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Incisional Hernia in Adult Liver Transplant Recipients
( Ji Soo Lee ),( Kyeong Sik Kim ),( Chan Woo Cho ),( Kyo Won Lee ),( Gyu-seoung Choi ),( Jong Man Kim ),( Choon Hyuck David Kwon ),( Jae-won Joh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Incisional hernia is one of the complication following abdominal operation. Patients undergoing liver transplantation have a high risk of developing an incisional hernia because of immunosuppression. The purpose of this study is to review incisional hernia cases after liver transplantation and to identify the risk factors for hernia formation. Methods: We retrospectively reviewed and analyzed the medical records of the ninety-four incisional hernia patients after liver transplant recipients from January 2000 to December 2015 in single center institution. Results: 1463 underwent adult liver transplantation during the study period. 94 Incisional hernia patients were found among them. The overall incisional hernia rate was 6.4 %. Mean age was 54 years old and 76.6 % were men. No significant difference was observed for sex, diagnosis, smoking, alcohol, albumin, Child-Pugh score, MELD score, intensive care unit stay, hepatorenal syndrome, ventilator, spontaneous bacterial peritonitis, diabetes, bile leakage, wound problems between patients with incisional hernia and patients without incisional hernia. The characteristics of patients with incisional hernia showed old recipient, more body weight, higher body mass index, living donor recipient compared with patients without incisional hernia. Hypertension, tuberculosis, rejection, postoperative complication event before hernia were significant risk factor (p<0.05). Conclusions: Present study identifies the risk factors for incisional hernia. Surgeons should strive to reduce the risk of incisional hernia after adult liver transplantation.
( Jong Man Kim ),( Kwang-woong Lee ),( Gi-won Song ),( Bo-hyun Jung ),( Hae Won Lee ),( Nam-joon Yi ),( Choonhyuck David Kwon ),( Shin Hwang ),( Kyung-suk Suh ),( Jae-won Joh ),( Suk-koo Lee ),( Sung- 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.3
Background/Aims: The relationship between patient survival and biopsy-proven acute rejection (BPAR) in liver transplant recipients with hepatitis C remains unclear. The aims of this study were to compare the characteristics of patients with and without BPAR and to identify risk factors for BPAR. Methods: We retrospectively reviewed the records of 169 HCV-RNA-positive patients who underwent LT at three centers. Results: BPAR occurred in 39 (23.1%) of the HCV-RNA-positive recipients after LT. The 1-, 3-, and 5-year survival rates were 92.1%, 90.3%, and 88.5%, respectively, in patients without BPAR, and 75.7%, 63.4%, and 58.9% in patients with BPAR (P<0.001). Multivariate analyses showed that BPAR was associated with the non-use of basiliximab and tacrolimus and the use of cyclosporin in LT recipients with HCV RNA-positive. Conclusions: The results of the present study suggest that the immunosuppression status of HCV-RNA-positive LT recipients should be carefully determined in order to prevent BPAR and to improve patient survival. (Clin Mol Hepatol 2016;22:366-371)
Outcomes for patients with HCV after liver transplantation in Korea
Jong Man Kim,Kwang-Woong Lee,Gi-Won Song,Bo-Hyun Jung,Hae Won Lee,Nam-Joon Yi,Choon Hyuck David Kwon,Shin Hwang,Kyung-Suk Suh,Jae-Won Joh,Suk-Koo Lee,Sung-Gyu Lee 대한외과학회 2015 Annals of Surgical Treatment and Research Vol.90 No.1
Purpose: HCV-related liver disease is the most common indication for liver transplantation (LT) in Western countries, whereas HCV LT is rare in Korea. We conducted a survey of HCV RNA-positive patients who underwent LT and investigated the prognostic factors for patient survival and the effects of immunosuppression. Methods: We retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent LT. Results: The 1-, 3-, and 5-year overall survival rates were 78.8%, 75.3%, and 73.1%, respectively. Excluding the cases of hospital mortality (n = 23), 169 patients were evaluated for patient survival. Most patients were genotype 1 (n = 111, 65.7%) or genotype 2 (n = 42, 24.9%). The proportion of living donors for LT (n = 135, 79.9%) was higher than that of deceased donors (deceased donor liver transplantation [DDLT], n = 34, 20.1%). The median donor and recipient ages were 32 years and 56 years, respectively. Twenty-eight patients (16.6%) died during the observation period. Seventy-five patients underwent universal prophylaxis and 15 received preemptive therapy. HCV recurrence was detected in 97 patients.Recipients who were older than 60, received DDLT, used cyclosporine, or suffered acute rejection had lower rates of survival. Conclusion: Patent survival rates of HCV patients after LT in Korea were comparable with other countries.
Jong Man Kim,Kwang-Woong Lee,Gi-Won Song,Bo-Hyun Jung,Hae Won Lee,Nam-Joon Yi,Choon Hyuck David Kwon,Shin Hwang,Kyung-Suk Suh,Jae-Won Joh,Suk-Koo Lee,Sung-Gyu Lee 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.6
Purpose: There is no consensus regarding the difference in outcomes of HCV in patients who receive living donor liver transplantation (LDLT) or compared to deceased donor liver transplantation (DDLT). The aims of this study were to compare characteristics between LDLT and DDLT groups and to identify risk factors affecting patient survival. Methods: We retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent liver transplantation. Results: Thirty-five patients underwent DDLT, and 146 underwent LDLT. The 1-, 3-, and 5-year patient survival rates were 66.7%, 63.0%, and 63.0% in the DDLT group and 86.1%, 82.3%, and 79.5% in the LDLT group (P = 0.024), respectively. After propensity matching, the patient survival curve of the LDLT group was higher than that of the DDLT group. However, there was no statistically significant difference in patient survival between the 2 groups (P = 0.061). Recipient age ≥ 60 years, LDLT, and use of tacrolimus were positively associated with patient survival in multivariate analyses. Conclusion: LDLT appears to be suitable for HCV-infected patients if appropriate living donor is available.
Jong Man Kim,Hyojun Park,Hye Ryoun Jang,Jae Berm Park,Choon Hyuck David Kwon,Wooseong Huh,Joon Hyeok Lee,Sung Joo Kim,Jae-Won Joh 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.5
Purpose: HBsAg-positive kidney recipients are at increased risk for mortality and graft failure. The aims of this study were to identify the outcomes of HBsAg-positive recipients who received preemptive antiviral agents after successful kidney transplantation and to analyze risk factors for HBV reactivation. Methods: We retrospectively reviewed the medical records of 944 patients performed kidney transplantation between 1999 and 2010. Results: HBsAg-negative recipients were 902 patients and HBsAg-positive recipients, 42. Among HBsAg-positive recipients, HBV reactivation was detected in 7 patients and well controlled by switch or combination therapy. Graft failure developed in only one patient due to chronic rejection regardless of HBV reactivation but no deaths occurred. All patients were alive at the end of follow-up and none developed end-stage liver disease or hepatocellular carcinoma. There was statistically significant difference in graft survival between HBsAg-positive recipients and HBsAg-negative. Multivariate analysis identified increased HBV DNA levels (>5 × 10<SUP>4</SUP> IU/mL) in the HBsAg-positive kidney transplant recipients as a risk factor for HBV reactivation (P = 0.007). Conclusion: Effective viral suppression with antiviral agents in HBsAg-positive renal transplant recipients improves patient outcome and allograft survival. Antiviral therapy may be especially beneficial in patients with high HBV DNA levels prior to transplantation.
( Jong Man Kim ),( Choon Hyuck David Kwon ),( Jae Won Joh ),( Jae Berm Park ),( Sung Joo Kim ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Hepatocellular carcinoma (HCC) has a high predilection for portal vein invasion. The objective of this study was to investigate clinicopathologic characteristics and outcomes of HCC patients with pathological portal vein invasion. Methods: We retrospectively reviewed the clinicopathologic data and outcomes of 83 HCC patients with portal vein invasion and 1056 patients without portal vein invasion who underwent liver resection. Results: Increased serum alkaline phosphatase (ALP) levels, increased maximum tumor size, and intrahepatic metastasis were predisposing factors for portal vein invasion by multivariate analysis. The median disease-free survival and overall survival of HCC patients with portal vein invasion was 4.5 months and 25 months, respectively. The 1-year, 2-year, and 3-year disease-free survival rates were 30.6%, 26.1%, and 21.2%, respectively, and overall survival rates in HCC patients with portal vein invasion were 68.6%, 54.2%, and 41.6%, respectively. The first detection site was lung in HCC patients with portal vein invasion and liver in HCC patients without portal vein invasion. C-reactive protein (CRP) was a significant independent predictor of tumor recurrence in HCC with portal vein invasion after surgery. Conclusions: Increased ALP levels, increased maximum tumor size, and intrahepatic metastasis were independent predictors of portal vein invasion in HCC. CRP level was closely associated with the predisposing factor of tumor recurrence in HCC patients with portal vein invasion after surgical resection, and lung metastasis was common.
HCC : How can we expand the criteria of Liver transplantation in hepatocellular carcinoma? (초)
( Jong Man Kim ),( Hyung Hwan Moon ),( Yougn Nam Noh ),( Sang Hyun Song ),( Mill Jae Shin ),( Choon Hyuck David Kwon ),( Sung Joo Kim ),( Jae Won Joh ),( Suk Koo Lee ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)
Encapsulating peritoneal sclerosis in liver transplant recipients
Kyo Won Lee,Chan Woo Cho,Nuri Lee,Sanghoon Lee,Jong Man Kim,Gyu-Seong Choi,Choon Hyuck David Kwon,Jae-Won Joh,Suk-Koo Lee 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.3
Encapsulating peritoneal sclerosis (EPS) is a rare cause of intestinal obstruction by a thick fibrous membrane wrapping around the small intestine. It is a possible complication after liver transplantation (LT) that can be fatal. This report describes 2 cases of EPS after LT that were successfully treated with surgery, corticosteroids, tamoxifen, and mammalian target of rapamycin inhibitor. After treatment in both cases, the patients were able to start oral feeding and have been symptom free for more than 1 year. These cases suggests that for the management of EPS, surgical treatment is mandatory when the patients present with symptoms of intestinal obstruction or if there are findings suggestive of decreased mural perfusion. Surgery should be accompanied with medical treatment to prevent the relapse of EPS.