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Jae Keun Park,Ju-Il Yang,Jong Kyun Lee,Joo Kyung Park,Kwang Hyuck Lee,Kyu Taek Lee,Jae-Won Joh,Choon Hyuck David Kwon,Jong Man Kim 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.1
Background/Aims: Biliary strictures remain one of the most challenging aspects after living donor liver transplantation (LDLT). The aim of this study was to assess long-term outcome of endoscopic treatment of biliary strictures occurring after LDLT and to identify risk factors of recurrent biliary strictures following endoscopic retrograde biliary drainage (ERBD) in LDLT. Methods: A total of 1,106 patients underwent LDLT from May 1995 to May 2014. We compared the risk factors between patients with and without recurrent biliary strictures. Results: Biliary strictures developed in 24.0% of patients. Technical success rate of ERBD for biliary stricture after LDLT was 66.2% (145/219). Among 145 patients managed by endoscopic drainage, stricture resolution occurred in 69 with median duration of stent indwelling of 13.6 months (range, 0.5 to 67.3 months), and stricture recurrence was seen in 20 (21.3%) out of 94. The median recurrence-free duration after final endoscopic success was 13.1 months (range, 0.5 to 67.3 months). Older donor age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03 to 1.17; p=0.004) and non-B, non-C liver cirrhosis (HR, 5.10; 95% CI, 1.10 to 25.00; p=0.043) were associated with higher recurrence of biliary stricture. Conclusions: Long-term stricture resolution rate after ERBD insertion for biliary stricture occurring after LDLT was 73.4%. Clinicians should pay careful attention during following-up to decide when to remove ERBD in patients who have factors associated with recurrent biliary strictures.
( Mill Jae Shin ),( Sang Hyun Song ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Tae Seok Kim ),( Jong Man Kim ),( Choon Hyuck David Kwon ),( Sung Joo Kim ),( Jae Won Joh ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Purpose: At the time of transplantation, the recipient serum is tested with the prospective donor lymphocytes to identify specific reactivity in the donor-specific crossmatch. A positive crossmatch is a contraindication for kidney transplantation because of the higher incidence of antibody mediated rejection. However, numerous studies has found that the liver is resistant to it. We investigated the relationship between the pretransplant lymphocytotoxic crossmatch results and the long-term outcome after liver transplantation in a single center. Methods: From January 1996 to December 2010, 1021 living or deceased donor liver transplant recipients were included. Their medical records and pretransplant crossmatch results were collected. Results: 69 of 1021 (6.8%) liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 952 performed with a negative crossmatch. No significant differences in rejection, biliary complication, vascular complication, primary disease recurrence and de novo malignancy were found in negative and positive T- or B-lymphocytotoxic crossmatch recipients. Graft loss and patient survival were not inferior in the recipient group testing positive crossmatch. Besides, T and B cell crossmatch against donor showed positive results initially. But recipient`s autocontrol (recipient`s cell + recipient`s serum) also showed similar positive results. After dithiothreitol (DTT) treatment, all previous positive result was converted to negative. So, IgM class autoantibody against recipient`s own antigen was strongly suggested. We defined these subpopulation as false positive crossmatch group, accounting for 41 (4.0%) recipients. Significantly high incidences of de novo malignancies, especially lymphoid malignancy including posttransplant lymphoproliferative disorder, were observed in false positive crossmatch recipients compared to those of negative controls. (p=0.018 in overall de novo malignancy, p=0.029 in lymphoid malignancy) Conclusion: This study demonstrated that the presence of circulating IgM autoantibody in the recipient may be a risk factor for de novo malignancy, specially lymphoid malignancy. Although the precise mechanism remains unclear, immunologic factors is considered to involve in the pathogenesis of de novo malignancy.
( Mll Jae Shin ),( Sang Hyun Song ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Tae Seok Kim ),( Jong Man Kim ),( Choon Hyuck ),( David Kwon ),( Sung Joo Kim ),( Jae Won Joh ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Purpose: At the time of transplantation, the recipient serum is tested with the prospective donor lymphocytes to identify specific reactivity in the donor-specific crossmatch. A positive crossmatch is a contraindication for kidney transplantation because of the higher incidence of antibody mediated rejection. However, numerous studies has found that the liver is resistant to it. We investigated the relationship between the pretransplant lymphocytotoxic crossmatch results and the long-term outcome after liver transplantation in a single center. Methods: From January 1996 to December 2010, 1021 living or deceased donor liver transplant recipients were included. Their medical records and pretransplant crossmatch results were collected. Results: 69 of 1021 (6.8%) liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 952 performed with a negative crossmatch. No significant differences in rejection, biliary complication, vascular complication, primary disease recurrence and de novo malignancy were found in negative and positive T- or B-lymphocytotoxic crossmatch recipients. Graft loss and patient survival were not inferior in the recipient group testing positive crossmatch. Besides, T and B cell crossmatch against donor showed positive results initially. But recipient``s autocontrol (recipient``s cell + recipient``s serum) also showed similar positive results. After dithiothreitol (DTT) treatment, all previous positive result was converted to negative. So, IgM class autoantibody against recipient``s own antigen was strongly suggested. We defined these subpopulation as false positive crossmatch group, accounting for 41 (4.0%) recipients. Significantly high incidences of de novo malignancies, especially lymphoid malignancy including posttransplant lymphoproliferative disorder, were observed in false positive crossmatch recipients compared to those of negative controls. (p=0.018 in overall de novo malignancy, p=0.029 in lymphoid malignancy) Conclusion: This study demonstrated that the presence of circulating IgM autoantibody in the recipient may be a risk factor for de novo malignancy, specially lymphoid malignancy. Although the precise mechanism remains unclear, immunologic factors is considered to involve in the pathogenesis of de novo malignancy.
Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea
Choi, Won Suk,Kang, Cheol-In,Kim, Yonjae,Choi, Jae-Phil,Joh, Joon Sung,Shin, Hyoung-Shik,Kim, Gayeon,Peck, Kyong Ran,Chung, Doo Ryeon,Kim, Hye Ok,Song, Sook Hee,Kim, Yang Ree,Sohn, Kyung Mok,Jung, You The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.2
<P><B>Background</B></P><P>From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015.</P><P><B>Materials and Methods</B></P><P>We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay.</P><P><B>Results</B></P><P>The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death.</P><P><B>Conclusion</B></P><P>The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.</P>
Kyo Won Lee,Chan Woo Cho,Nuri Lee,Gyu-Seong Choi,Yang Hyun Cho,Jong Man Kim,Choon Hyuck David Kwon,Jae-Won Joh 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.3
Purpose: This study was designed to assess the outcome of the extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients with refractory septic shock and predict the prognosis of those cases. Methods: From February 2005 to October 2012, ECMO was used in 8 cases of refractory septic shock. Laboratory values including lactate and total bilirubin level just before starting ECMO were obtained and sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACH) II score and simplified acute physiology score (SAPS) 3 were calculated. Subsequent peak serum lactate and total bilirubin level, and SOFA score after 24 hours of starting ECMO were measured. Results: Comparisons were made between survivors and nonsurvivors. ECMO was weaned off successfully in 3 patients (37.5%) and 2 patients (25%) survived to hospital discharge. Clinical scores including SOFA, APACH II, and SAPS3 and laboratory results including lactate, total bilirubin and CRP were not significantly different between survivor and nonsurvivor groups. Lactate level and SOFA score tended to decrease after ECMO support in survivor group and total bilirubin and CRP level tended to increase in nonsurvivor group. Conclusion: Our findings suggest that the implantation of ECMO might be considered in highly selected LT recipients with refractory septic shock.
Lim, Jae Hoon,Kim, Min Ju,Chiang, Liu Wei,Lim, Hyo Keun,Park, Cheol Keun,Paik, Seung Woon,Joh, Jae Won,Koh, Kwang Cheol 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.2
Objective: The objective of this study was evaluate the diagnostic efficacy of three-phase helical dynamic CT in the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis. Materials and Methods: Three-phase helical dynamic CT in 77 patients with advanced liver cirrhosis was evaluated prospectively before orthotopic liver transplantation. The histopathologically confirmed hepatocellular carcinomas in the explanted livers were compared with pretransplantation CT results by one-to-one correlation. Results: Histopathologic examination of the explanted livers revealed 72 hepatocellular carcinomas in 41 patients. The size of the hepatocellular carcinomas was 0.5-14.0 cm (mean, 1.6 cm). The use of helical dynamic CT enabled the detection of 38 of 72 hepatocellular carcinomas (sensitivity, 53%). Fifteen of 35 (43%) hepatocellular carcinomas smaller than 2 cm and 23 of 37 (62%), hepatocellular carcinomas ranging from 2.0 cm to 14.0 cm were detected. Patient sensitivity and specificity in the detection of hepatocellular carcinoma were 81% (33/41) and 94% (34/36), respectively. Conclusions: Three-phase helical dynamic CT is insensitive for detection of hepatocellular carcinomas in patients with advanced liver cirrhosis, especially for hepatocellular carcinomas smaller than 2 cm.(Korean J Hepatol 2002;8:201-208)