Review Article ㅣ 2023-11-30 848 263

Biological immunosuppressive agents used in liver transplantation

Cheon-Soo Park¹ , Yong-Kyu Chung²

Ann Liver Transplant 2023; 3(2): 63-68

Abstract  

Full Text PDF Cite Share

Abstract : Liver transplantation (LT) has become the preferred treatment for conditions like end-stage liver failure and hepatocellular carcinoma. With advancements in immunosuppressive therapies over time, there have been significant improvements in both graft and patient survival rates. However, the side effects of these immunosuppressive drugs now pose a major challenge to the quality of life and long-term outcomes post-transplantation. The key goal of personalized immunosuppression is to strike a fine balance between effective immunosuppression and minimizing side effects. Immunosuppressive agents are generally divided into two main categories: biological and pharmacological agents. Most treatment protocols combine multiple agents with varied mechanisms of action to lower the required dosages and reduce toxicity. The post-transplant immunosuppression process typically involves an intensive phase in the initial three months, when alloreactivity is heightened, followed by a maintenance phase that incorporates immunosuppression minimization strategies. This review was focused on the biologic agents employed in the treatment of LT recipients.

Review Article ㅣ 2023-11-30 563 170

Living donor liver transplantation for Wilson disease: A collective review

Jeong-Ik Park¹ , Yong-Kyu Chung²

Ann Liver Transplant 2023; 3(2): 73-79

Abstract  

Full Text PDF Cite Share

Abstract : Wilson disease (WD) is a recognized metabolic disorder characterized by abnormal copper accumulation and excretion in the human body. The liver-related symptoms may range from acute liver failure to chronic liver disease. Liver transplantation (LT) is primarily indicated for two conditions of WD as acute liver failure and chronic liver disease. LT offers a crucial lifeline for those with WD, with high success rates for graft and patient survival. Living donor liver transplantation (LDLT) recipients for WD generally exhibit superior survival rates, including graft survival, compared to those undergoing LT for other conditions. However, they are still susceptible to the usual risks associated with LDLT. This study intended to review the LDLT cases for WD with acute liver failure and chronic liver disease in the literature. This review included 12 LDLT studies and case reports from Japan (n=3), Turkey (n=2), India (n=2), China (n=2), Saudi Arabia (n=1), Korea (n=1), and United Arab Emirates (n=1). The findings of this review reinforce the efficacy of LDLT in WD, particularly in instances of acute liver failure, while also acknowledging its effectiveness in chronic liver disease.

Review Article ㅣ 2023-11-30 414 146

ADV score is a reliable surrogate biomarker of hepatocellular carcinoma in liver resection and transplantation

Shin Hwang , Dong-Hwan Jung , Gi-Won Song

Ann Liver Transplant 2023; 3(2): 86-93

Abstract  

Full Text PDF Cite Share

Abstract : A composite score, known as the ADV score, which is calculated by multiplying the levels of α-fetoprotein and des-γ-carboxy prothrombin along with tumor volume, has been demonstrated as an all-encompassing prognostic indicator for hepatocellular carcinoma (HCC) subsequent to hepatic resection and liver transplantation. This ADV score serves as a quantifiable metric that reflects the underlying characteristics of the tumor. This study was designed to validate the prognostic impact of ADV score in patients who underwent hepatic resection or liver transplantation for HCC through a collective review of twelve studies. The role of ADV score in hepatic resection was assessed in eight studies including five single-center studies, two multi-center studies and one international study. The role of ADV score in liver transplantation was assessed in five studies including four single-center studies and one Korea nationwide multi-center study. The culmination of evidence from these twelve investigations affirms the ADV score's role as a comprehensive surrogate biomarker for predicting the prognosis following hepatic resection or liver transplantation in patients diagnosed with HCC. The utilization of the ADV score for prognostic predictions offers a dependable means to inform the management of patients across varying stages of HCC, facilitating the tailoring of individualized postoperative follow-up plans based on the assessed risk of HCC recurrence.

Review Article ㅣ 2023-11-30 414 193

Liver transplantation for giant hepatic hemangioma: A collective review

Cheon-Soo Park¹ , Yong-Kyu Chung²

Ann Liver Transplant 2023; 3(2): 69-72

Abstract  

Full Text PDF Cite Share

Abstract : Giant hepatic hemangiomas (HHs) have been often considered benign, but their huge size and potential complications can make them far from benign in their impact on the lives. Amid the myriad of treatment options available, liver transplantation (LT) has been performed for giant HHs that have serious clinical manifestations. This study reviewed the role of LT as an indication for giant HH. The literature was searched using search terms as follows in all possible combinations: “liver hemangioma”, “giant hemangioma”, “liver transplantation”, and “Kasabach-Merritt syndrome”. A total of 18 studies were finally included in the present analysis, which recruited 19 patients. The mean age of patients was 39.9±8.6 years. The most common reported symptoms were abdominal distention, respiratory distress, upper abdominal pain, excessive bleeding, and coagulopathy. Preoperative laboratory tests showed abnormal liver function in all patients. Nine patients were diagnosed with Kasabach-Merritt syndrome. Fourteen patients received deceased donor LT whereas the remaining 5 patients underwent living donor LT. No intraoperative or postoperative 90-day mortality following LT was documented. All abnormal blood parameters returned to normal within few days postoperatively in all patients. All patients were alive at the time of their documentation. In conclusion, LT is a safe and effective treatment option in the management of symptomatic or complicated giant HH in selected patients.

Review Article ㅣ 2024-05-31 408 135

Surveillance and management of de novo malignancy after liver transplantation

Woo-Hyoung Kang

Ann Liver Transplant 2024; 4(1): 10-15

Abstract  

Full Text PDF Cite Share

Abstract : Liver transplantation (LT) has significantly improved long-term survival rates, but recipients face increased risks of de novo malignancy (DNM) due to immunosuppression. DNM patterns differ worldwide, with post-transplant lymphoproliferative disorder common in Western countries, while South Korea sees more gastric and colorectal cancers. Risk factors include immunosuppressive drugs, underlying conditions, and lifestyle factors. Screening strategies should be tailored to regional DNM patterns, with regular surveillance crucial for early detection and management. Minimizing immunosuppressant usage and prompt local treatment upon DNM detection offer favorable outcomes for LT recipients.

Review Article ㅣ 2023-05-31 385 336

Liver transplantation for hepatic epithelioid hemangioendothelioma: A review of European and Korean experience

Jeong-Ik Park¹ , Bo Hyun Jung²

Ann Liver Transplant 2023; 3(1): 6-10

Abstract  

Full Text PDF Cite Share

Abstract : Indications for liver transplantation (LT) are gradually expanding with the introduction of outcomes that act as benchmarks for the efficacy of newer indications. This review intended to summarize the current evidence in LT for hepatic epithelioid hemangioendothelioma (HEHE). Despite the limited worldwide experience with LT due to the global rarity of HEHE, the reported outcomes have generally been favorable. A European collaborative study presented the results of the second HEHE-European Liver Transplant Registry study, which showed overall posttransplant recurrence rate of 24.8% and 5-year disease-free survival rate of 79.4%. This study identified three risk factors for disease recurrence: short pretransplant waiting time of less than 120 days, macrovascular invasion, and hilar lymph node involvement. A Korean single-center study presented the outcomes in four patients with HEHE who underwent living donor liver transplantation from 2007 to 2016. All patients were preoperatively diagnosed with HEHE. The tumors were multiple and scattered over the entire liver, precluding liver resection. The mean model for end-stage liver disease score was 10.8±5.7. All patients underwent living donor LT using modified right liver grafts, with a graft-to-recipient weight ratio of 1.11±0.19. All patients recovered uneventfully after LT, resulting in 5-year disease-free and overall patient survival rates of 75% each. In conclusion, LT can be considered as an effective treatment for patients with unresectable HEHE that is confined within the liver and with acceptable risk factors.

Original Article ㅣ 2023-11-30 383 164

Safety of living donors in liver transplantation in a low volume center

Seong-Hwan Chang

Ann Liver Transplant 2023; 3(2): 100-103

Abstract  

Full Text PDF Cite Share

Abstract : Background: Living donor liver transplantation (LDLT) is an unavoidable procedure due to shortage of deceased donors. Since the first successful LDLT, many reports have shown excellent outcomes, but the safety of the donors after donation is still one of the main issues. And many studies have concluded that complex procedures may have better outcomes when their surgery is performed in high-volume rather than low-volume centers. Therefore, we are going to evaluate the overall safety of living donors in our center which is a low-volume center. Methods: Among the 54 liver transplantations, which is total number of liver transplants in our institution from June 2006, 29 living donors of adult LDLT, which were performed from June 2006 to December 2015, were analyzed. The first 11 LDLT were performed with the help of an outside experienced liver transplantation team and the other 18 LDLT were performed in our center independently. Results: There was no operative mortality and no re-operation. The mean age of donors was 27.8 years (16–52 years). Mean remnant volume was 39.0% (32.6%–46.5%). The mean operation time was 5 hours and 38.3 minutes (4 hours 10 minutes to 7 hours 45 minutes). The mean amount of estimated blood loss was 541.4 mL (200–1,200 mL). The mean hospital stay was 12.9 days (9–27 days). There was one major complication which was biliary stricture and three minor complications, which were mild depression with poor diet, wound infection, and postoperative blood transfusion. Conclusion: Sincere assistance of an experienced liver transplantation team and thorough preparation of a new transplantation team could guarantee a favorable safety of donors even in a low-volume transplant center.

Review Article ㅣ 2022-11-30 376 178

Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Jeong-Ik Park¹ , Yong-Kyu Chung²

Ann Liver Transplant 2022; 2(2): 107-111

Abstract  

Full Text PDF Cite Share

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.