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황신,송기원,정영규,안철수,김기훈,문덕복,하태용,정동환,박길춘,윤영인,조휘동,권재현,강상현,정이지,최진욱,이성규 대한의학회 2019 Journal of Korean medical science Vol.34 No.38
Background: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. This study established an individualized HBV prophylaxis protocol, through optimization of hepatitis B immunoglobulin (HBIG) administration, with application of simulative half-life (SHL). Methods: This study involved five parts: Part 1 developed the SHL estimation method with 20 patients; Parts 2 and 3 assessed the SHL variability and developed a simulation model to apply SHL in 100 patients; Part 4 validated the simulation model in 114 patients, and Part 5 was a cross-sectional study on the current status of HBIG infusion intervals in 660 patients. Results: In Part 1, infusion of 10,000 IU HBIG induced add-on rise hepatitis B surface antibody (anti-HBs) titer of 5,252.5 ± 873.7 IU/L, which was 4.4% lower than actual measurement. Mean SHL of 20.0 ± 3.7 days was 2.2% longer than actual measurement. In Part 2, the medians of the intra- and inter-individual coefficient of variation in SHL were 13.5% and 18.5%, respectively. Pretransplant HBV DNA load and posttransplant antiviral therapy did not affect SHL. In Part 3, a simulation model was developed to determine the interval of HBIG infusion, by using SHL. In Part 4, all 114 patients were successfully managed with regular HBIG infusion intervals of ≥ 8 weeks, and the interval was prolonged to ≥ 12 weeks in 89.4%, with a target trough anti-HBs titer ≥ 200 IU/L. In Part 5, 47.4% of our patients received HBIG excessively, at a target trough titer of 500 IU/L. Conclusion: SHL estimation using only clinically available parameters seems to be reliably accurate when compared with actual measurements. We believe that SHL estimation is helpful to establish a personalized HBV prophylaxis protocol for optimizing HBIG administration.
복강경 담낭절제술 시의 의인성 담도 손상에 속발한 근위부 담도 괴사 및 협착의 치료
황신 한국간담췌외과학회 2005 한국간담췌외과학회지 Vol.9 No.3
Purpose: Most bile duct injuries can be recognized intraoperatively, or within a few days after a laparoscopic cholecystectomy, with a favorable prognosis following proper management. However, a significant delay in the diagnosis, improper management, or other risk factors can lead to serious intractable biliary complications. Herein, the clinical courses of these serious biliary complications were analyzed to find their optimal treatment methods. Methods: Between 1998 an 2003, 9 cases of serious biliary complications were encountered following a laparoscopic cholecystectomy. Patients detected early and with uneventful biliary reconstruction were excluded. Their mid- and long-term clinical courses were retrospectively analyzed. Results: Their treatment methods undertaken to them were divided as follows: Primary hepaticojejunostiomy (HJ) to the necrotic proximal bile duct (n=3): delayed stricture occurred in 1 patient among them; HJ to the delayed-onset proximal bile duct stricture (n=2): There was no recurrence; Right lobectomy and HJ to the proximal bile duct stricture after right portal vein embolization (n=3): There was no recurrence; And, induction of parenchymal atrophy applied to the isolated right posterior duct injury through portal vein embolization and sequential bile duct occlusion (n=1). Conclusion: Necrosis and stricture of the injured proximalbile duct should be managed by a case-by-case basis because every patient revealed different clinical features. Longterm surveillance over 5 years is recommended to detect lateonset biliary stricture. Purpose: Most bile duct injuries can be recognized intraoperatively, or within a few days after a laparoscopic cholecystectomy, with a favorable prognosis following proper management. However, a significant delay in the diagnosis, improper management, or other risk factors can lead to serious intractable biliary complications. Herein, the clinical courses of these serious biliary complications were analyzed to find their optimal treatment methods. Methods: Between 1998 an 2003, 9 cases of serious biliary complications were encountered following a laparoscopic cholecystectomy. Patients detected early and with uneventful biliary reconstruction were excluded. Their mid- and long-term clinical courses were retrospectively analyzed. Results: Their treatment methods undertaken to them were divided as follows: Primary hepaticojejunostiomy (HJ) to the necrotic proximal bile duct (n=3): delayed stricture occurred in 1 patient among them; HJ to the delayed-onset proximal bile duct stricture (n=2): There was no recurrence; Right lobectomy and HJ to the proximal bile duct stricture after right portal vein embolization (n=3): There was no recurrence; And, induction of parenchymal atrophy applied to the isolated right posterior duct injury through portal vein embolization and sequential bile duct occlusion (n=1). Conclusion: Necrosis and stricture of the injured proximalbile duct should be managed by a case-by-case basis because every patient revealed different clinical features. Longterm surveillance over 5 years is recommended to detect lateonset biliary stricture.
황신,문덕복,이승규 대한의사협회 2008 대한의사협회지 Vol.51 No.8
Living donor liver transplantation (LDLT) has been an established treatment modality for patients with end- stage liver diseases, especially in countries with scarcity of deceased donors. The annual number of LDLT cases in Korea has been steeply increasing, exceeding that of Japan and even doubling that of United States in 2007. When comparing LDLT and deceased donor liver transplantation (DDLT), the timely availability and quality of liver grafts are superior in LDLT, but there are definite drawbacks from anatomical sharing of 1 liver organ by 2 individuals as well as potential donor risk. Biliary complications seem to be the most intractable problems following adult LDLT. The indications for LDLT are nearly identical to those of DDLT. The optimal timing for performing LDLT is not clearly defined, but an earlier transplantation is often recommended before serious worsening of general conditions. The post - transplant management following LDLT is often more difficult than that of DDLT although early liver regeneration makes the liver graft large enough. Current situation in Korea requires a heavy demand on DDLT, but it is still very difficult to expect a rapid rise of deceased donor number within a few years. Thus, LDLT may continue to play the pivotal role to compensate for the serious shortage of deceased donor organs. Coercion to living donors should be prohibited in any situation. The medical team and our whole society should pay special attention to caring of living donors in order to encourage organ donation.