The Prognosis of Gastroschisis and Omphalocele

Jwa, Eunkyoung,Kim, Seong Chul,Kim, Dae Yeon,Hwang, Ji-Hee,Namgoong, Jung-Man,Kim, In-Koo Korean Association of Pediatric Surgeons 2014 소아외과 Vol.20 No.2

Purpose: Gastroschisis and omphalocele are major anterior abdominal wall defects. The purpose of this study was to analyze the clinical differences and mortalities of gastroschisis and omphalocele in Asan Medical Center. Methods: A retrospective review of the medical records was conducted of 103 cases of gastroschisis and omphalocele from September 1989 to February 2013 in Asan Medical Center in Korea. Results: There were 43 cases (41.7%) of gastroschisis and 60 cases (58.3%) of omphalocele. There was a female predominance in both gastroschisis (60.5%) and omphalocele (58.3%). The average gestational age at delivery was $36.7{\pm}0.4$ weeks for both groups. The mean birth weights were $2,381.9{\pm}80.6g$ for gastroschisis and $2,779.4{\pm}82.8g$ for omphalocele (p=0.001). Mean maternal ages in the gastroschisis and omphalocele groups were $27.5{\pm}0.7$ years and $30.5{\pm}0.7$ years, respectively (p=0.002). Associated malformations were documented in 13 infants (30.2%) with gastroschisis and 46 infants (76.7%) with omphalocele (p<0.001). All of gastroschisis patients except one underwent surgery including 31 primary repairs and 11 staged repairs. Fifty-two infants with omphalocele underwent surgery-primary repair in 41 infants and staged repair in 11 infants. Among 103 cases, 19 cases (18.4%) expired. Mortality rates of gastroschisis and omphalocele were 23.3% (10/43 cases) and 15.0% (9/60 cases), respectively (p=0.287). The main causes of death were abdominal compartment syndrome (6/10 cases) in gastroschisis, respiratory failure (4/9 cases) and discharge against medical advice (4/9 cases) in omphalocele. Conclusion: Gastroschisisis was associated with younger maternal age and lower birth weight than omphalocele. Associated malformations were more common in omphalocele. The mortality rates did not make a statistical significance. This might be the improvement of treatment of cardiac anomalies, because no patient died from cardiac dysfunction in our study. Furthermore, abdominal compartment syndrome might be the main cause of death in gastroschisis.

In vitro immune cell monitoring as a guide for long-term immunosuppression in adult liver transplant recipients

Eunkyoung Jwa,Shin Hwang,Yong-Jae Kwon,Nayoung Kim,Gi-Won Song,Dong-Hwan Jung,Chul-Soo Ahn,Eunyoung Tak,Deok-Bog Moon,Ki-Hun Kim,Tae-Yong Ha,Gil-Chun Park,Sung-Gyu Lee 한국간담췌외과학회 2015 한국간담췌외과학회지 Vol.19 No.4

Backgrounds/Aims: We evaluated the clinical usability of immune cell monitoring in adult liver transplantation (LT) recipients. Methods: This study was composed of two parts as using calcineurin phosphatase (CNP) activity assay and ImmuKnow assay independently as in vitro monitoring tools of immune cell function in adult LT recipients. Results: There was a rough correlation between CNP activity and tacrolimus concentration in 33 patients. This association was evident in patients who were only administered tacrolimus, but disappeared after the co-administration of mycophenolate. In 118 healthy individuals, the mean proportion of helper T-cells was 37.4±8.1%. According to ImmuKnow assay, their immune responses were strong in 12 patients (10.2%), moderate in 92 patients (78.0%), and low in 14 patients (11.9%). In 85 patients waiting for LT, there was a rough correlation between the ImmuKnow ATP level and age. Their immune responses were strong in 0 patients (0%), moderate in 8 patients (9.4%), and low in 77 patients (90.6%). There was a difference in the ImmuKnow ATP levels between healthy individuals and patients with liver disease. In 137 LT recipients, there was no correlation between the ImmuKnow ATP levels and tacrolimus concentration. This trend did not change after grouping the patients according to co-administration with mycophenolate. Eight recipients experienced acute rejection, but none showed strong immune response. Conclusions: We think that both CNP activity assay and ImmuKnow assay are too limited to objectively determine the level of immunosuppression. Further studies should be performed to identify other methods for immune function monitoring.

Impact of extended living donor criteria focusing on donor safety in living donor liver transplantation

Joodong KIM,Donglak CHOI,Eunkyoung JWA 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.-

Upper midline incision could be standard procedure for living donor right hepatectomy

Joodong KIM,Donglak CHOI,Eunkyoung JWA 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.-

Extended Living Liver Donor Criteria Focusing on Donor Safety in Living Donor Liver Transplatation

( Joodong Kim ),( Dong Lak Choi ),( Eunkyoung Jwa ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Donor safety has been considered as primary focus of transplant programs that perform living donor liver transplantation (LDLT) and moreover, a major living donor complications seem to be avoidable through the strict selection criteria of living donor. Recently, conventional donor selection criteria has been modified to expand the donor pool in LDLT but the extended donor concept is not clearly defined yet. Herein, we describe our center’s experience for extended donor criteria for LDLT focusing on donor safety. Methods: We retrospectively reviewed the outcomes of 424 living donor right hepatectomy (LDRH) including 105 extended criteria donors who performed at our institution from January 2010 to June 2019. Extended Donor was defined with criteria as follows; 1) old donor (age >40 years) with remnant liver volume of <35%, 2) young donor (age ≤40 years) with remnant liver volume <29% and minimal fatty change (<15%), 3) young donor with mild hepatosteatosis (15%-30%) and remnant liver volume < 35%. The outcomes in extended living donors were compared with those in living donors under conventional criteria focusing on donor safety. Posthepatectomy liver failure (PHLF) was defined according to the International Study Group of Liver Surgery (ISGLS) criteria. We also included statistical analysis of risk factors that are related to PHLF. Results: PHLF occurred in 43 donors (10.1%). Most cases were grade A except one case in conventional donor group (grade B) and PHLF did not occur more frequently in extended donor group. (7.6% vs. 11.0% P=0.32) and the incidence of major postoperative complications requiring any interventions did not differ between the 2 groups. Moreover, no difference in either posttransplant graft function or survival was apparent between the 2 groups. In multivariate logistic regression analyses, only the event for major complications (OR, 3.002; 95% CI, 1.042- 8,649; P=0.042) was associated with PHLF but not related to extended criteria. Conclusions: LDRH under our extended donor criteria could be performed to expand donor pools without adverse effects on donor safety.

Upper Midline Incision Is Enough to Do Living Donor Right Hepatectomy

( Joodong Kim ),( Dong Lak Choi ),( Eunkyoung Jwa ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Pure laparoscopic donor hepatectomy has become more popular because of the donor’s demand for cosmetic and functional concern. However, laparoscopic approach has not been performed in almost living right donor hepatectomy (LDRH) because this is more technically demanding and is associated with increased donor morbidity. Instead, several studies have described LDRH using upper midline incision (UMI) to reduce donor morbidity. Herein, we describe our experience with small UMI as a standard procedure for LDRH. Methods: We retrospectively reviewed the outcomes of 444 living donor right hepatectomy (LDRH) at our institution from January 2010 to June 2019; 124 donors received LDRH using UMI (UMI group), whereas 320 donors underwent LDRH using J shaped incision. (J shaped group) We began to use small UMI during LDRH since 2016 and now, this incision has been standard procedure for LDRH regardless of graft type, body mass index, graft weight or vascular variation. Patient demographics, intraoperative parameters, laboratory data and postoperative complications, were compared between the 2 groups. Results: The mean size of the UMIs is 12.9cm (ranged from 11 to 16cm) and the overall complication rates did not differ significantly between the 2 groups. Most postoperative parameters are not different between the 2 groups but postoperative hospital stay and operation time in UMI group were significantly lower than those in J shaped group. In multivariate logistic regression analyses, only large graft (>900g) and severe hepatic steatosis (≥15%) were significant risk factors for difficult operation but not related to type of incision. Moreover, in high risk group for operation (donors with large graft or severe graft steatosis), neither the operation time nor intraoperative blood loss in UMI group were higher than those in J shaped group. Conclusions: LDRH could be safely performed under small UMI and this UMI could be considered as standard procedure during LDRH.

Successful introduction of Model for End-stage Liver Disease scoring in deceased donor liver transplantation in Korea

Soo-Min Ha,Shin Hwang,Gi-Won Song,Chul-Soo Ahn,Deok-Bog Moon,Tae-Yong Ha,Dong-Hwan Jung,Gil-Chun Park,Ki-Hun Kim,Dae-Yeon Kim,Jungman Namgung,Woo-Hyoung Kang,Seok-Hwan Kim,Eunkyoung Jwa,Jae-Hyeon Kwon 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.4

Backgrounds/Aims: Model for End-stage Liver Disease (MELD) score was adopted in June 2016 in Korea. Methods: We analyzed changes in volumes and outcomes of deceased donor liver transplantation (DDLT) for 1 year before and after introduction of MELD scoring at Asan Medical Center. Results: There were 64 cases of DDLT in 1 year before MELD introduction and 106 in 1 year after MELD introduction, an increase of 65%. The volume of DDLTs abruptly increased during first 3 months, but then returned to its usual level before MELD introduction, which indicated 3-month depletion of accumulated recipient pool with high MELD scores. The number of pediatric DDLT cases increased from 3 before MELD introduction to 11 after it, making up 21.4% and 47.8% of all cases of pediatric liver transplantation, respectively. The number of cases of retransplanted DDLTs increased from 4 to 27, representing 6.3% and 25.5% of all DDLT cases, respectively. The number of status 1 DDLT cases increased from 5 to 12, being 7.8% and 11.3% of all cases. Patient survival outcomes were similar before and after MELD introduction. Conclusions: The number of DDLTs temporarily increased after adoption of MELD scoring due to accumulated recipient pool with high MELD scores. The numbers of retransplanted and pediatric DDLT cases significantly increased. Patient survival in adult and pediatric DDLT was comparable before and after adoption of MELD scoring. These results imply that Korean MELD score-based allocation system was successfully established within its first year.