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( Nam-joon Yi ),( Kwang-woong Lee ),( Kyung-suk Suh ),( Suk Kyun Hong ),( Kyung Chul Yoon ),( Dongkyu Oh ),( Berik Rovgaliyev ),( Joon Koo Han ),( Min Uk Kim ),( Jeong Min Lee ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Biliary complication (BC) is prevalent in pediatric liver transplantation (PLT), with reported rates from 12% to 50%. This study analyzed which factors of perioperative variables caused BCs and how BCs affected graft and patient survival in PLT. Methods: A retrospective analysis reviewed 237 consecutive pediatric recipients from 1988 to 2015 in a Korean high-volume living donor LT (LDLT) center. The median follow-up was 80.3 (range, 28.7-153.9) months. Results: Of these 237 patients, 23 (9.7%) patients developed BCs. The overall 1-, 5-, and 10-year patient and graft survival rates were 89.8%, 87.8%, and 86.9% and 88.2%, 86.7%, and 85.8%. The 1-, 5-, and 10-year BC-free survival rates were 91.8%, 89.8%, and 89.0%. There was no significant difference of both patient and graft survival rate between the patients with and without BCs (P >0.05). In multivariate analysis, type of liver transplant (LDLT 12.8% vs. whole LT 5.0% vs. split LT 2.4%), portal vein complication (21.7% vs. 6.5%), and hepatic vein complication (26.0% vs. 8.9%) were revealed as significant contributor to BCs (P<0.05). Conclusions: Despite of BCs, graft and patient survival rates were not significantly affected. Although the rate of BC was acceptable, LDLT was one of the risk factors of BCs in PLT, and meticulous technique to avoid vascular complication could also improve the outcome of biliary reconstruction.
( Nam-joon Yi ),( Sanghee Song ),( Ok-kyung Kim ),( Hyeyoung Kim ),( Suk Kyun Hong ),( Kyung Chul Yoon ),( Hyo-sin Kim ),( Youngrok Choi ),( Hae Won Lee ),( Kwang-woon Lee ),( Kyung-suk Suh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Purpose: Organ shortage has been a hot issue especially in the field of liver transplantation (LT) in Asian countries including Korea. In order to increase the donor pool, the policy of split LT (SLT) has been recently changed and recently number of SLT has been increased in Korea. However the outcome of SLT in Korea has not been reported. Methods: This study evaluated the outcomes of SLT using the Korean Network for Organ Sharing (KONOS) between January 2005 and December 2014. Cases with two recipients from one deceased-donor were considered as SLT. A total of 200 cases of 100 pairs of SLT were examined. Results: The recipient population was 107 adults and 93 children. The type of SLT composed of adult/children pair in 87 (87.0%). The median donor age and body weight were 25.0 (9~48) years and 66.3 (38~120) kg. Adult recipients`` median age was 53.1 (25~77) years, and body weight 62.2 (35~101) kg. UNOS status 1 and 2A was 57 (53.3%) in adult recipients. The median donor / recipient weigh ratio (DRWR) was 1.12 (0.56~1.95); the DRWR<1.0 was 37.4%. Pediatric recipients`` median age was 2.82 (0~16) year and body weight was 13.2 (range, 3.6~55) kg. The median DRWR was 6.80 (1.09~17.04); the DRWR>10.0 was 22.6%. UNOS status 1 in pediatric recipients was 10 (10.8%). The overall patients’ survival outcome was 75.5%, but it was worse in adult recipients (67.3% vs. 84.9%) (Fig.1) (p=0.004). In adult recipients, prolonged prothrombin time (INR>1.5) of the donor and center sharing were poor prognostic factors in multivariate analysis (p<0.05). Conclusion: Although the outcome of SLT in Korea was acceptable, the outcome was worse in urgent and big adult recipients, especially in cases of marginal donor with prolonged INR and low volume center. Further evaluation should be performed to make a good guideline for allocation of the deceased donor for SLT.
Prevention and Management of Small-for-Size Syndrome of Liver Transplantation
Nam-Joon Yi 이화여자대학교 의과학연구소 2022 EMJ (Ewha medical journal) Vol.45 No.2
Small-for-size syndrome (SFSS) is a critical complication of partial liver transplantation, particularly in adult-to-adult living donor liver transplantation (ALDLT) using a small graft. Minimally required liver graft size for a successful ALDLT is classically 40% of a standard recipient’s liver volume or 0.8% of recipient body weight. Recent progress in perioperative care and technical improvement push the lower limit of safe graft size to 25% of the recipient’s standard liver volume or 0.6% of the graft versus recipient weight ratio although this is an ongoing debate. The clinical manifestations of SFSS include various symptoms and signs related to graft dysfunction and portal hypertension in patients with small grafts. The risk factors for SFSS include poor preoperative patient condition, including portal pressure, surgical techniques to reduce portal pressure, and graft quality and size. Hence, various approaches have been explored to modulate inflow and pressure to a small graft and to decrease the outflow block to alleviate this SFSS as well as the selection of a patient and graft. Additionally, recent research and efforts to prevent and treat SFSS are reviewed.
Indication or Contraindication of Liver Transplantation in Patient with Portal Vein Thrombosis
( Nam-joon Yi ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longeran absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most importantrisk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether otherinherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on theliver disease progression, especially when it is nonocclusive.PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation andTIPS are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulationis approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported,but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to beused during LT.If a conventional end-to-end anastomotic technique is used, there is not a major impact on post-LT survival. However, the problemis the extensive thrombosis from portal to splachnic venous thrombosis (SVT) (Fig.1) PVT is more commonly managed by endovenousthrombectomy (Fig.1. A ,B), while SVT requires more complex technical expedients (Fig. 1. C, D). Several surgical techniqueshave been proposed, i.e., extensive eversion thrombectomy, anastomosis to collateral vein, reno-portal anastomosis, cavo-portalhemi-transposition, portal-arterialization, and combined Liver-Intestinal transplantation. In order to achieve satisfactory outcomes,careful planning of the surgical strategy is mandatory. The excellent results that are obtained nowadays confirm that,even extended, SVT is no longer an absolute contraindication for LT. Patients with advanced PVT may preferentially be referredto specialized centers, in which complex vascular approaches and even multivisceral transplantation are performed.
Alteration of MRP2 expression and the graft outcome after liver transplantation
Nam-Joon Yi,Joohyun Kim,YoungRok Choi,Heyoung Kim,Kyoung Bun Lee,Ja-June Jang,Jae Young Lee,Jeong Min Lee,Joon Koo Han,Kwang-Woong Lee,Kyung-Suk Suh 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.5
Purpose: Multidrug resistance-associated protein (MRP) 2 is a glutathione conjugate in the canalicular membrane of hepatocytes. Early graft damage after liver transplantation (LT) can result in alteration of MRP2 expression. The purpose of this study was to evaluate the relationship between the pattern of MRP2 alteration and graft outcome. Methods: Forty-one paraffin-embedded liver graft tissues obtained by protocol biopsy within 2 months after LT; these were stained using monoclonal antibodies of MRP2. We selected 15 live donor biopsy samples as a control, that showed homogenous canalicular staining for MRP2. The pattern of canalicular MRP2 staining of graft was classified into 3 types: homogenous (type C0), focal (type C1), and no (type C2,) staining of the canaliculi. Results: In total, 17.1% graft tissues were type C0, 36.6% were type C1, and 46.3% were type C2. The median operation time was longer in patients with type C2 (562.6 minutes) than in patients with type C0 (393.8 minutes) (P = 0.038). The rates of posttransplant complications were higher in patients with type C2 (100%) than in patients with type C0 (42.9%) and C1 (73.3%) (P < 0.001). Conclusion: MRP2 expression pattern was altered in 82.9% after LT. The pattern of MRP2 alteration was associated with longer operation time and higher rates of post-LT complications.