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( Deok-bog Moon ),( Gil-chun Park ),( Wan-jun Kim ),( Hee-ju Kim ),( Sung-gyu Lee ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: In patients having combined invasion of inferior vena cava (IVC) and hepatic vein (HV) invasion, ex situ hepatic resection and autotransplantation is the recommended treatment option. However, when invasion of hepatic hilum is coexist, curative surgical treatment has not been reported until now. We successfully treated cholangiocarcinoma (CC) patient having invasion of all the major hepatic structures and report our valuable experience. Methods: 54-years-old hepatitis B virus carrier female had 4.5 cm sized cholangiocarcinoma originating from caudate lobe. CT scan showed invasion of retrohepatic IVC, Middle & Left HV trunk, and all structures of hilum including right anterior and posterior portal veins (PVs), left PV, hepatic arteries (HAs), and bile ducts (BDs). For R0 resection, we performed in-vivo hepatectomy of tumor free liver and sent for backtable surgery. En bloc total hepatectomy including retrohepatic IVC was performed for Remnant liver with tumor with tumor free margin. Under venovenous bypass, IVC was replaced with artificial graft, and the two HV (RHV, MHV) and PV openings of tumor free liver (ie, extended right lobe, ERL) was made into one respectively using fresh cadaveric iliac vein at the backtable. The ERL was successfully autotransplanted using piggyback technique. Results: The biopsy confirmed cholangiocarcinoma with R0 resection margin. The patient was discharged at postoperative 23rd day without any complication. However, she required HV stenting and PV stenting on postoperative 1 and 4 months, respectively. On postoperative 13 months, she is doing well without recurrence. Conclusions: When tumor invade not only IVC and HV but also hilar structures, In vivo hepatectomy of tumor free liver plus en bloc total hepatectomy of tumor containing remnant liver with retrohepatic IVC, and then autotransplantation can be indicated and successfully performed.
( Deok-bog Moon ),( Sung-gyu Lee ),( Shin Hwang ),( Ki-hun Kim ),( Chul-soo Ahn ),( Tae-yong Ha ),( Gi-won Song ),( Dong-hwan Jung ),( Gil-chun Park ),( Woo-hyung Kang ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: The large volume of adult living donor liver transplantations (ALDLTs) at our center affords a unique opportunity to examine the impact of acute-on-chronic liver failure (ACLF) among high-MELD score patients. Methods: From February 1998 to March 2010, 1958 cirrhotic recipients were analyzed to study the relationship between MELD scores and ALDLT outcomes. A total of 327 high-MELD score recipients were categorized into ACLF and non-ACLF groups, and their outcomes were compared. Results: The five-year graft and patient survival in the high MELD group were 75.2% and 76.4%, respectively, which were significantly worse than the low and intermediate MELD groups. The presence of ACLF associated with higher MELD scores appeared to be the dominant factor responsible for the inferior results of patients with in MELD score of 30~34 points. The five-year graft survivals in the ACLF group was 70.5% and in the non-ACLF group 81.0% (P = 0.035). Conclusions: Therefore, ALDLT should be performed as soon as possible in high-MELD score patients prior to ACLF development. Moreover, ACLF patients should be separately categorized when analyzing the outcomes of ALDLT. ALDLT for ACLF patients should not be discouraged because favorable outcomes can be expected through timely ALDLT and comprehensive management.
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)