs: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). CONCLUSION The common features of PTLD development were as follows: (1) EBV-positive donors placed into EBV-naive recipients, (2) primary EBV infection approximately 6 months after transplantation, (3) young age, 1 year old at operation, and (4) requirement for intensive posttransplantation immunosuppression.
Collapse
Affiliation(s)
- J S Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Lee EN, Kim EY, Lee J, Lee HJ, Lee KW, Joh JW, Lee SK, Lee DS, Lee HH, Kim SJ. Adenovirus-mediated CTLA4 immunoglobulin G gene therapy in cardiac xenotransplantation. Transplant Proc 2005; 36:2425-8. [PMID: 15561268 DOI: 10.1016/j.transproceed.2004.08.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND CTLA4 immunoglobulin (CTLA4 Ig), which binds with high affinity to B7-1 and B7-2, interrupts T-cell activation by inhibiting the costimulatory signal. CTLA4Ig has been used to achieve antigen-specific tolerance induction in cardiac allografts. On the other hand, we have shown that short-term administration of deoxyspergualin (DSG) and daily cyclosporine (CsA) induces long-term survival of cardiac xenotransplants. We hypothesized that the combination therapy of DSG and adenovirus-mediated CTLA4IgG might induce long-term, survival or tolerance in cardiac xenotransplantation. OBJECTIVES Syrian hamster hearts were transplanted heterotopically into Lewis rats. We compared the survival time and immunopathology of the following five groups: (1) no treatment; (2) DSG (5 mg/kg per day intramuscularly [IM], days -1 to +7) alone; (3) CsA (15 mg/kg per day IM, day 0 to rejection) plus DSG; (4) AdexLacZ (LacZ-adenovirus 1 x 10(9) (PFU intravenously [IV], day -7) plus DSG; and (5) AdexCTLA4IgG (CTLA4IgG-adenovirus 1 x 10(9) PFU IV, day -7) plus DSG. RESULTS The survival times were: (1) no treatment, 3.7 days; (2) DSG alone, 12.4 days; (3) CyA plus DSG, >100 days; (4) AdexLacZ plus DSG, 11.0 days; and (5) AdexCTLA4IgG plus DSG, 23.6 days. Adenovirus-mediated CTLA4IgG therapy with DSG prolonged survival time significantly compared with DSG alone or AdexLacZ plus DSG, but CTLA4IgG therapy was not as effective as CsA. Immunopathology showed the deposition of C3 and IgM on the endothelium in the AdexCTLA4IgG plus DSG group. CONCLUSIONS We showed that the effectiveness of adenovirus-mediated CTLA4IgG gene therapy in cardiac xenotransplantation in less than that of CsA. Combination therapy with inhibition of the B7/CD28 constimulatory signal and DSG administration might not be sufficient for long-term survival or tolerance in cardiac xenotransplantation.
Collapse
Affiliation(s)
- E N Lee
- Transplantation Research Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lee HH, Joh JW, Lee KW, Kim SJ, Lee DS, Park JH, Choi SH, Heo JS, Hyon WS, Kwak MS, Lee SK. Small-for-size graft in adult living-donor liver transplantation. Transplant Proc 2005; 36:2274-6. [PMID: 15561216 DOI: 10.1016/j.transproceed.2004.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the era of living donor liver transplantation (LDLT), graft size is related to recipient prognosis. This study was performed to compare the clinical outcomes according to the graft-to-recipient weight ratio (GRWR) in adult LDLT. Seventy-nine adult patients who had undergone LDLT between June 1997 and June 2002 were retrospectively analyzed. The patients were divided into two groups according to the GRWR (group I, GRWR < 0.8%, n = 11; group II, GRWR > or = 0.8%, n = 68). The mean follow-up period was 19.4 (range 1 to 48) months. The recipients were 62 men (78.5%) and 17 women (21.5%) of mean age 45.2 (range 18 to 63) years. The overall patient survival rates were 74.7% at 1 year and 70.7% at 2 years. The patient survival rate in group I was 54.6% at 1 year and 40.9% at 2 years, whereas that in group II was 77.9% at 1 year and 75.3% at 2 years, showing a significant difference (P = .03). There were no significant differences in postoperative total bilirubin, transaminase enzyme level, prothrombin time (INR), portal vein flow on Doppler sonography, amount of ascites through the drain, complications, or acute rejection rates between the two groups. In conclusion, the minimum acceptable graft size in an adult-to-adult LDLT is GRWR of 0.8%. This study suggests that careful postoperative management and/or technical modifications during surgery are necessary, because small-for-size grafts (GRWR < 0.8%) result in lower patient survival rates.
Collapse
Affiliation(s)
- H H Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Choi SH, Lee HH, Lee DS, Choi JH, Heo JS, Lee KW, Joh JW, Kim SJ, Yoo BC, Lee JH, Choi MS, Choe YH, Lee SK. Clinicopathological features of incidental hepatocellular carcinoma in liver transplantation. Transplant Proc 2005; 36:2293-4. [PMID: 15561224 DOI: 10.1016/j.transproceed.2004.08.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of detecting hepatocellular carcinoma (HCC) in a removed recipient liver after a liver transplant is not rare. The clinical features are expected to be different from the preoperatively diagnosed HCC. The aim of this study was to evaluate the clinicopathological features of incidental HCC. This study retrospectively analyzed five cases of incidental HCC among 51 liver transplant cases of HCC operated from September 1996 to February 2002. The proportion of an incidental HCC was 9.8%. The mean age was 46.2 years with a higher prevalence in may (80%, four cases). The alpha-fetoprotein level was normal or mildly elevated. HBsAg was positive in all cases. Imaging studies revealed regenerative or dysplastic nodules, or no specific lesion. The pathological findings demonstrated a mean size of 1.16 cm, multiplicity in three cases (60%), no microvascular invasion, and Edmonson grade I (60%) and II (40%). There was no recurrence of the HCC. However, two patients died due to an intracranial hemorrhage and a graft failure, respectively. In conclusion, incidentally found HCC showed less invasive pathological features and a better prognosis.
Collapse
Affiliation(s)
- S H Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lee HH, Joh JW, Park JH, Lee KW, Heo JS, Choi SH, Kim SJ, Lee SK. Microvascular Tumor Embolism: Independent Prognostic Factor After Liver Transplantation in Hepatocellular Carcinoma. Transplant Proc 2005; 37:1251-3. [PMID: 15848686 DOI: 10.1016/j.transproceed.2005.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Microscopic tumor cell dissemination may be a more important factor in the recurrence of hepatocellular carcinoma (HCC) after liver transplantation, probably because of posttransplant immunosuppression. The presence of microvascular tumor embolism was undetermined as a factor for HCC recurrence after orthotopic liver transplantation (OLT). This study evaluated whether microvascular tumor embolism affects recurrence-free survival and correlates with other clinicopathologic factors after OLT among patients with HCC. From September 1996 to June 2003, 72 OLTs for HCC were enrolled in this study. Median follow-up was 22.8 months. Among 41 patients without microvascular tumor embolism, 1-year, 2-year, and 5-year recurrence-free survival rates were all 97.6%, while these rates were 77.3%, 68.2%, and 59.7%, respectively, for 31 patients (43.1%) with microvascular tumor embolism (P = .0006). The 5-year recurrence-free survival rate showed significant differences for a pT2 tumor (P = .0073), for maximal tumor size <3 cm (P = .0328), for > or =5 cm solitary tumor (P = .0095), and for the presence of a tumor capsule (P = .0012), within the Milan criteria (P = .0376). At multivariate analysis, significant independent predictors for HCC recurrence were microvascular tumor embolism and histopathologic grade. In conclusion, microvascular tumor embolism is an independent predictor of HCC recurrence after liver transplantation. Although OLT is a safe and effective treatment for HCC within the Milan criteria, the presence of microvascular tumor embolism at pathologic examination can predict its recurrence. In these cases, the feasibility of immunosuppressive therapy or adjuvant chemotherapy must be considered to prevent tumor recurrence.
Collapse
Affiliation(s)
- H H Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Lee J, Lee EN, Kim EY, Lee HJ, Park HJ, Sun CL, Lee SK, Joh JW, Lee KW, Kwon GY, Kim SJ. 4-1BB promotes long-term survival in skin allografts treated with anti-CD45RB and anti-CD40L monoclonal antibodies. Transplant Proc 2005; 37:123-5. [PMID: 15808569 DOI: 10.1016/j.transproceed.2005.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
4-1BB (CD137) is a T-cell co-stimulatory molecule that promotes T cell activation. Using a skin transplantation model, we observed that simultaneous administration of monoclonal antibodies (mAb) targeting CD45RB and CD40L prolonged skin allograft in co-stimulation blockade (CTLA4-Ig and anti-CD40L mAb)-resistant mice, because of reducing CD8(+) T cells and CD4(+) CD45RB(high) T cells. Anti-CD45RB mAb (45RB) blocks the activation of T helper 1 (Th1) cells and generates regulatory T cells (T(reg)). The experimental design included five groups: group 1, control; group 2, 45RB-MR1; group 3, 45B-MR1 + 4-IBBL; group 4, anti-CD4 mAb plus group 3 treatment; group 5, anti-CD8 mAb plus group 3 treatment. In this study we highlight the involvement of 4-1BB/4-1BBL in the development of T-cell responses. C57BL/6 recipients of BALB/c skin grafts were treated with 45RB, anti-CD40L mAb (MR1), and antagonistic anti-4-1BBL mAb (4-1BBL) on days 0, 2, 4, 6, and 8 posttransplantation. Additional 4-1BBL further prolonged skin graft survival, although the percentage of splenocyte-derived CD8(+) T cells was reduced similarly in both groups. Use of 4-1BBL seems to have additive effects on T(reg) cells, which play a major role in the maintenance of tolerance. Even after immunosuppressive therapy in combination with CD4(+) T-cell depletion, we did not achieve prolonged graft survival, possibly because of the absense of T(reg) cells, which require CD4-independent CD8(+) T cells, based on the observation of increasing proportion of CD8(+) T cells in similar degree as the control group.
Collapse
Affiliation(s)
- J Lee
- Transplantation Research Center, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, 135-710
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Lee HH, Lee DS, Yoo KE, Lee KW, Kim SJ, Joh JW, Seo JM, Choe YH, Lee SK. Case of living donor liver transplantation in a patient with biliary atresia combined with situs inversus. Transplant Proc 2004; 36:2282-3. [PMID: 15561219 DOI: 10.1016/j.transproceed.2004.08.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Until recently, situs inversus was considered to be an absolute contraindication for liver transplantation. However, recent reports have suggested that situs inversus should not be considered a contraindication. This study presents a successful living donor liver transplantation performed in a 4-month-old male infant with biliary atresia and situs inversus. The surgical findings revealed abdominal situs inversus with polysplenia and an absent retrohepatic inferior vena cava and intestinal malrotation.
Collapse
Affiliation(s)
- H H Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Lee KW, Park JB, Yoon JJ, Lee JH, Kim SY, Jung HJ, Lee SK, Kim SJ, Lee HH, Lee DS, Joh JW. The viability and function of cryopreserved hepatocyte spheroids with different cryopreservation solutions. Transplant Proc 2004; 36:2462-3. [PMID: 15561281 DOI: 10.1016/j.transproceed.2004.08.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to evaluate the viability and function of cryopreserved hepatocyte spheroids using different cryopreservation solutions in order to elucidate the efficiency of cryopreservation. Hepatocytes isolated from a Sprague-Dawley rat were formed into spheroids by 24 hours of rotational culture. The spheroids were cryopreserved using a programmed linear freezer in a liquid nitrogen tank for 24 hours in four different cryopreservation solutions: UW solution (UW), William E media (WE), fetal bovine serum (FBS), and a mixture (MIX). After thawing, they were cultured for 4 days. With each hepatocyte spheroid, the viability using the MTT assay and hepatocyte-specific functions, such as ammonia clearance, urea nitrogen synthesis, and albumin secretion, were analyzed. The viabilities of cryopreserved hepatocyte spheroids were 64.8% +/- 10.2% (UW), 33.2% +/- 9.7% (WE), 69.3% +/- 8.7% (FBS), and 48.4% +/- 15.5% (MIX). Ammonia clearance of spheroids cyropreserved in UW solution was 0.93 +/- 0.13 mmol/L per well per day, which was not significantly different from freshly cultured spheroids. From the aspect of urea nitrogen synthesis, spheroids cryopreserved with UW, FBS, and MIX solution were not significantly different from freshly cultured spheroids. The amount of albumin secretion by the UW cryopreserved spheroids was significantly greater than that of other cryopreserved spheroids. Cryopreserved hepatocyte spheroids in UW solution were not significantly different from freshly cultured spheroids with respect to viability and function. UW solution was superior to other cryopreservation solutions for viability and functions.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
UNLABELLED In adult-to-adult living donor liver transplantation (LDLT), right lobe grafts without a middle hepatic vein can cause hepatic congestion and disturbance of venous drainage. To solve this problem, various types of interposition vein graft have been used. OBJECTIVES We used various types of interposition vein grafts for drainage of the paramedian portion of the right lobe in living donor liver transplantation. METHODS From June 1996 to June 2003, 37 of 176 patients (128 adults, 48 pediatric) who underwent LDLT received vein grafts for drainage of segments V, VIII, or the inferior portion of the right lobe. RESULTS In 36 adult cases the reconstruction included the inferior mesenteric vein of the donor (n = 14); cadaveric iliac vein stored at cold (4 degrees C) temperature (n = 5); cryopreserved (-180 degrees C) cadaveric iliac vein (n = 10); cryopreserved cadaveric iliac artery (n = 1 case); donor ovarian vein (n = 1); recipient umbilical vein (n = 3); recipient saphenous vein (n = 1); recipient left portal vein (n = 1); recipient left hepatic vein (n = 1). In a pediatric case with malignant hemangioendothelioma that encased and compressed the inferior vena cava, we used an interposition vein graft to replace the inferior vena cava. CONCLUSION Various types of interposition vein grafts can be used in living donor liver transplantation. Cryopreserved cadaveric iliac vein and artery are useful to solve these drainage problems.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Lee KW, Lee DS, Lee HH, Kim SJ, Joh JW, Seo JM, Choe YH, Lee SK. Prevention of de novo hepatitis B infection from HbcAb-positive donors in living donor liver transplantation. Transplant Proc 2004; 36:2311-2. [PMID: 15561233 DOI: 10.1016/j.transproceed.2004.08.139] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hepatitis B virus (HBV) prophylaxis is necessary to prevent de novo hepatitis B infection from HbcAb-positive donors. However, which protocol is more effective is somewhat controversial. Also, it is uncertain whether it is necessary to administer HBV prophylaxis for HbsAb-positive recipients. This study attempted to determine whether it is necessary to administer HBV prophylaxis for HbsAb-positive patients and to evaluate the efficacy of an HBIG monotherapy protocol. From May 1996 to July 2001, among 128 donors examined for HbcAb, 58 donors (45.3%) were HbcAb-positive. Eighteen HbcAb-positive grafts were transplanted to HbsAg-negative recipients. The 4 patients who died of unrelated causes were excluded from this study. Of 14 study cases, 12 recipients were HbsAb-positive, and 2 were HbsAb-naive. Prior to late 1998, we used HBV vaccination only for de novo infection prophylaxis. However, starting from December 1998, HBIG was administered from the time of the liver transplantation regardless of HBsAb positivity. The overall rate of de novo HBV infections from HbcAb-positive donors was 21.4% (3 of 14). All 3 recipients without HBIG prophylaxis presented with de novo HBV infections. Two were HbsAb-positive preoperatively. No de novo HBV infections occurred among recipients with HBIG prophylaxis. Therefore, it is essential to administer HBV prophylaxis even for vaccinated HbsAb-positive patients. HBIG monotherapy is effective to prevent de novo hepatitis B infections from HbcAb-positive donors in living donor liver transplantation.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Lee DS, Woo JG, Lee HH, Lee KW, Joh JW, Kim SJ, Choi SH, Heo JS, Hyon WS, Kim GS, Lee SK. Auxiliary partial orthotopic liver transplantation in the treatment of acute liver failure: A case report. Transplant Proc 2004; 36:2228-9. [PMID: 15561200 DOI: 10.1016/j.transproceed.2004.08.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A successful experience with auxiliary partial orthotopic liver transplantation (APOLT) for acute liver failure is reported in a 29-year-old woman who experienced jaundice, generalized erythema for 7 days, and decreased mentation for 3 days. Two months prior, she suffered pulmonary tuberculosis, being currently treated with antituberculous medications, which caused the fulminant hepatic failure. We decided to perform APOLT based on two facts. The first was the possibility that the diseased native liver may recover sufficiently to withdraw the immunosuppressants. Second, the pulmonary tuberculosis may have been worsened by immunosuppression. We removed the extended lateral section of the recipient for the graft. The left hepatic vein of the extended left lateral graft was anastomosed to the left hepatic vein of the recipient. The left portal vein of the graft was anastomosed to the left portal vein of the recipient. The right portal vein of the recipient was left without any manipulation. A duct-to-duct anastomosis was performed. On postoperative day 3, antituberculous medications were started. On the postoperative day 37, she was discharged without any problems. On the postoperative day 120, she showed no event of rejection, and her pulmonary symptoms improved. We performed the operation without transection of the portal branch to the native liver, but no functional competition has been discovered.
Collapse
Affiliation(s)
- D S Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
The development of posttransplant lymphoproliferative disease (PTLD) is strongly linked to infection with the Epstein-Barr virus (EBV), immunosuppression-state, the type of allograft, and EBV-seronegativity. A 18-month-old girl who had undergone living donor liver transplantation using the left lateral segment from her father was treated with tacrolimus and corticosteroid as an immunosuppressant regimen. She was readmitted 3 months after the transplant to evaluate the etiology of dyspnea and abdominal fullness as well as a decreased urine volume. She was diagnosed as an anastomotic stenosis of the hepatic vein for which she underwent balloon angioplasty. The treatment was repeated at postoperative month 5, 8, and 11. As postoperative 6 months, the result of the serological EBV-CA (IgG/IgM) was positive. In postoperative month 10, the EBV PCR serologic test become positive, and a laryngeal biopsy revealed PTLD. She was treated with acyclovir and gangyclovir as well as reduced immunosuppression. We report herein a rare case of laryngeal PTLD in a patient who had undergone living donor liver transplant with paternal allograft.
Collapse
Affiliation(s)
- H H Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Lee KW, Yoon JJ, Lee JH, Kim SY, Jung HJ, Kim SJ, Joh JW, Lee HH, Lee DS, Lee SK. Sustained release of vascular endothelial growth factor from calcium-induced alginate hydrogels reinforced by heparin and chitosan. Transplant Proc 2004; 36:2464-5. [PMID: 15561282 DOI: 10.1016/j.transproceed.2004.08.078] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A possible alternative for immunosuppression is a microencapsulation technique using hydrogels, which have been utilized for cell immobilization and drug delivery systems. Angiogenesis is crucial for delivery of the metabolic products to the host tissues as well as to supply oxygen and nutrients to cells. The local delivery of angiogenic growth factors, such as VEGF and basic FGF, has been recently studied to enhance angiogenesis on peripheral tissue of graft. In this study, we evaluated sustained VEGF release with a model using hydrogels coated with chitosan and heparin in vitro. We fabricated calcium alginate gels and chitosan-coated calcium alginate gels. Heparinized chitosan-coated calcium-induced alginate hydrogel beads were prepared by soaking chitosan-coated calcium alginate gels in heparin solution. We compared the stability and VEGF release manner between three kinds of hydrogels. To compare the stability, 5 mL of each hydrogel was incubated with 20 mL PBS under the rotational culture. Compression forces were measured using a rheometer. The amount of VEGF released from the gels was measured by ELISA. The heparin-coated chitosan alginate hydrogels showed the highest surface stability among the three hydrogels. VEGF from the heparinized gel was released in sustained manner up to 10 days in vitro. Chitosan-coated alginate gels released 90% of loaded VEGF within 5 days. These results suggest that local delivery of VEGF using a heparinized hydrogel may provide a long-term supply of angiogenic growth factor that might induce new vessel formation in vivo.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Lee KW, Kim SJ, Lee DS, Lee HH, Joh JW, Lee SK, Oh HY, Kim DJ, Kim YG, Huh WS, Oh WI, Lee BB. Effect of panel-reactive antibody positivity on graft rejection before or after kidney transplantation. Transplant Proc 2004; 36:2009-10. [PMID: 15518726 DOI: 10.1016/j.transproceed.2004.08.137] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Because it is well known that kidney transplant recipients with preformed lymphocytotoxic antibodies against HLA antigens have increased graft rejection rates, a serological crossmatch is routinely performed before kidney transplantation. But, the presence of these antibodies is not routinely monitored after transplantation. We investigated the panel-reactive antibody (PRA) response to know whether variations before or after kidney transplantation were associated with graft rejection. METHODS We prospectively analyzed sera from 350 renal allograft recipients from September 1998 to March 2003. Pretransplantation and posttransplantation sera at 3 or 5 weeks postoperatively were tested in PRA. Recipients were stratified into 3 groups according to their PRA levels group I, PRA = 0; group II, PRA = less than 50%, and group III, PRA = more than 50%. RESULTS The total graft rejection rate among 350 recipients was 9.4% (n = 33). Twenty-four pretransplantation PRA-positive recipients had a graft rejection rate of 20.8% (n = 5), compared with an 8.6% (n = 28) rate among 326 pretransplantation PRA-negative recipients. Six of 24 posttransplantation PRA-positive recipients (25%) experienced a graft rejection versus 27 (8.3%) of 326 posttransplantation PRA-negative subjects. Among the pretransplantation PRA stratae, the rejection rate in group III was 25% (1 of 4) versus 20% (4 of 20) in group II and 8.6% (28 of 326) in group I (P < .05). According to the postransplantation PRA level, 37.5% (3 of 8) in group III versus 18.8% (3 of 16) in group II and 8.3% (27 of 326) in group I (P < .05) had a graft rejection. CONCLUSION Our study suggests that the PRA response pretransplantation and in the early posttransplantation period correlates with the kidney allograft rejection rate.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kim SJ, Lee KW, Lee DS, Lee HH, Lee SK, Kim B, Huh WS, Oh HY, Joh JW. Randomized trial of tacrolimus versus cyclosporine in steroid withdrawal in living donor renal transplant recipients. Transplant Proc 2004; 36:2098-100. [PMID: 15518759 DOI: 10.1016/j.transproceed.2004.08.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The introduction of new immunosuppressants has prompted trials of steroid withdrawal. However, several groups have reported a higher incidence of rejection. We conducted a randomized two-arm, parallel-group, open-label, prospective study to compare steroid withdrawal (at 6 months posttransplant) from the regimens of tacrolimus + mycophenolate mofetil (MMF) (FK group) versus cyclosporine + MMF (CSA group). The entry criteria were recipients of first living donor transplants with no diabetes mellitus (DM), congestive heart failure, chronic liver disease, or acute rejection within 6 months posttransplant. The primary endpoint was a biopsy-proven acute rejection episode or treatment failure within 1 year posttransplant. While 87 recipients were assigned to FK (n = 43) and CSA groups (n = 44) before transplantation, 76 recipients (FK 39, CSA 37) could be tapered off steroids at 6 months posttransplant, since 11 were excluded due to acute rejection within 6 months posttransplant (FK two, CSA three) or protocol violations (FK two, CSA four). After steroid withdrawal, the incidence of acute rejection episodes was 0% in the FK group and 13.5% in the CSA group (P < .05). Other results at 12 months posttransplantation were comparable: the incidences of DM 7.8% versus 0% (FK group vs CSA group), hypercholesterolemia 41.0% versus 59.5%, hypertensives 48.7% versus 59.6% as well as the levels of plasma creatinine 1.21 +/- 0.24 versus 1.31 +/- 0.50 mg/dL (P > .05 in every variable). These data suggest that steroid withdrawal is successful in first living donor renal transplant recipients. Tacrolimus may be significantly more effective than cyclosporine to prevent acute rejection after steroid withdrawal.
Collapse
Affiliation(s)
- S J Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Kim SJ, Lee HH, Lee DS, Lee KW, Joh JW, Woo DH, Kwon GY, Oh HY, Kim YG, Huh WS, Kim DJ, Kim GS, Lee SK, Lee BB. Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation. Transplant Proc 2004; 36:2038-9. [PMID: 15518737 DOI: 10.1016/j.transproceed.2004.08.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Numerous studies have reported various prognostic factors that affect graft and patient survival in living and cadaveric donor kidney transplantation (KT). The purpose of this study was to evaluate the clinical outcomes and prognostic factors affecting graft and patient survivals in living and cadaveric donor KT. Between February 1995 and December 2001, 421 patients who had undergone cadaveric donor KT (group I: 216 cases, 51.3%) or living donor KT (group II: 205 cases, 48.7%), were retrospectively analyzed. Five-year overall graft survival rates in living was significantly better than that in cadaveric donor KT, respectively (P = .0234). There was no difference in patient survival rates between the two groups. Such factors as absence of rejection, female donor, female recipient, adult KT according to recipient age (>14 years), and donor serum creatinine level just before transplantation (< 2.5 mg/dL) were significantly associated with good graft survival among cadaveric donor KT, whereas two factors-absence of rejection and adult KT according to recipient age (>14 years)-influenced graft survival in living donor KT. In multivariate analysis, the only significant prognostic factor related to graft survival was the presence of rejection. In conclusion, we suggest that the presence of rejection is the only factor that impairs graft survival in both cadaveric and living donor KT, while other factors affected graft survival differently in the two groups.
Collapse
Affiliation(s)
- S J Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Lee KW, Lee HH, Lee DS, Kim SJ, Joh JW, Oh HY, Kim JW, Kim YG, Huh WS, Kim DJ, Lee SK, Lee BB. Polymerase chain reaction for the diagnosis of human polyomavirus-associated nephropathy in renal transplant recipients. Transplant Proc 2004; 36:2116-7. [PMID: 15518766 DOI: 10.1016/j.transproceed.2004.08.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human polyomavirus type BK may be related to interstitial nephropathy or renal-allograft dysfunction. Patients with nephropathy due to infection with human polyomavirus may be identified early using the polymerase chain reaction(PCR). We attempted to evaluate whether the positive response in the PCR test of BK virus DNA in the plasma of renal transplant recipients affects the function of the renal allograft. Seventy-seven patients were prospectively analyzed according to the operative sex, age, sources of allograft, serum creatinine levels during PCR test for BK virus, postoperative type of immunosuppressant, and presence of graft rejection. Two groups were distinguished according to the PCR result for BK virus: group 1 (n = 12) positive PCR reaction and group 2 (n = 65) negative reaction. The mean follow-up was 32.6 weeks. The incidence of positive PCR tests for BK virus replication after renal transplantation was 15.6%. Decoy cells in the urine were detected in 20.7%. The incidence of BK virus nephropathy was 1.3%. The mean serum creatinine levels of group 1 and 2 at the time of the PCR tests were 1.34 and 1.22, respectively. The rejection rates in group 1 and 2 were 8% and 4.5%, respectively (P > .05). We consider that a PCR assay to detect BK virus in renal recipients blood may be useful to identify patients at risk for nephropathy. It may serve as a noninvasive indicator of BK virus replication, although this study is limited by the short follow-up and small numbers.
Collapse
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Lim DH, Kim DY, Kang MK, Kim YI, Kang WK, Park CK, Kim S, Noh JH, Joh JW, Choi SH, Sohn TS, Heo JS, Park CH, Park JO, Lee JE, Park YJ, Nam HR, Park W, Ahn YC, Huh SJ. Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view. Br J Cancer 2004; 91:11-7. [PMID: 15162146 PMCID: PMC2364765 DOI: 10.1038/sj.bjc.6601896] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.
Collapse
Affiliation(s)
- D H Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - D Y Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea. E-mail:
| | - M K Kang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y I Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - W K Kang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - C K Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J H Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J W Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S H Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - T S Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J S Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - C H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J O Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J E Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y J Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - H R Nam
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - W Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y C Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S J Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| |
Collapse
|
36
|
Lee WY, Lee KW, Heo JS, Choi SH, Kim SJ, Joh JW, Lee SK. Prolongation of pig liver perfusion time by gabexate mesilate continuous infusion in extracorporeal perfusion system using Bio-pump. Transplant Proc 2003; 35:128-9. [PMID: 12591335 DOI: 10.1016/s0041-1345(02)03776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W Y Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | |
Collapse
|
37
|
Lee KW, Joh JW, Kim SJ, Park JH, Chon SE, Choi SH, Heo JS, Song JH, Kim SM, Peck KR, Kim YI, Lee BB, Lee SK. Living donor liver transplantation using graft infested with clonorchis sinensis: two cases. Transplant Proc 2003; 35:66-7. [PMID: 12591310 DOI: 10.1016/s0041-1345(02)03955-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lee KW, Son TS, Joh JW, Kim SJ, Park JH, Chon SE, Choi SH, Heo JS, Kim YI, Lee BB, Lee SK. Perioperative cytokine response after liver transplantation. Transplant Proc 2003; 35:407-8. [PMID: 12591462 DOI: 10.1016/s0041-1345(02)03956-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Chon SE, Lee KW, Joh JW, Kim SJ, Park JH, Lee SK, Oh HY, Huh WS, Kim YI, Lee BB. Factors affecting the graft survival in cadaver donor kidney transplantation. Transplant Proc 2003; 35:147-8. [PMID: 12591342 DOI: 10.1016/s0041-1345(02)03767-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S E Chon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Kim SJ, Yang TY, Jeong IK, Lee MK, Choo SW, Lee KW, Joh JW, Lee SK, Lee BB, Kim KW. Retransplantation of islets after simultaneous islet-kidney transplantation: a case report. Transplant Proc 2003; 35:476-8. [PMID: 12591492 DOI: 10.1016/s0041-1345(02)04005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S J Kim
- Department of Surgery, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Park JH, Noh JH, Lee KW, Lee SK, Kim SJ, Choi SH, Heo JS, Chon SE, Paik SW, Koh KW, Lee JH, Choi MS, Kim YI, Lee BB, Joh JW. Safety of the donor with right hepatic lobectomy in the living donor liver transplantation. Transplant Proc 2003; 35:57-8. [PMID: 12591306 DOI: 10.1016/s0041-1345(02)03949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J H Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Park SJ, Paik SW, Choi MS, Lee JH, Koh KC, Kim SJ, Joh JW, Lee SK. Is lamivudine with 1-week HBlg as effective as long-term high-dose HBlg in HBV prophylaxis after liver transplantation? Transplant Proc 2002; 34:1252-4. [PMID: 12072331 DOI: 10.1016/s0041-1345(02)02637-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- S-J Park
- Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Lee KW, Lee SK, Joh JW, Kim SJ, Park JH, Chon SE, Choi SH, Heo JS, Paik SW, Koh KW, Lee JH, Choi MS, Kim YI, Lee BB. Comparison of the efficacy in prevention of hepatitis B virus recurrence after liver transplantation between HBIG and lamivudine. Transplant Proc 2001; 33:3643-4. [PMID: 11750547 DOI: 10.1016/s0041-1345(01)02567-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Choi IS, Park JB, Kim SJ, Joh JW, Lee SK, Huh WS, Oh HY, Kim SM, Peck KR, Song JH, Kim MK, Ko YH, Lee BB. Tuberculous abscess of the graft in a renal transplant recipient after chronic rejection: case report. Transplant Proc 2000; 32:1957-8. [PMID: 11120018 DOI: 10.1016/s0041-1345(00)01510-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- I S Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Choi IS, Kim SJ, Kim BY, Joh JW, Kim YI, Lee SK, Huh WS, Oh HY, Kim DJ, Kim YG, Kim MK, Ko YH, Lee BB. Candida polyarthritis in a renal transplant patient: case report of a patient successfully treated with amphotericin B. Transplant Proc 2000; 32:1963-4. [PMID: 11120021 DOI: 10.1016/s0041-1345(00)01513-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I S Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Joh JW, Park KC, Choi IS, Choi SH, Heo JS, Sohn TS, Kim SJ, Kim YI, Lee WY, Baek NS, Kim MK, Koh YH, Lee SK, Lee BB. Three cases of posttransplant lymphoproliferative disorder in recipients of liver transplantation. Transplant Proc 2000; 32:2260-1. [PMID: 11120157 DOI: 10.1016/s0041-1345(00)01656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J W Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kim SJ, Joh JW, Lee SK, Choi IS, Lee WY, Heo JS, Lee MK, Yang TY, Jeong IK, Oh SH, Kim BJ, Kim KW, Lee BB. Pancreatic islet cell autotransplantation in the canine model. Transplant Proc 2000; 32:2473-4. [PMID: 11120251 DOI: 10.1016/s0041-1345(00)01750-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S J Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Lee SK, Park JH, Joh JW, Kim SJ, Choi IS, Choi SH, Heo JS, Lee WY, Sohn TS, Kim YI, Paik SW, Koh KC, Lee JH, Kim SM, Peck KR, Song JH, Lee BB. Prophylaxis against hepatitis B recurrence following liver transplantation in HBs Ag(+) patients. Transplant Proc 2000; 32:2248-9. [PMID: 11120152 DOI: 10.1016/s0041-1345(00)01786-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S K Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lim JH, Kim CK, Lee WJ, Park CK, Koh KC, Paik SW, Joh JW. Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol 2000; 175:693-8. [PMID: 10954452 DOI: 10.2214/ajr.175.3.1750693] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic efficacy of three-phase helical dynamic CT in the detection and characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers. SUBJECTS AND METHODS Three-phase helical dynamic CT in 41 patients with liver cirrhosis was evaluated prospectively before orthotopic liver transplantation. The numbers of hepatocellular carcinomas and dysplastic nodules were assessed in the explanted livers and compared with pretransplantation CT findings. RESULTS Examination of the explanted livers revealed 21 hepatocellular carcinomas in 15 patients and 23 dysplastic nodules in 10 patients. The size of the hepatocellular carcinomas was 0.6-5. 0 cm (mean, 1.9 cm), and that of the dysplastic nodules was 0.7-2.0 cm (mean, 1.0 cm). The use of helical dynamic CT enabled detection of 15 of 21 hepatocellular carcinomas (sensitivity, 71%) and nine of 23 dysplastic nodules (sensitivity, 39%). Patient sensitivity and specificity in the detection of hepatocellular carcinomas were 80% (12/15) and 96% (25/26), respectively, and for dysplastic nodules, 50% (5/10) and 97% (30/31), respectively. CONCLUSION Three-phase helical dynamic CT is relatively insensitive for detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers, especially for dysplastic nodules and hepatocellular carcinomas smaller than 2 cm.
Collapse
Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, 135-710 Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE The purpose of this study was to determine the utility of preoperative CT in predicting early recurrence of hepatocellular carcinoma after partial hepatic resection. MATERIALS AND METHODS Preoperative three-phase helical CT scans in 53 patients with hepatocellular carcinoma were retrospectively reviewed by two radiologists. In 27 patients (group I), HCC had recurred within six months, while 26 (group II) had remained disease free for at least two years. In each group, preoperative CT findings were evaluated in each group for the tumor size and number, the presence or absence of capsule, distinctness of tumor margin, perinodular extension, and the presence or absence of portal vein thrombosis. RESULTS In group I, a tumor capsule of tumor was seen in five of 27 patients (19%), and in group II, in 16 of 26 (62%) (p =.001). The tumor margin was distinct in eight patients (30%) in group I and in 20 (77%) in group II (p =.001). Multiple tumors, perinodular extension, and portal vein thrombosis were more frequently seen in group I but the differences were not statistically significant (p >.05). Tumor size was similar in each group (p >.05). CONCLUSION Preoperative CT findings that may help predict the early recurrence of hepatocellular carcinoma after surgical resection are an absence of capsule of tumors and an indistinct margin. Reference to these findings during preoperative CT can guide clinicians in their choice of treatment.
Collapse
Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|