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- 저자 : ( Taganova An ) (검색결과 4 건)
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( Taganova An ),( Lee Kw ),( Jeong Jh ),( Suh Sw ),( Yi Nj ),( Kim Hy ),( Suh Ks ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Different anatomical variations of the intrahepatic bile ducts, and in particular its right half, is one of the important risk factors for billiary complication in recipients undergoing living-donor liver transplantation (LDLT). The authors already reported high risk group of biliary injury during living donor hepatecotmy according to the anatomy of the right posterior bile duct (RPBD). We ex perienced a case with the bile duct injury in the graft which was unnoticed during living donor hepatectomy. 26 years old male underwent right liver hepatectomy for donation to his father 55 years old. The preoperative MRCP showed long caudal segment of RPBD, which has been reported as high risk for biliary complication in the recipient. There was no problem during donor hepatectomy and bench surgery. However, we found that RPBD was not easily identified and RPBD was partially ligated when probing was tried just before biliary anastomosis. We opened ligated RPBD. But the wall was thin. We opened damaged wall of RPBD and duct-to-duct anastomosis was done without stent. According to this case, we learned several lessons: 1) Understanding of the preoperative risk of bile duct injury during hepatectomy based on preoperative MRCP is important, 2) different bile duct division method in the high risk patient should be applied, 3) comparison of the biliary anatomy by probing the graft during bench with that of preop erative MRCP is necessary to detect unknown bile duct injury, 4) injured wall should be opened and anastomosed using healthy duct is important to reduce delayed biliary complications.
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( Sabit Dossanbayev ),( Alya Taganova ),( Zhaksylyk Doskaliyev ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: There were many studies showed the successful preg nancy and delivery in patients after liver transplantation. From 2012 more than 100 living donor liver transplantations has carried out in Kazakhstan and our report represents the first successful pregnancy and delivery in recipient after liver trans plantation. Methods: Orthotopic transplantation of right liver lobe from a living related donor was performed to our patient from her el der brother. The main cause of liver cirrhosis was autoimmune hepatitis. After one year of LDLT the patient informed us about unplanned pregnancy. Results: Among complications in early postoperative period the portal vein thrombosis was detected and successfully treated by heparin monotherapy. No other complications found in late period after transplantation. The standard third-component immunosuppressive therapy (CNI + MMF + GCS) was applied during the first year after transplantation. After the sudden information of 2 weeks pregnancy the MMF application was canceled. In first three months no significant alterations were found during the childbearing. On 18-20 weeks the first signs of liver rejection was appeared where sensitization of HLA class 1 was 0% and HLA class 2 consisted 91%. As a main treat ment the pulse therapy with GCS and plasmapheresis were performed. On 40 weeks delivery was successfully done by Ce sarean section. The child was male with weight - 2830 g, and height - 54.3 cm and without no visible any defects. Conclusions: In our case, it was an acceptable outcome for both mother and baby, although considered a high risk preg nancy.
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Features of Care the Pregnant Woman after Liver Transplantation
( Aibolat Smagulov ),( Doskali Marlen ),( Rysmakhanov Myltykbai ),( Taganova Aliya ),( Kulmaganbetov Aidos ),( Seidakhmetov Akhmet ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: As known the first case of pregnancy after liver transplantation has been in 1978 (Armenti VT1 et. al., Liver Transpl. 2000). During three years 127 living donor liver transplantations has carried out in Kazakhstan and our report represents the first successful pregnancy and childbirth after liver transplantation. Methods: Our patient is 27 years old for long period suffered from liver cirrhosis caused by autoimmune hepatitis. In December 2013 orthotopic transplantation of right liver lobe from a living related donor was performed. The donor was her elder brother. Results: In postoperative period it was portal vein thrombosis which treated by heparin monotherapy. No other complications found in late period after transplantation. The standard third-component immunosuppressive therapy (CI + MMF + GCS) was applied during the first year after transplantation. One year later it was suddenly known that patient is pregnant and it was 2 week of pregnancy when MMF application was canceled. First signs of liver rejection was appeared on 18-20 weeks where sensitization of HLA class 1 was 0% and HLA class 2 consisted 91%. As a main therapy pulse therapy with GCS and plasmapheresis were performed. During observation all signs of rejection and laboratory data decreased in 4 weeks and patientperformed a screening of fetus where no pathological alterations were found. On 40 weeks delivery was successfully done by Cesarean section. The child was male with weight - 2830 g, and height - 54.3 cm and without no visible any defects. Conclusions: In our case, it was an acceptable outcome for both mother and baby, although considered a high risk pregnancy. Regarding our data there is no evidence of specific structural malformations among children born to female liver transplant recipients, but it is still under observation when it should be decided with immunosuppressive therapy alterations.
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( Suk Kyun Hong ),( Nam-joon Yi ),( Kyung Chul Yoon ),( Hyo-sin Kim ),( Hyeyoung Kim ),( Kwang-woong Lee ),( Kyung-suk Suh ),( Aliya Taganova ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Few studies have focused on the comparison of post-liver transplant (LT) outcome between hepatitis B virus (HBV) and alcoholic liver disease (ALD) in a living donor liver transplantation (LDLT) dominant Asian country where HBV is endemic and there no strict regulation of pre-transplant abstinence for ALD. The aim of this study is to evaluate the efficacy of deceased donor liver transplantation (DDLT) in patients with ALD comparing post-transplant outcome with HBV. Methods: We retrospectively analyzed data from 220 patients who received DDLT at Seoul National University Hospital from January 2010 to December 2014. Results: 107 patients underwent primary DDLT for HBV and 38 patients for ALD. 74 patients (69.2%) in HBV group and 30 patients (78.9%) in ALD group were UNOS (United Network for Organ Sharing) status 2A (P=0.250). There was no significant difference in the overall survival rate between the two groups (1-, 3-year survival rates of 90.7% and 82.1%, respectively vs. 92.1% and 82.3%, respectively; P=1.000). The major complication was infection which was more frequent in ALD group (19.6% vs. 43.8%; P=0.018). By multivariate analysis, independent prognostic factor was a high serum GGT level on post-LT 1 year (≥70 IU/L). Conclusions: In conclusion, outcome of DDLT for ALD was not worse than that for HBV in Korea without pre-transplant strict application of abstinence as selection criteria of DDLT.
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