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( 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.
( Sang Hyun Song ),( Choon Hyuck David Kwon ),( Jae Won Joh ),( Jong Man Kim ),( Mill Jae Shin ),( Sung Joo Kim ),( Suk Koo Lee ),( Tae Suk Kim ),( Hyung Hwan Moon ),( Sang Hoon Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: Portal vein thrombosis (PVT) is a surgical challenge in liver transplantation (LTx). Presence of PVT was considered as a contraindication for LTx in some centers due to the controversy revolving around the long term outcome of these patients. Therefore, we studied the long term outcome of adult patients with PVT in LTx in a tertiary institution with specialized transplantation unit. Methods: There were 570 cases of adult liver transplantation between 2004 and 2009 in our institution. We excluded 99 cases of deceased donor liver transplantations to facilitate incidence, outcome and surgical management. There were 56 patients with existing PVT before 471 living donor liver transplantations. Patients with PVT were divided into 2 groups according to Yerdal`s classification, mild PVT group (Yerdel group 1 & 2) 43 cases and severe PVT group (Yerdel group 3 & 4) 13 cases. Results: Patients with PVT constituted 11.8% (n=56) in our cohort. When comparing between patients without and with PVT, we did not find statistical difference in terms of age, gender, Child-Pugh score, MELD score & indication for LTx (benign vs malignancy). Rate of PV complication was 3.4% in the non-PVT group and 8.9% in PVT group (p=0.047). Duration of operation and total amount of blood transfusion were also comparable between two groups. The overall survival of PVT group was not significantly different compared to the non-PVT group (p=0.059). Demographics of 43 cases of mild PVT (76.7%) and 13 cases of severe PVT (23.3%) were not different except in severe PVT group had more malignancy cases (27 cases vs 2 cases, p=0.011). The median overall survival of mild PVT group is comparable with non-PVT group (p=0.059) and the median overall survival of severe PVT group is 32 months (1-88) and non-PVT group is 41 months (1-93) (p=0.066). 5-year survival rate of severe PVT is about 60%. Conclusions: Existing PVT prior to liver transplantation does not lead to poorer long term outcome. However in severe cases, we need more careful approach. Therefore, PVT should not be a contraindication to liver transplantation.
Preliminary Experience of Laparoscopic Hepatectomy for Hepatocellular Carcinoma
Gwan Chul Lee,Choon Hyuck David Kwon,Jae Won Joh,Jin Seok Heo,Gum O. Jung,Ju Ik Moon,Jong Man Kim,Mill Jae Shin,Moon Suk Choi 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1
Purpose: Laparoscopic liver resection has gained much popularity in recent years, but relatively few centers have performed hepatectomies in hepatocellular carcinoma (HCC) patients due to the technical difficulties faced with underlying liver cirrhosis. We now present our early experience with laparoscopic liver resection in HCC performed in a single institution. Methods: From October 2003 until March 2009, 39 laparoscopic liver resections were performed on HCC patients among whom 26 had underlying liver cirrhosis. Results: The location of the tumor was in the left lateral section in 15, segment 5 or 6 in 20, segment 4 in 3 and caudate lobe in 1. Resection involving less than a monosegment was done in 26 and more than 2 segments in 13. Tumor size ranged from 0.8 cm to 6.6 cm (median 2.35) and the resection margin from 0.1 to 6 cm (median 1.5 cm). All patients were either stage I (29) or II (10). There was no difference between cirrhotic and non-cirrhotic patients in operation time (median 210 minutes, range 60∼637), change of hematocrit value (4.8%, ?1∼19.6%), or hospital stay (8 days, 3∼67 days). The median follow up duration was 15.1 months, and the 2-year recurrence free survival rate was 48.3%. Conclusion: Laparoscopic liver resection in HCC with or without underlying cirrhosis seems to be feasible with minimal morbidity, especially in well selected cases with early stage HCC.
( Tae Seok Kim ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Sang Hyun Song ),( Mill Jae Shin ),( Jong Man Kim ),( Choon Hyuck David Kwon ),( Sung Joo Kim ),( Suk Koo Lee ),( Jae Won Joh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: The prognosis of FHF depends on the etiology and reversibility. Although the King`s College Hospital (KCH) criteria and Clichy/Villejuif criteria remain the most widely used prognostic criteria of FHF, there are also limitations due to geographically various and different causes of disease. Furthermore it is difficult to estimate prognosis after liver transplantation (LT) according to these criteria. Therefore, we identified the etiologic difference of FHF in Korea, and analyzed the prognostic factors after LT for FHF. Methods: We retrospectively reviewed medical records of 42 patients diagnosed with FHF and underwent LT from April 1999 to April 2011 at Samsung Medical Center, Seoul, Korea. We evaluated the etiologic change and difference compared with western countries. The patients were categorized into two groups according to the in-hospital result of LT; survival group (n=35) and mortality group (n=7). Perioperative profiles were compared between groups to identify the in-hospital poor prognostic factors after LT for FHF. Results: The most common cause of FHF underwent LT was toxic hepatitis (45.2%). Unlike western countries, there was no paracetamol-related FHF but herbal medication or folk remedies are the most frequent causes of toxic hepatitis (58%). There was no patient underwent LT due to HAV-related FHF until 2005, however HAV-related FHF increased significantly and comprised the main portion of FHF (34.5%) after 2005. Encephalopathy grade, onset time, pre-transplantation need of renal replacement and ventilator treatment were significant prognostic factors after LT for FHF in univariate analysis. In multivariate analysis, pre-transplantation renal replacement treatment was the independent prognostic factor after LT for FHF. Conclusions: In this study, we showed the different etiology of FHF in Korea and identified the renal replacement treatment as an independent prognostic factor after LT for FHF. In order to confirm the prognostic factors after LT for FHF, large size of studies are needed.
HCC : Single center experience of Liver transplnatation in patients with portal vein thrombosis (초)
( Sang Hyun Song ),( Choon Hyuck David Kwon ),( Jong Man Kim ),( Mill Jae Shin ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Tae Suk Kim ),( Jae Won Joh ),( Sung Joo Kim ),( Suk Koo Lee ),( Hye Ran Yi ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)