Ex) Article Title, Author, Keywords
Ex) Article Title, Author, Keywords
Original Article
2021-05-31
1344
500
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
https://doi.org/10.52604/alt.21.0003Abstract : Background: Model for end-stage liver disease (MELD) score-based allocation system was started in 2016 in Korea. This study aimed to analyze the profiles of adult patients who underwent living donor liver transplantation (LDLT) in the pre- and post-MELD eras. Methods: This study was a retrospective double-arm analysis using a single-institution LDLT cohort. We compared the LDLT recipient profiles by focusing on pretransplant MELD score for 4 years before and after the introduction of the MELD scorebased allocation system. Patients without and with hepatocellular carcinoma (HCC) were categorized as Group A and B in the pre-MELD era and Group C and D in the post-MELD era, respectively. Results: The number of patients in Groups A, B, C and D was 615, 599, 704 and 713, respectively; and their MELD scores were 19.0±9.4, 11.2±5.6, 17.9±8.5 and 11.6±5.7, respectively. Clinical parameters of liver cirrhosis indicate that Group A had worse general conditions than Group C; and Groups B and D had similar general conditions. The comparative analysis between Groups A and C revealed the mean and median MELD scores as 19.0±9.4 and 17.9±8.5 (p=0.009), and 16 and 15 (p=0.077), respectively. The comparative analysis between Groups B and D revealed the mean and median MELD scores as 11.2±5.6 and 11.6±5.7 (p=0.14), and 9 and 9 (p=0.14), respectively. Conclusion: Median pretransplant MELD score was in the range of 15-16 in LDLT recipients without HCC and 9 in those with HCC. Introduction of MELD score in deceased donor organ allocation system resulted in a marginal decrease in the pretransplant MELD score in patients undergoing LDLT without HCC, but no change in those with HCC.
Review Article
2021-05-31
1155
374
Dong-Hwan Jung , Shin Hwang , Gi-Won Song
Ann Liver Transplant 2021; 1(1): 29-47
https://doi.org/10.52604/alt.21.0005Abstract : With accumulated experience on living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), several major Korean transplant centers presented institutional or multicenter selection criteria of LDLT for HCC based on their own experience. This study intended to review the selection criteria of LDLT for HCC developed in the major Korean LT centers. Extended criteria for primary liver transplantation (LT) were developed in Asan Medical Center (AMC) in 2008, the Catholic University of Korea in 2012, Samsung Medical Center in 2014, National Cancer Center Korea in 2016, the model to predict tumor recurrence after LDLT (MoRAL) in three centers in 2016, A-P 200 criteria in Pusan National University in 2016, patient selection by tumor markers in LT for advanced HCC in eight centers, composite criteria using clinical and PET factors in two centers in 2019, tumor size and number, AFP, PIVKA-II, PET (SNAPP) score in AMC in 2021, and quantitative prognostic prediction using AFP-PIVKA-II-tumor volume (ADV) score in AMC in 2021. The criteria for salvage LT were developed from a multicenter study involving three centers in 2014 and from AMC in 2020. Posttransplant prognostic prediction models for early or non-viable HCC were developed in AMC for super-selection criteria in 2011 and pretransplant treatment-induced complete tumor necrosis in 2017. The importance of tumor biology in HCC treatment has been emphasized more than before. The expression of serum tumor markers is a surrogate biomarker reflecting the tumor biology. Pretransplant radiological assessment of HCC combined with tumor marker expression or PET finding will provide reliable information that will assist the decision to perform LDLT in patients with HCC of various stages.
Review Article
2021-05-31
1065
335
Shin Hwang1,2,3 , Ju Hee Bae2,3 , In-Ok Kim2,3 , Jung-Ja Hong2
Ann Liver Transplant 2021; 1(1): 79-85
https://doi.org/10.52604/alt.21.0016Abstract : Vascular allografts are important materials to facilitate partial liver graft reconstruction in living donor liver transplantation (LDLT). Tissue banks are essential in providing vascular allografts used in LDLT. This study is intended to present the details of vascular allograft procurement, cryopreservation, and transplantation techniques, which are currently used in the Asan Medical Center Tissue Bank according to the standard operating procedure (SOP). Vascular allografts can be procured from the deceased organ donors or tissue donors. In practice, the majority of vessel donors are deceased multiorgan donors, thus the vessel grafts are harvested following multiorgan donation. The vascular allografts are cryopreserved according to the SOP and stored at —150°C in the vapor phase of liquid nitrogen. They can be kept for 10 years at the tissue bank. For clinical use, the cryopreserved vessel grafts are melted rapidly. At our institution, the majority of cryopreserved vascular allografts have been used for LDLT operations and some of them are also used for various hepatobiliary and vascular surgeries. In conclusion, the supply of vascular allografts through cryopreservation at the institutional tissue bank is an essential preparation to facilitate adult LDLT operations requiring various vascular reconstruction that use patches or conduits.
Review Article
2021-05-31
1004
998
Shin Hwang , Jung-Man Namgoong
Ann Liver Transplant 2021; 1(1): 71-78
https://doi.org/10.52604/alt.21.0007Abstract : Pediatric recipients, especially infants, are vulnerable to vascular complications because recipient vessels are smaller than those in adult liver transplantation (LT). Once portal vein (PV) stenosis occurs, it is often difficult to treat it through radiological angioplasty. Endovascular stenting is regarded as the final life-saving procedure, with a likelihood of needing retransplantation later. We have established standardized customization of surgical techniques for pediatric LT. Here, we present our tailored standardization of PV reconstruction for pediatric LT with the following 5 topics. 1) tadpole vein homograft conduit interposition for hypoplastic PV in infant patients undergoing split or living donor LT; 2) side-to-side anastomosis for hypoplastic PV in infant patients undergoing infant-to-infant whole liver LT; 3) PV branch patch venoplasty for size-matching in pediatric patients undergoing split or living donor liver transplantation; 4) PV conduit interposition in pediatric patients with congenital absence of PV; 5) wedged patch venoplasty for small-sized graft left PV. There are two features in our techniques for PV reconstruction: 1) frequent use of vein homograft; and 2) funneling of the recipient PV to match with the graft PV. In conclusion, secure PV reconstruction is important for successful pediatric LT. Thus, every effort should be made to ensure obtainment of sufficient portal blood inflow. From the viewpoint of hemodynamics principles, a funnel-shaped PV conduit is the most desirable configuration to ensure effective flow from the splanchnic system in infant patients with PV hypoplasia.
How-I-Do-It
2021-05-31
930
322
Dong-Hwan Jung , Shin Hwang , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Gil-Chun Park , Byeong-Gon Na , Sung-Gyu Lee
Ann Liver Transplant 2021; 1(1): 86-94
https://doi.org/10.52604/alt.21.0004Abstract : The inferior right hepatic veins (IRHVs) and major short hepatic veins (SHVs) are indicated for vascular reconstruction to prevent hepatic venous congestion of the right liver grafts. As separate anastomoses of multiple IRHV/SHVs are vulnerable to stenosis, single large anastomosis through the unification of multiple hepatic vein openings is preferred. All right hepatic vein (RHV) openings can be unified through quilt unification venoplasty (QUV). After the introduction of QUV in 2004, we have developed several techniques and institutional guidelines for QUV. There are two types of QUV, all-in-one and RHV types. All-in-one QUV unifies the orthodox RHV, IRHV, SHV, and middle hepatic vein (MHV) branches using a large patch and MHV conduit. QUV for RHVs unifies the orthodox RHV, IRHV, and SHV, with separate reconstruction of the MHV conduit because a conjoined MHV conduit can be associated with outflow problems. For side-to-side anastomosis of QUV as like the double vena cava reconstruction, deep side-clamping of the recipient inferior vena cava is usually performed; however, shallow partial clamping can be used if necessary. The anatomy of the donor liver SHVs and the availability of sizable vessel patches are the primary determinants for designing the individualized configuration of QUV. We suggest that QUV using various vessel patches is useful for secure reconstruction of multiple IRHVs and SHVs to achieve successful implantation of the right liver grafts.
Original Article
2021-05-31
824
265
Jinsoo Rhu1 , Kyeong Deok Kim1 , Gyu-Seong Choi1 , Jong Man Kim1 , Gaab Soo Kim2 , Jae-Won Joh1
Ann Liver Transplant 2021; 1(1): 24-28
https://doi.org/10.52604/alt.21.0013Abstract : Background: To analyze the mean operating time of donors and recipients during living donor liver transplantation. Methods: Donors and recipients who underwent living donor liver transplantation during the period of 2016 to 2020 were included in the study. Mean operating time, which was defined as the duration between the entrance and exit from the operating room, was calculated. The mean operating time for donors and recipients according to the year performed were compared using the independent t-test. Results: A total of 472 cases of living donor liver transplantation cases were included to the study. Laparoscopic donor hepatectomy comprised 80.3% of cases in 2016, reaching 100% in 2020. Mean recipient operating time was 643.7±88.0 minutes in 2016, decreasing to 488.0±75.3 minutes in 2020. Mean donor operating time was 375.6±60.5 minutes in 2016, decreasing to 265.5±38.1 minutes in 2020. Conclusion: During a five-year period of laparoscopic living donor hepatectomy adaptation, the operating time for both recipients and donors decreased significantly.
Case Report
2021-05-31
803
444
Tae Beom Lee , Hyo Jung Ko , Jae Ryong Shim , Byung Hyun Choi , Kwangho Yang , Je Ho Ryu
Ann Liver Transplant 2021; 1(1): 100-104
https://doi.org/10.52604/alt.21.0015Abstract : Liver transplantation (LT) is the definitive treatment for end-stage liver disease. Acute rejection used to be a common complication up to 70% of recipients within the first year. Steroid pulse therapy is a helpful treatment for this complication but is not a preferred treatment for steroid-resistant acute rejection (SRAR). We report the successful treatment of patients diagnosed with steroid-resistant acute rejection. The patient, a 42-year-old male, diagnosed with chronic hepatitis b related liver cirrhosis, underwent living donor liver transplantation on 28th December 2015. This patient was given 20 mg basiliximab as induction therapy on days 0 and 4 post-transplantation. The immunosuppressive maintenance regimens for this patient included a double regimen (tacrolimus and steroid). At 20 months after transplantation, he was admitted to our hospital, presenting elevated serum levels of liver enzymes and total bilirubin. We performed the liver biopsy after vascular or biliary complications were excluded by computed tomography. A liver biopsy showed acute cellular rejection. Steroid pulse therapy was not effective. The liver biopsy was repeated to obtain an exact diagnosis. A second liver biopsy also confirmed acute cellular rejection. He was diagnosed with steroid-resistant acute rejection. He received 1.5 mg/kg/day anti-thymocyte globulin for 5 days. He received antihistamine and antipyretic before anti-thymocyte globulin infusion to reduce or prevent adverse effects of anti-thymocyte globulin. The patient was stopped tacrolimus and 5 mg/kg/day ganciclovir; ceftazidime prophylaxis was given during anti-thymocyte globulin therapy. After anti-thymocyte globulin treatment, His liver enzymes and total bilirubin were decreased. He was discharged 34 days later and almost normalized his liver enzymes and total bilirubin. We have shown that anti-thymocyte globulin is safe and effective for treating steroid-resistant acute rejection, preventing graft loss of chronic rejection.
Review Article
2021-05-31
725
310
Shin Hwang , Jung-Man Namgoong
Ann Liver Transplant 2021; 1(1): 58-70
https://doi.org/10.52604/alt.21.0006Abstract : Pediatric recipients are vulnerable to vascular complications because recipient vessels are small. Once graft outflow vein stenosis occurs, it is difficult to treat it effectively. To minimize the risk of hepatic vein outflow obstruction, it is necessary to perform individually designed reconstruction customized to each pediatric liver transplantation (LT) operation. We present our tailored surgical techniques for hepatic vein reconstruction in pediatric LT with the following five topics. 1) recipient hepatic vein unification venoplasty for implantation of left liver and left lateral section grafts; 2) graft hepatic vein venoplasty for left lateral section grafts; 3) graft hepatic vein venoplasty for left lateral section grafts with anomalous left hepatic vein anatomy; 4) graft hepatic vein unification venoplasty for left liver grafts; 5) inferior vena cava replacement during pediatric living donor liver transplantation; and 6) modified piggyback anastomosis of the graft inferior vena cava in infant-to-infant whole liver transplantation. There are three features in our techniques for graft hepatic vein reconstruction, including maximal usage of the recipient hepatic vein stumps, maximal widening of the graft outflow vein orifice through unification and patch venoplasty, and frequent use of vein homografts. In conclusion, secure graft outflow vein reconstruction is the most important step for successful pediatric LT. Thus, every effort should be done to minimize the risk of hepatic vein outflow obstruction. We strongly suggest that the diameter of graft hepatic vein anastomosis should be made as large as possible regardless of recipient age and body size.
Original Article
2021-05-31
725
375
Byeong-Gon Na , Shin Hwang , Gil-Chun Park , Gi-Won Song , Dong-Hwan Jung , Tae-Yong Ha , Chul-Soo Ahn , Deok-Bog Moon , Ki-Hun Kim , Young-In Yoon , Woo-Hyoung Kang , Hwui-Dong Cho , Minjae Kim , Sang Hoon Kim , Sung-Gyu Lee
Ann Liver Transplant 2021; 1(1): 2-9
https://doi.org/10.52604/alt.21.0002Abstract : Background: Since 2016, Korean liver organ allocation system has been based on model for end-stage liver disease (MELD). Some patients on waiting list progressed to MELDs >40 due to serious shortage of donor organs. This study investigated prognosis of deceased donor liver transplantation (DDLT) recipients with MELD scores >40. Methods: Data from adult patients with MELD scores ≥31 who underwent DDLT between June 2016 and November 2019 were retrospectively evaluated. Patients were categorized according to Korean Network for Organ Sharing (KONOS) status 3, 2, or MELD-over-40. Results: During the study period, 168 DDLT operations were performed in 160 patients with KONOS status 3 in 77 (48.1%), status 2 in 65 (40.6%) and MELD-over-40 in 18 (11.3%). Graft survival rates of primary DDLT were 84.0% at 1 year and 70.7% at 3 years. Overall patient survival was 85.2% at 1 year and 70.7% at 3 years. The 3-year patient survival was 74.4%, 75.7%, and 52.7% in KONOS status 3, status 2, and MELD-over-40 groups (p=0.19). Pretransplant ventilator support was associated with inferior patient survival outcomes (p=0.043), but pretransplant renal replacement therapy showed no prognostic significance. Retransplantation showed a significant prognostic difference (p<0.001). Multivariate analysis for overall patient survival showed that pretransplant ventilator support and retransplantation were significant prognostic factors, but MELD score >40 was not seen to be an independent risk factor. Conclusion: This analysis revealed that very high MELD scores >40 appear to confer additional risk in patients with KONOS status 2 although it was not an independent prognostic factor.
Editorial
2021-05-31
721
485
Ann Liver Transplant 2021; 1(1): 1-1
https://doi.org/10.52604/alt.21.0001
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
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