Ex) Article Title, Author, Keywords
Ex) Article Title, Author, Keywords
Review Article ㅣ 2022-11-30 0 88 60
Ann Liver Transplant 2022; 2(2): 107-111https://doi.org/10.52604/alt.22.0021
Abstract : Graft-versus-host disease (GVHD) occurs when donor lymphocytes recognize recipient cell surface antigens as foreign and react against them. Although GVHD is rare, it is a life-threatening complication. Following liver transplantation (LT), the incidence of GVHD is estimated to be 0.1% to 2%. However, more than 50% of affected patients have died. Living donor LT (LDLT) has a special risk of GVHD because implicating human leukocyte antigen (HLA) matching status between recipients and close-relative living donors. Therefore, we reviewed Korean GVHD cases following LDLT to identify LDLT-oriented characteristics of GVHD. This study included one case from each of three centers and three cases from one high-volume center. One-way donor-recipient HLA match was identified by HLA typing for donor and recipient. Of these six cases of LDLT diagnosed with GVHD, all patients died due to GVHD and its associated complications. In conclusion, post-LT GVHD is a fatal complication despite aggressive treatment approaches. Preventive measures, early diagnosis, early initiation of treatment protocols, prophylactic treatment, and appropriate palliative care are necessary to achieve success against GVHD. Further studies should be performed to reveal the mechanisms of GVHD and improve outcomes of patients who develop GVHD following LT.
Review Article ㅣ 2022-11-30 0 75 51
Ann Liver Transplant 2022; 2(2): 112-116https://doi.org/10.52604/alt.22.0023
Abstract : Split liver transplantation (SLT) was developed to increase the number of donor graft livers used for liver transplantation. In conventional SLT, the liver of the deceased donor is divided into two parts, the left lateral section for pediatric recipients and the extended right liver graft for adult recipients. This review presents the Korean experience of SLT for adult and pediatric recipients to delineate the characteristics of SLT. An analysis of the multicenter experience using the Korean Network for Organ Sharing data revealed that a sufficient volume of the graft estimated from donor-to-recipient weight ratio-matching could lead to better outcomes of adult SLTs with an extended right liver graft. A single-center experience of SLT on adult recipients presented that survival outcomes were similar in adult SLT and whole liver transplantation recipients, probably due to selection of high-quality grafts and low-risk recipients. An analysis of the Korean multi-center experience on pediatric recipients presented that the graft and overall survival rates of SLT and living donor liver transplantation were not different in pediatric patients, and that fulminant hepatic failure was the only risk factor affecting graft survival outcome. In conclusion, this collective review demonstrated that survival outcomes were comparable between adult SLT and whole liver transplantation recipients as well as pediatric SLT and living donor liver transplantation. Judicious selection of donors and adult recipients for SLT might expand the liver graft pool for pediatric patients without affecting adult recipients undergoing SLT.
Review Article ㅣ 2022-11-30 0 80 45
Ann Liver Transplant 2022; 2(2): 117-120https://doi.org/10.52604/alt.22.0024
Abstract : Split liver transplantation for two adult patients (SLT2A) is a procedure that involves donor liver split into two hemi-liver grafts for two patients. Since one whole liver graft can be shared between two adult recipients, SLT2A could increase the number of available grafts and reduce the waitlist time and mortality. Considering that principles and techniques of liver splitting are similar between adult living donor liver transplantation and SLT2A, accumulation of experience on living donor liver transplantation has greatly influenced the development of SLT2A in Korea. Therefore, we reviewed the Korean experience of SLT2A to delineate the characteristics of SLT2A in Korea. The first case report of SLT2A in Korea was successfully performed through in situ splitting in 2003. In Asan Medical Center, 16 cases of adult SLT2A from 8 deceased donors were performed using in situ splitting technique from 2003 to 2014. Patient and graft survival rates did not differ significantly between SLT2A and whole liver transplantation groups. Eight cases of SLT2A have been performed in Seoul St. Mary’s Hospital since 2017. Of them, two died. In conclusion, SLT2A is a feasible option to expand door pools under selected situations of deceased donor liver transplantation in current setting of Korea.
Review Article ㅣ 2022-11-30 0 71 53
Ann Liver Transplant 2022; 2(2): 121-126https://doi.org/10.52604/alt.22.0022
Abstract : During liver transplantation (LT) in pediatric patients, graft size matching to the recipient’s abdomen is of critical importance. In order for the left lateral section (LLS) graft to be as small as possible, the LLS has to be reduced to be a monosegment or hyper-reduced LLS (HRLLS) graft. The demand for LT in small infants has been persistently present, but the number of LT using monosegment or HRLLS grafts is very limited in Korea. Therefore, this study investigates pediatric LT using HRLLS or monosegment grafts to delineate its characteristics in Korea. The average age and body weight of the patients were 4.0±1.7 months and 5.3±1.4 kg, respectively, for three cases of pediatric LT with HRLLS graft. The mean weight of the HRLLS grafts was 191.7±62.1 g and the graft-recipient weight ratio was 3.75%±1.57%. All patients recovered from their respective LT operation and are actually in good health, more than 6 years after the LT. There was one case of pediatric deceased donor LT with in situ size reduction of recipient-graft size. Another case presented dextroplantation of a reduced LLS graft. A case of pediatric living donor LT using a monosegment graft procured by pure 3-dimensional laparoscopic LLS resection and in situ reduction was also reported. In conclusion, making a HRLLS or monosegment graft during living donor LT and split LT can be a useful option for treating pediatric patients.
Review Article ㅣ 2022-11-30 0 63 43
Ann Liver Transplant 2022; 2(2): 127-131https://doi.org/10.52604/alt.22.0025
Abstract : Middle hepatic vein (MHV) reconstruction with an interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT) using a right lobe graft when the donor's MHV trunk is preserved in the donor's remnant liver. Although large-size vein allografts are suitable for MHV reconstruction, their supply is often limited. Various synthetic vascular grafts (SVGs) have been frequently used due to their availability and high patency rates. However, unwanted migration of an SVG into the hollow viscus is an unexpected serious complication. Since its first report in 2011, at least nine case reports or short series of SVG migration following LDLT have been published. Postoperative complications and interventional treatments undertaken are other influencing factors of SVG-associated complications. Contrast-enhanced computed tomography is the best modality for early detection of SVG-related complications including infection and suspected gastrointestinal tract penetration. The second study is endoscopic evaluation of the stomach, duodenum, and other adjacent structures. There is no definite consensus about the treatment of SVG migration into a hollow viscus. The majority of patients undergo definitive treatment including surgical removal. However, some patients without any symptoms or sign are under close observation. In conclusion, the risk of unwanted SVG migration is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using SVG.
Original Article ㅣ 2022-11-30 1 75 50
Young Kyoung You , Jinha Chun , Yoonyoung Choi , Yoonkyoung Woo , Joseph Ahn , Ho Joong Choi
Ann Liver Transplant 2022; 2(2): 132-138https://doi.org/10.52604/alt.22.0018
Abstract : Background: Split liver transplantation has been explored as one of method to increase donor supply. Concerns about the complexity and increased risk of vascular and biliary complexity makes split liver transplantation stable so far. Technical complexity has been overcome in South Korea due to abundant experience of living donor liver transplantation. However, liver transplantation of full right and full left liver has not been popularized because of ambiguousness in allocation policy for adult split liver in Korea. Methods: Four deceased marginal donor split liver procedures were performed for eight adult recipients in our institute since 2017. Results: Three of four donors had elevated aspartate aminotransferase or alanine aminotransferase level beyond three times of reference range. One of them was 60 years old. Three splits were made in situ and one split procedure was carried out ex vivo. After splitting liver, all four right graft were allocated to patients of high model for end-stage liver disease score and the left grafts with main vascular structures were transplanted to sub-urgent waiting list individuals. Graft to recipient body weight ratio range for both right and left liver graft were 1.5 to 2.2 and 0.9 to 1.4 respectively. Cold ischemic time ranged from 59 minutes to 388 minutes. Graft liver function of all recipients recovered without remarkable events. One recipient of right liver graft died in 11 post-transplantation months due to aggravating preexisting myelofibrosis and one left liver recipient for liver re-transplantation of primary liver graft failure expired due to cerebral infarct on post-transplantation 21 days. Conclusion: Split liver graft from selected deceased marginal donor graft to both adult recipients has the potential to expand donor pool.
Case Report ㅣ 2022-11-30 0 92 38
Ann Liver Transplant 2022; 2(2): 139-143https://doi.org/10.52604/alt.22.0016
Abstract : This report introduces a novel strategy for modulating portal inflow during liver transplantation in a patient with portal vein thrombosis without evident systemic shunt formation. Two living donor liver transplantation cases which used meso-reno-portal anastomosis for portal flow augmentation were reviewed. Two patients with Yerdel’s grade IV portal vein thrombosis without evident systemic shunt formation underwent successful living donor liver transplantation. The first patient had two jumping grafts from superior mesenteric vein and left renal vein anastomosed together which was concurrently anastomosed to the portal vein. For six months, both flows were patent and after six months, left renal vein flow was occluded leaving only superior mesenteric venous flow which was enough for the liver. The second patient had a jumping graft from left renal vein which was anastomosed in an end-to-side manner to the main portal vein which was concurrently anastomosed to the graft’s portal vein. For three months, the patient had intact flow from both the portal vein and left renal vein. By these two cases, we report that in portal vein thrombosis without evident systemic shunt formation, meso-reno-portal anastomosis can augment the portal flow which can be beneficial for successful transplantation.
Case Report ㅣ 2022-11-30 0 69 27
Jung-Man Namgoong1 , Shin Hwang1 , Gil-Chun Park1 , Suhyeon Ha1 , Sujin Gang1 , Jueun Park1 , Seak Hee Oh2
Ann Liver Transplant 2022; 2(2): 144-150https://doi.org/10.52604/alt.22.0019
Abstract : Congenital absence of the portal vein (CAPV) is a rare venous malformation in which the mesenteric venous blood drains directly into systemic circulation. We report the case of a pediatric living donor liver transplantation (LDLT) for CAPV with an intrahepatic portosystemic shunt. A 3-year-old boy was diagnosed with CAPV at the age of 1 year. There was no evidence of portal hypertension due to complete diversion of the portal blood flow into the retrohepatic inferior vena cava. The patient suffered from hepatic encephalopathy; therefore, we decided to perform LDLT. The graft was the left liver from the 31-year-old mother of the patient. The recipient hepatectomy was performed according to standard procedures of pediatric LDLT. Portal vein reconstruction was performed using a branch patch of the native portal vein. The patient recovered uneventfully from the LDLT. The reconstructed portal vein was maintained well without any hemodynamic abnormalities. In conclusion, the features of CAPV and portocaval shunt may vary among CAPV patients; thus, portal vein reconstruction should be customized according to anatomical variations.
Case Report ㅣ 2022-11-30 0 64 47
Sung-Min Kim , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Woo-Hyoung Kang , Young-In Yoon , Shin Hwang
Ann Liver Transplant 2022; 2(2): 151-156https://doi.org/10.52604/alt.22.0020
Abstract : Liver transplantation (LT) is an accepted treatment for some hepatic malignancies including hepatocellular carcinoma. We herein present two cases of primary hepatic angiosarcoma (PHAS) who underwent deceased donor LT (DDLT). The first case was a 61-year-old male who was diagnosed with cryptogenic liver cirrhosis. He underwent transarterial chemoembolization for multiple liver nodular lesions. Because of progressive hepatic failure with a model for end-stage liver disease (MELD) score of 40, he underwent DDLT. PHAS was not diagnosed for the explant liver at the time of DDLT. However, it was confirmed through immunohistochemical staining studies at 3 months after LT. The patient passed away at 5 months after LT due to tumor progression. The second case was a 74-year-old male with cryptogenic liver cirrhosis. He suffered from hepatorenal syndrome with a MELD score of 40. Thus, he underwent DDLT. PHAS was diagnosed for the explant liver at the time of DDLT. At 6 months after LT, tumor recurrence was identified and the patient passed away at 12 months after LT due to tumor progression. This is the first report of two adult cases of LT recipients with PHAS in Korea. If we had recognized the possibility of PHAS, the decision to perform LT would not be taken easily despite MELD score of 40. Our experience suggests that PHAS is still a contraindication of LT.
Case Report ㅣ 2022-11-30 1 65 51
Rak Kyun Oh , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Woo-Hyoung Kang , Young-In Yoon , Haesong Lee , Shin Hwang
Ann Liver Transplant 2022; 2(2): 157-161https://doi.org/10.52604/alt.22.0026
Abstract : Middle hepatic vein (MHV) reconstruction with interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT). Unwanted migration of a synthetic vascular graft into the hollow viscus has been sporadically reported. We herein present a case of Hemashield graft migration into the duodenum following LDLT. A 64-year-old male patient presented with LDLT due to liver cirrhosis and hepatocellular carcinoma. The MHV openings in the right liver graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient middle-left hepatic vein trunk. The patient had uneventful recovery after LDLT surgery. Computed tomography (CT) scans taken at one year and two years showed no abnormal finding. However, gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb. The patient had no signs or symptoms and no problems with diet. The Hemashield graft migration was identified by retrospective review of 1-year and 2-year CT scans probably due to no radio-opacity of Hemashield graft. Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more. The patient has been doing well for two years six months after LDLT. In conclusion, every synthetic vascular graft can penetrate adjacent organs and soft tissues, and its incidence is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using synthetic vascular grafts.
Case Report ㅣ 2022-11-30 0 72 41
Ann Liver Transplant 2022; 2(2): 162-168https://doi.org/10.52604/alt.22.0017
Abstract : Laparoscopic cholecystectomy can result in various injuries of the bile duct. Surgical treatment of such complications is difficult and may often result in intractable postoperative management. Herein, we present a case of laparoscopic-cholecystectomy-induced isolated right-anterior-section (RAS) bile duct injury. The RAS duct injury was identified immediately after laparoscopic cholecystectomy, and percutaneous biliary drainage was performed to control bile leak. Imaging results showed that the RAS duct was irrelevantly ligated, probably owing to a rare anatomical anomaly. Considering the difficulty of surgical treatment, atrophy induction of the RAS parenchyma was performed through portal vein embolization. This treatment comprised percutaneous drainage of the bile leak, percutaneous embolization of the RAS portal branch to inhibit bile production, and induction of heavy adhesion at the site of bile leak. These procedures were implemented for approximately 3 months prior to removal of the pigtail catheter, and the patient was free of complications at 6 months after operation. Parenchymal atrophy induction therapy using portal vein embolization combined with percutaneous biliary drainage is therefore an effective treatment option for managing laparoscopic-cholecystectomy-associated isolated sectional bile duct injury.
Sang Hoon Kim , Shin Hwang , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Ki-Hun Kim , Young-In Yoon , Woo-Hyoung Kang , Hwui-Dong Cho , Minjae Kim , Byeong-Gon Na , Sung-Min Kim , Geunhyeok Yang , Sung-Gyu Lee
Ann Liver Transplant 2021; 1(1): 10-17
Dong-Hwan Jung , Shin Hwang , Gi-Won Song
Ann Liver Transplant 2021; 1(1): 29-47
Shin Hwang1,2,3 , Ju Hee Bae2,3 , In-Ok Kim2,3 , Jung-Ja Hong2
Ann Liver Transplant 2021; 1(1): 79-85