Clinical Outcomes of Late Conversion to Once-Daily Tacrolimus after Liver Transplant

( Deok Gie Kim ),( Yoon Bin Jung ),( Jee Youn Lee ),( Jae Geun Lee ),( Sung Hoon Kim ),( Han Dai Hoon ),( Man Ki Ju ),( Gi Hong Choi ),( Jin Sub Choi ),( Myoung Soo Kim ),( Soon Il Kim ),( Dong Jin Jo 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Since a once-daily tacrolimus (TAC-OD) has been introduced in the field of transplantation, many studies reported advantages of the new drug, such as the better adherence and the less intrapatient variability than the twice-daily tacrolimus (TAC-TD). Recently, promising results were announced regarding better clinical outcomes of the early conversion to TAC-OD in liver transplant patients. In this study, we investigated clinical outcomes of late conversion to TAC-OD more than 6 months after transplantation. Methods: A total 281 patients who received liver transplant patient from January 2012 to January 2017 took TAC-TD from operation. Of them, 38 patients were converted to TAC_OD 6 months after transplantation, while others remained with TAC-TD. We compared graft survival and postoperative complication between two groups, especially with regard to biliary complication known as implication of chronic rejection. Results: Among the patients, 151 were living donor liver transplantation. There was no difference in demographics and operative characteristics between two groups. Biliary stricture occurred later after 6 month after transplantation was 18 (7.4 %) in TAC-TD and 2 (5.3 %) in TAC-OD. The cumulative incidence was not statistically different. However, overall graft survival rate was significantly higher in TAC-OD than that in TAC-TD (P=0.049). Biliary stenosis free survival was also higher without significance (P=0.065). Adverse event of drug was similar between two groups. Conclusions: Late conversion to TAC-OD was safe and feasible. It has advantages of graft survival compared to TAC-TD.

Necessity for the Elimination of Total Necrosis from Hepatocellular Carcinoma Staging after Liver Transplantation

( Deok Gie Kim ),( Yoon Bin Jung ),( Jae Geun Lee ),( Dong Jin Joo ),( Soon Il Kim ),( Myoung Soo Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Bridging therapy for unresectable hepatocellular carcinoma (HCC) is an effective treatment in the patients waiting liver transplantation. Herein, we evaluated whether the degree of TN affect the staging for HCC after liver transplantation. Methods: We conducted a retrospective study of 391 consecutive HCC patients underwent liver transplantation between September 2005 and December 2016. Pathologic staging was made after counting out tumor masses with TN. The group comparison for 10 year HCC recurrence free survival (RFS) was conducted between the patients downstaged or non-downstaged by adjustment with TN. Results: Among patients, 252 received one or more number of bridging therapies such as transarterial chemoemolization or radiofrequency ablation. Patients within UCSF criteria showed significantly better RFS over 10 years (P<0.001). There was significant difference between groups changing over UCSF criteria after adjusting TN (P<0.001) although only Within UCSF to complete TN group showed significantly higher RFS in inter-group analysis. For AJCC TNM staging, 92 (23.5%) patients were downstaged by TN. Group comparison demonstrated that down staged Stage I and II group had similar RFS with non-downstaged Stage I group (P=0.919) but had higher RFS than non-downstaged Stage II and IIIA group (P=0.048). Down-staged T0 group showed higher RFS than non-downstaged Stage II and IIIA group (P=0.005) but similar RFS with other two groups (P=0.418 and 0.438 respectively). For UNOS T staging, 85 (21.7%) patients were downstaged by TN. In the group comparison, only down staged T0 group showed significantly higher RFS than other groups. Conclusions: In this study, TNM stage I and II adjusted by TN showed better RFS than higher original stage of HCCs but showed similar RFS with patients with lower stage. We conclude HCC with total necrosis dose not need to be considered in the TNM staging.

Clinical Significance of Lactate Clearance for the Development of Early Allograft Dysfunction and Short-Term Prognosis in Deceased Donor Liver Transplantation

( Deok Gie Kim ),( Jee Youn Lee ),( Seung Hwan Song ),( Jae Geun Lee ),( Han Dai Hoon ),( Dong Jin Joo ),( Man Ki Ju ),( Gi Hong Choi ),( Jin Sub Choi ),( Myoung Soo Kim ),( Soon Il Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: This retrospective study evaluated lactate clearance (LC) as a predictor of early allograft dysfunction (EAD) and short-term outcomes in patients receiving deceased donor liver transplantation. Methods: We performed a retrospective analysis for 181 consecutive deceased donor liver transplantation from January 2011 to May 2016. LCs were calculated at 6, 12, 18 and 24 hours after reperfusion (LC6, LC12, LC18 and LC24). Results: Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755-0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469- 31.639). In-hospital and 6-month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Conclusions: LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short-term prognosis after deceased donor liver transplantation.

Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

Kim Deok-Gie,Yim Seung Hyuk,Min Eun-Ki,Choi Mun Chae,Lee Jae Geun,Kim Myoung Soo,Joo Dong Jin 대한의학회 2023 Journal of Korean medical science Vol.38 No.35

Background: The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages. Methods: Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed. Results: MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P < 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%. Conclusion: MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

타격식 굴착공법과 RCD공법을 이용한 육상굴착 성능평가

김욱기(Kim, Uk gie),박선근(Park, Sun keun),조삼덕(Cho, Sam deok),김주형(Kim, Ju Hyong),최창호(Choi, Chang ho) 대한토목학회 2012 대한토목학회 학술대회 Vol.2012 No.10

점성개질제를 이용한 수중 불분리성 그라우트재의 수중 속채움 보강 특성 분석

김욱기(Uk-Gie Kim),조삼덕(Sam-Deok Cho),박봉근(Bong-Geun Park),김주형(Juhyong Kim) 한국지반신소재학회 2013 한국지반신소재학회 논문집 Vol.12 No.2

본 연구에서는 계면활성제계 개질제를 이용하여 수중에서 재료분리가 발생하지 않으면서도 유동성을 충분히 갖는 수중 불분리성 점탄성 그라우트재와 일반 그라우팅 재료의 강도 특성과 속채움 보강 재료로서의 특성을 분석하였다. 특히, 해수를 활용하여 점탄성 그라우팅 재료를 제작하는 경우에 대해 중점적으로 시험을 수행한 결과, 담수를 사용하여 그라우트 재료를 제작하는 경우와 마찬가지로 수중 불분리성 특성을 잘 나타내었으며, 이에 따른 균질한 점탄성 그라우트재의 강도를 확보할 수 있을 것으로 평가되었다. 또한, 모형시험을 통해 그라우트재의 침투성을 이용하여 속채움 골재의 보강특성을 평가한 결과, 수중 불분리성 그라우팅 재료는 일반 그라우트재와 비교하여 충분한 강도가 발휘되었으며, 점성에 의한 수중 불분리 특성으로 속채움 보강재로서 좋은 시공 품질을 확보할 수 있을 것으로 평가되었다. This study introduces strength characteristics of the anti-washout grouting material using viscous modifiers and its characteristics mixed with coarse materials. Especially, this study focused on the strength characteristics of the grouts mixed with sea water. It is found that the anti-washout grout mixed with sea water has enough strength and good resistance to segregation just like that with fresh water. Also, a small scale test was performed to evaluate the solidification characteristic of the anti-washout grout mixed with coarse fill materials. It is also found that the strength of anti-washout grout mixed with coarse fill materials is greater and better segregation resistance than those of conventional grout with fill materials.

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

( Jong Man Kim ),( Deok Gie Kim ),( Jihyun Kim ),( Keunsung Lee ),( Kwang-woong Lee ),( Je Ho Ryu ),( Bong-wan Kim ),( Dong Lak Choi ),( Young Kyoung You ),( Dong-sik Kim ),( Yang Won Nah ),( Koo Jeon 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.3

Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications. (Clin Mol Hepatol 2021;27:451-462)

Hepatocellular carcinoma in old age: are there any benefits of liver resection in old age?

신인식,Deok Gie Kim,Sung Whan Cha,Seong Hee Kang,Sung Hoon Kim,Moon Young Kim,Soon Koo Baik 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.2

Purpose: Elderly individuals have comorbidities that can adversely affect surgical outcomes. Some studies reported that elderly patients with hepatocellular carcinoma (HCC) have higher liver- and non-liver–related deaths. Therefore, palliative treatments are preferred in these patients. We compared surgical treatment outcomes between young and old age groups. Methods: In total, 233 liver resections were performed in patients with HCC from March 2012 to December 2018. We retrospectively reviewed medical records. The old age group was defined as patients aged more than 70 years. We compared perioperative characteristics and surgical outcomes and analyzed the prognostic factors for disease-free survival (DFS) and overall survival (OS) rates. Results: The young and old age group included 184 and 49 patients, respectively. Preoperative characteristics were similar. Major liver resection rate was similar (young age group, 26.1% vs. old age group, 20.4%), but the operation time was a little bit shorter in old age group. Major postoperative complications were 23 (12.5%) and 9 (18.4%) in the young and old age group (P = 0.351). Median non-liver–related overall survival were 80 and 76 months (P = 0.889) and liver-related OS were 76 and 76 months (P = 0.514) in the young and old age groups, respectively. Age was not an independent risk factor for DFS and OS. Conclusion: Elderly patients showed similar non-liver- and liver-related OS rates as young patients after liver resection. Postoperative complications were also similar. If elderly patients are well selected, they can receive curative treatment and show good surgical outcomes.

초등학교 건물 내진보강을 위한 팩마이크로파일 적용사례

김욱기(Uk-Gie Kim),최창호(Changho Choi),조삼덕(Sam-Deok Cho) 한국지반신소재학회 2013 한국지반신소재학회 학술발표회 Vol.2013 No.4

This paper presents a case study of pack-micropile application for seismic retrofit project of old elementary school building. The method of structural mitigation for seismic reinforcement was investigated and, as a result, displacement amplification damper system and shear wall were designed to install for the building. These structural reinforcement requires additional bearing capacity of foundation. Correspondingly, 28 pack-micropiles were additionally installed at the bottom of shear wall and dampers. The pack-micropile provides a specific way to grout bore-hole to increase frictional resistance between surrounding soil and pile-structure. In order to increase such resistance woven geotextile is wrapped to the reinforcement steel pipe for pressure grouting. Grouting materials are mainly injected in two steps: (1) gravity-type grouting inside drilling steel-casing and (2) pressurized grouting into the geotextile pack after inserting reinforcement and removing the drilling steel-casing. The second step builds a tight interface between surrounding ground and pile-structure and provides higher frictional bearing resistance. The tensile proof load tests were performed for the installed pack-micropiles according to the FHWA guideline. Test result showed that the measured ultimate load capacity satisfies the design capacity.

Impact of Model for End-Stage Liver Disease Score Based Allocation System in Korea

( Juhan Lee ),( Deok Gie Kim ),( Jee Youn Lee ),( Jae Geun Lee ),( Dong Jin Joo ),( Soon Il Kim ),( Myoung Soo Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: In June of 2016, the Korean Network for Organ Sharing implemented model for end-stage liver disease (MELD) score based allocation system to better prioritize deceased donor liver transplant (DDLT) candidates. The aim of this study was to assess the impact of MELD based allocation system. Methods: We compared waitlist and post-transplant outcomes in the first 4 months of MELD allocation system (from June to September, 2016) to an equivalent time period before (from February to May, 2016). Results: A total of 1114 candidates were listed (510 pre-MELD, 604 post-MELD) and 340 patients (156 pre-MELD, 184 post-MELD) received DDLT during the study period. As expected, introduction of MELD allocation system increased mean MELD score at transplant (24.6 ± 8.6 pre-MELD, 35.0 ± 6.1 post-MELD, P<0.001). Although overall transplant rates remained similar between pre-MELD and MELD era, the transplant rate significantly increased for candidates with high MELD score (MELD ≥31) in MELD era. The proportion of inter- regional shift increased from 28.8% to 44.0%. Post-transplant patient survival rate was 85.6% before and 83.1% after MELD implementation (P=0.537). There was no significant correlation between MELD scores at transplant and post-transplant survival. Significant transplant survival benefit was observed at MELD scores of ≥20 compared to candidates on the waitlist, and the magnitude of transplant benefit increased with increasing MELD score. Conclusions: The MELD system addresses the goal of fairness well. The implementation of the MELD system was associated with reduction in geographic disparities. Although sicker patients received liver transplantation in the MELD era, post-transplant survival was similar in both periods.