Review : Liver Transplantation

( Deok Bog Moon ),( Sung Gyu Lee ) The Editorial Office of Gut and Liver 2009 Gut and Liver Vol.3 No.3

Liver transplantation has become a lifesaving procedure for patients who have chronic end-stage liver disease and acute liver failure. The satisfactory outcome of liver transplantation has led to insufficient supplies of deceased donor organs, particularly in East Asia. Hence, East Asian surgeons are concentrating on developing and performing living-donor liver transplantation (LDLT). This review article describes an update on the present status of liver transplantation, mainly in adults, and highlights some recent developments on indications for transplantation, patient selection, donor and recipient operation between LDLT and deceased-donor liver transplantation (DDLT), immunosuppression, and long-term management of liver transplant recipients. Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT. In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acuteon- chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible. With increasing numbers of liver transplantations and longterm survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment. (Gut and Liver 2009;3:145-165)

Pediatric Liver Transplantation Experience in Kazakhstan

( Gari Kuttymuratov ),( Damir Zhenalayev ),( Dulat Mustafinov ),( Aiymkul Ashimkhanova ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The aim is to analyze the first results of pediatric liver transplantation experience. Currently in Kazakhstan on the waiting list for liver transplantation there are approximately 22 children various congenital or acquired liver pathologies. Most of the children with end stage liver disease need a donor organ transplant before the age of 1 year old. During the period from 2012 to 2015 at National Research Center for Maternity and Child in Astana, there are total of 6 pediatric living donor liver transplantations were performed in Kazakhstan. In all cases, the left lateral segment of the donor liver was allocated for transplantation. Age of recipients ranged from 5 months up to 6 year old. The donors are close relatives of the recipient, their age ranged from 24 to 36 years. In 5 out of 6 cases in children under the age of 1 year old the etiology of liver cirrhosis was biliary atresia. In a 6 y.o. child the underlying cause of cirrhosis was autoimmune hepatitis. All liver transplantation performed with the participation of foreign experts from India, Turkey, and The Republic of Belarus. Methods: Prospective study from the start of the first pediatric liver transplantation. Results: Postoperative complications were not observed in donors. One child under the age of 5 months had a PO-complication as hepatic artery thrombosis (HAT). The surgical actions to fix the vascular damage were unsuccessful and the child was taken by sanitary aviation to hospital in Istanbul, Turkey, where he had another liver transplantation from a living donor. In the remaining five recipients there were no complications observed, and they discharged from the hospital. Due to the severe shortage of donors, the mortality rate of children on a waiting list is up to 54%. Conclusions: The lack of experience of local transplant surgeons in carrying out highly advanced surgeries in young children, forcing patients to carry out similar operations in foreign clinics by governmental funding or on their own expense. The most common surgery for liver transplantation Kazakhstani children held in South Korean hospitals, Germany, Turkey, India. On behalf of our colleagues and patients we want to thank our friends - colleagues from South Korea, Turkey, India, for their help and support in the development of transplantation in the Republic of Kazakhstan.

A Risk Factor for Chronic Kidney Disease after Liver Transplantation

( Jung Hyun Kwon ),( Sun Hong Yoo ),( Soon Woo Nam ),( Jong Youl Lee ),( Young Chul Yoon ),( Jun Suh Lee ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Post-liver transplant chronic kidney disease (CKD) is a significant morbidity. The aim of this study is to evaluate the risk factors for post LT CKD. Methods: A total of 57 consecutive patients undergoing liver transplantation at Incheon St. Mary’s Hospital were analyzed from 2013 to 2017. CKD was defined as glomerular filtration rate (GFR) < 60 ml/min/1.73 m². Risk factors for developing CKD were investigated. Results: 37 (64.9%) patients underwent deceased donor liver transplantation (DDLT) and 27 (47.4%) patients had hepatocellular carcinoma at the timing of liver transplantation. Before liver transplantation, 17 (29.8%) patients had prior diabetes and 16 (28.1%) patients had prior hypertension. 14 (24.6%) patients were renal replacement therapy (RRT) at the perioperative period (12 (54.1%) patients in DDLT versus 2 (20%) patients in Living donor liver transplantation (LDLT), P=0.013)) but only one patient (1/14) maintained RRT after liver transplantation. Three new patients started de novo RRT after liver transplantation. The cumulative incidences of CKD were 31.8% (14/44) at 3 months and 44.8% (13/29) at one year after liver transplantation. The GFR at baseline and post operation 7 day, and the volume of blood loss during operation were proved the risk factors of CKD at one year after liver transplantation. However, the perioperative RRT, the presence of prior diabetes or hypertension, DDLT were not influenced on developing CKD at one year after liver transplantation. Conclusions: The present study showed the baseline and post-operation 7 days GFR, blood loss during operation were predictive factors for post LT CKD. Personalized care about GFR directed may improve post-transplant outcomes.

Liver Transplantation for Alcoholic Liver Disease

( Yermakhan Assylkhanuly ),( Gani Kuttymuratov ),( Bakhyt Zharkimbekov ),( Mels Asykbayev ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The most commonly affected organ remains the liver with a risk of alcoholic liver disease (ALD) which can range from asymptomatic to alcoholic hepatitis to alcoholic cirrhosis. Alcoholic liver disease (ALD) is the third most common diagnosis among patients which operation is required liver transplantation (LT) in the Kazakhstan. Pretransplant abstinence broadly achieves two goals; it allows a window window of opportunity for the liver to stabilize, and it allows opportunity to examine the patient’s commitment. Methods: In our center, liver transplant from a living donor to3 recipient with alcoholic liver disease in the outcome of liver cirrhosis. For the 6-8 months prior to the hospitalization of the patient during abstinence, it is important for patients who are prepared for orthotropic liver transplantation (OLT). Results: Indications for OLT was Child-Turcotte-Pugh score >7 with single episode of spontaneous bacterial peritonitis andan estimated 1 year survival without transplantation. Conclusions: ALD is an acceptable indication for liver transplantation as survival of these patients after transplantation is similar to that seen in patients who receive grafts for other causes. Patient selection is important for rationing scarce organs, hence the use of prognostic models for predicting risk of relapse to alcoholism. Rate of graft loss is no greater and rejection of the graft is even less so in patients transplanted for ALD.

Novel Therapeutic Tool for Liver Disease through Direct Conversion Hepatocyte Transplantation

( Su Hyun Park ),( Seon In Hwang ),( Seo Yeon Hwang ),( So Hee Kang ),( Sera Yang ),( Jonghwa Kim ),( Wonseok Kang ),( Kyun-hwan Kim ),( Dong Wook Han ),( Yong-han Paik ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Until now there was no anti-fibrotic therapy available for liver cirrhosis. Stem cell therapies have been studied for the treatment of liver fibrosis. However, use of embryonic stem cell or induced pluripotent stem cell (iPSC) has limitations such as ethical concern or malignancy potential. Induced hepatocytes (iHEPs) generated by direct reprogramming technology may overcome these limitations. In this study we investigated the effect of iHEPs on acute liver injury and liver fibrosis induced by CCl4 intraperitoneal injection in mice. Methods: iHEPs were generated from mouse embryonic fibroblasts (MEFs) by direct reprogramming. Acute liver injury was induced by CCl4 intraperitoneal injection and GFP-labeled iHEPs were transplanted after 24h of CCl4 injection. Liver fibrosis was induced in BALB/c nude mice by intraperitoneal injection of CCl4 for 10 weeks. GFP-labeled iHEPs (1x106 cells in 100μl DMEM) were transplanted at week 8 by intrasplenic injection. Liver injury was assessed by serum ALT and AST measurement. Liver histology and fibrosis was assessed by H&E staining and Sirius Red staining. Results: In acute liver injury model, CCl4 induced AST and ALT elevation which was significantly reduced by transplantation of iHEPs (p<0.01). GFP- and albumin-expression were co-localized nearby the damaged portal vein area, indicating successful migration of transplanted iHEPs to the injured hepatic regions. GFP expression was detectable up to 72h post-transplantation by Western blot, suggesting persistence of transplanted iHEPs during the course of acute liver injury. In liver fibrosis model, liver injury was diminished by transplantation of iHEPs. Sirius Red staining revealed a significant reduction of fibrosis area in iHEP-transplantation group compared to control group (p<0.0001). Conclusions: We confirmed that iHEPs generated by direct reprogramming migrated to the liver after intrasplenic transplantation. Transplantation of iHEPs significantly attenuated acute liver injury and liver fibrosis induced by CCl4 injections. These data suggest that iHEPs may serve as a novel therapeutic strategy for treatment of liver fibrosis.

간 전체(100%) 및 부분(30%) 이식한 쥐에서의 면역 억제기능

이광수,박태서,정파종,곽진영 大韓移植學會 1993 Korean Journal of Transplantation Vol.7 No.1

간이식에서 간동맥 문합술

박명철,박동하,배남석,왕희정,김봉완,김치선 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.1

Purpose: Liver transplantation is considered as the treatment of choice in many acute and chronic liver diseases, and it is becoming more common. Since successful microscopic anastomosis of hepatic artery is a crucial requirement of successful liver transplantation, we studied and analyzed the result of hepatic artery anastomosis of liver transplantation in our liver transplantation center. Methods: 145 liver transplantations were performed from February 2005 to May 2008. Male to female ratio of the liver transplantation recipients was 3.4:1. Anastomosis of portal vein, hepatic vein and biliary tract was performed by the general surgeon, and anastomosis of hepatic artery was performed by the plastic surgeon under the loupe or microscopic vision. After the hepatic artery was reconstructed, anastomosed site status and flow were checked with Doppler ultrasonography intraoperatively and with contrast enhanced CT or angiography postoperatively if necessary. Results: Out of 145 liver transplantations, cadaveric liver donor was used 37 cases and living donor liver transplantation was performed 108 cases including the 2 dual donor liver transplantations. As for the baseline diseases that resulted in the liver transplantation, there were 57 cases of liver cirrhosis and hepatocellular carcinoma due to hepatitis B, taking up the greatest proportion. Single donor hepatic artery was used in 114 cases, and mean artery diameter was 2.92mm and mean artery length was 24.25mm. Hepatic artery was used as the recipient artery in every case except the 8 cases in which gastroepiploic artery was used as alternative. Out of 145 cases of hepatic artery anastomosis, 3 cases resulted in the thrombosis of the hepatic artery, requiring thrombectomy and re-anastomosis. In all 3 cases, thrombosis was found in left hepatic artery and there was no past history of hepatic artery chemoembolization. Conclusion: Incidence of hepatic artery thrombosis after the anastomosis of hepatic artery during liver transplantation was 2.1%, which is considered sufficiently low.

Continuing Five or More Locoregional Therapies before Living Donor Salvage Liver Transplantation for Hepatocellular Carcinoma Is Related to Poor Recurrence-Free Survival

( Jinsoo Rhu ),( Jong Man Kim ),( Gyu Seong Choi ),( Choon Hyuck David Kwon ),( Jae-won Joh ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: This study was designed to analyze factors related to the success of salvage liver transplantation in hepatocellular carcinoma (HCC). While liver resection is considered the best locoregional therapy in HCC, there is a high recurrence rate. Salvage liver transplantation may be the best treatment option when feasible. Methods: Patients who underwent living donor salvage liver transplantation for recurrent HCC after LR from November 1996 to May 2017 were included. Patient demographic data, clinical and pathologic characteristics, operative data, hospital course and follow-up data regarding initial liver resection, locoregional therapy after recurrence and salvage liver transplantation were reviewed. Prognostic factors for recurrence were analyzed using Cox proportional hazard ratio. Results: Eighty-five of 123 salvage liver transplantation patients were included. Patients who had five or more locoregional therapies prior to salvage liver transplantation (HR=3.74, CI=1.45- 9.64, P=0.006), hepatitis B (HR=9.20, CI=1.13-74.89, P=0.04), outside Milan criteria at the time of salvage liver transplantation (HR=2.66, CI=1.26-5.63, P=0.011) and an alpha-fetoprotein level above 1,000 ng/mL at the time of recurrence after initial liver resection (HR=6.48, CI=1.83-22.92, P=0.004) and at the time of transplantation (HR=3.43, CI=1.26-5.63, P=0.011) were related to significant risk of recurrence. Conclusions: Continuing five or more locoregional therapies for recurrent HCC after liver resection is related to poor recurrence-free survival after salvage liver transplantation.

간이식의 현재

김홍진 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

Liver transplantation is widely accepted as an effective therapeutic modality for a variety of irreversible acute and chronic liver diseases for which no satisfactory therapy is available. Following the first unsuccessful efforts at human liver transplantation in 1963, development of the procedure evolved at first slowly and steadily for 20 years and then rapidly over the past two decades. The growth of liver transplantation was facilitated by the conclusion of the national institutes of health consensus development conference in 1983 that liver transplantation is not an experimental procedure but an effective therapy that deserves broader application. The number of liver transplantations increased 2.4-fold(from 1,713 to 4,058) from 1988 to 1996, but the number of patients on the UNOS(united network of organ sharing) liver list increased 12.1-fold(from 616 to 7,467) ; as would be expected, the number of deaths of listed patients increased 4.9-fold(from 195 to 954). The current supply of donor livers is insufficient to meet this need, and organ donation has been stagnant or increased by only a few percent in recent years. These facts underscore the importance of the appropriate selection of candidates for liver transplantation and the development of operative procedures, such as living donor liver transplant, split liver transplant and auxiliary partial liver transplant.

Liver transplantation for azithromycin-induced severe liver injury

Hyun Joon Park,서광일,최영일 대한이식학회 2020 Korean Journal of Transplantation Vol.34 No.4

Drug-induced liver injury is the most common cause of acute liver failure in Western countries by prescription drugs and herbal medications. Liver injury due to azithromycin has rarely been reported. This is a brief report of a patient administered azithromycin and who developed acute liver failure leading to liver transplantation. We report the case of a 68-year-old woman who developed jaundice 1 week after she started taking a azithromycin. On the 3rd day of hospitalization, her hepatic function rapidly deteriorated and level of consciousness decreased to drowsiness. The model for end-stage liver disease score was confirmed to be 33, and liver transplantation was considered. On the 8th day of hospitalization, she underwent emergency living donor liver transplantation, receiving a right lobe liver graft from a 35-year-old male donor, the patient’s son. Currently, she is alive with good liver function after 25 months of transplant. This case suggests that azithromycin may cause rare hepatitis with liver failure. Therefore, at the beginning of the azithromycin treatment, patients should visit the hospital immediately if symptoms such as jaundice and abdominal pain are experienced.