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Ex) Article Title, Author, Keywords

Review Article

Liver transplantation in Wilson’s disease: A systematic review

Wilson’s disease (WD) is a rare genetic disorder affecting the metabolism of copper that may present with neurological symptoms. In cases leading to hepatic failure, liver transplantation (LT) may be necessary. The aim of this paper is to examine the literature on LT cases related to WD in terms of disease characteristics, the neurological conditions of patients and survival rates. The keywords “Wilson and transplant*” were used to perform a title and abstract search across three databases...
Review Article

Impact of COVID-19 on the number of deceased donors and organ transplantation in Western countries

The severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) pandemic has an impact on all facets of our health care system, including life-saving procedures. The COVID-19 in 2020 has a substantial impact on the transplant community. This study aimed to assess the impact of COVID-19 on the number of deceased donors and organ transplantation in Western countries by analyzing literature review. In Spain, the COVID-19 pandemic has posed significant challenges to the Spanish donation ...
Original Article

Analysis of nationwide volume of liver transplantation in Korea during 2020 shows no definitive decrease during COVID-19 outbreak

Background: Recent outbreak of Coronavirus disease 2019 (COVID-19) has discouraged organ donation. To determine its impact on liver transplantation (LT) at Korean transplant centers, it is necessary to analyze the incidence and type of LT in each center. Methods: The number of deceased donor LT (DDLT) and living donor LT (LDLT) operations performed during the year 2020 were analyzed using the Korean Network for Organ Sharing (KONOS) database. Results: During the 21-year period from 2000 to 2020,...

Minimal-incision donor right hepatectomy for living donor liver transplantation

For living donors, the second most important concern after the donor safety is the cosmetic aspect of abdominal incision. The present study aimed to present the technical details of minimal-incision laparotomy (MIL) in a case of living donor right hepatectomy with an eight minutes video clip. The recipient was a 57-year-old patient with alcoholic liver cirrhosis and the donor was his 28-year-old daughter of the recipient. The epigastrium area was narrow and the subcostal cartilages were elongate...

Current Issue Vol.3 No.2, November, 2023

  • Review Article

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


    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

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


    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

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


    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

    Ann Liver Transplant 2023; 3(2): 80-85


    Abstract : Wilson disease (WD) stands as an autosomal recessive disorder primarily brought about by genetic mutations affecting the ATP7B gene, yielding a prevalence rate estimated at 1:30,000 to 50,000 individuals. The ATP7B gene codes for an enzyme known as transmembrane copper-transporting ATPase, a crucial factor in the incorporation of copper into ceruloplasmin and its elimination through bile excretion. The malfunction or absence of this enzyme leads to the progressive buildup of copper within various organs, particularly the liver, nervous system, corneas, kidneys, and heart. Children afflicted with WD may manifest with asymptomatic liver issues, cirrhosis, or even acute liver failure, accompanied by or without neurological and psychiatric symptoms. Approximately 20% to 30% of WD patients experience acute liver failure, while the majority of others develop chronic progressive hepatitis or cirrhosis when left untreated. While genetic testing has gained significance in diagnosing WD, the diagnosis still relies on a combination of clinical observations and laboratory tests. In cases of liver failure and encephalopathy, liver transplantation emerges as a life-saving option for WD patients. This review addresses specific concerns pertinent to liver transplantation for pediatric WD patients.

  • Review Article

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


    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.

  • Original Article

    Analyzing bench-surgery time: A comparative study of pure laparoscopic and open left hepatectomy including the middle hepatic vein in living liver donors

    Suk Kyun Hong , Minseob Kim , Youngjin Kim , Jae-Yoon Kim , Jaewon Lee , Jiyoung Kim , Su young Hong , Jeong-Moo Lee , YoungRok Choi , Nam-Joon Yi , Kwang-Woong Lee , Kyung-Suk Suh

    Ann Liver Transplant 2023; 3(2): 94-99


    Abstract : Background: Pure laparoscopic donor hepatectomy (PLDH) has garnered attention due to its potential advantages in donor cosmesis and functional outcomes. This study focuses on bench-surgery in pure laparoscopic donor left hepatectomy (PLDLH) and compares it with conventional donor left hepatectomy (CDLH). Methods: We conducted a retrospective analysis of donor records, specifically comparing PLDLH, including the middle hepatic vein (MHV), performed from November 2015 to January 2018 with CDLH, including MHV, performed from August 2014 to September 2015. Key parameters examined encompassed bench-surgery time and the number of openings in the hepatic vein, portal vein, hepatic artery, and bile duct within the procured graft. Results: PLDLH exhibited significantly longer bench-surgery time (45.0 vs. 24.0 min, p=0.028), liver removal time (244.5 vs. 177.0 min, p=0.038), and warm ischemic time (10.5 vs. 3.0 min, p

  • Original Article

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


    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.

  • Original Article

    Ann Liver Transplant 2023; 3(2): 104-112


    Abstract : Background: Systemic treatment options for hepatocellular carcinoma (HCC) after liver transplantation (LT) are limited in patients in whom sorafenib treatment was failed. The purpose of our study was to compare outcomes among sorafenib, regorafenib, and nivolumab treatment groups in patients with recurrent HCC after LT. Methods: This study retrospectively evaluated patients who received sorafenib for recurrent HCC treatment after LT at a single center from March 2007 to December 2018. Some patients received regorafenib or nivolumab after sorafenib treatment failure. Results: Fifty-six patients were treated with sorafenib due to HCC recurrence. Among these, 38 patients (67.9%) continued treatment with sorafenib only; the other 18 patients (32.1%) were converted to regorafenib treatment. Ten patients of these 18 were converted to nivolumab after sorafenib and regorafenib therapy failed. The disease-free survival and overall survival (OS) from LT were not different among the three groups. In addition, OS from HCC recurrence, sorafenib usage, and usage of each systemic therapeutic agent were not different among the three groups. Three cases in the nivolumab group developed acute rejection; one of these led to graft failure and death due to antibody-mediated rejection. Conclusion: Sequential regorafenib or nivolumab treatment in recurrent HCC LT patients does not improve OS compared sorafenib treatment.

  • Case Report

    Short-term weight reduction program in potential donors with severe steatosis can reduce liver volume significantly that changes clinical decision in living donor transplantation

    Youngjin Kim , Kwang-Woong Lee , YoungRok Choi , Su young Hong , Nam-Joon Yi , Suk Kyun Hong , Jeong-Moo Lee , Kyung-Suk Suh

    Ann Liver Transplant 2023; 3(2): 113-117


    Abstract : Short-term weight reduction (SWR) programs have been demonstrated to ameliorate liver steatosis, transforming marginal donors into viable candidates for living donor liver transplantation (LDLT). These interventions impact objective indices of liver health through non-invasive imaging tools, expanding the pool of potential donors. Graft-to-recipient weight ratio (GRWR) is one of the important factors in recipient safety, therefore, needs to be considered for graft selection. A low GRWR can lead to impaired function, while a high GRWR can cause graft compression issues. We experienced one LDLT case that SWR program of the donor reduced the volume of the liver significantly together with qualitative improvement and changed a clinical decision to switch from using the left liver to the right liver as the graft during surgery. A healthy donor with fatty liver underwent SWR to enhance graft suitability. Initial imaging revealed fatty liver with a fat fraction of 15.3% and elevated alanine aminotransferase. Volumetric analysis favored the left liver (left liver GRWR, 1.11; right liver GRWR, 2.40). Post-SWR imaging showed reduced liver volume and improved hepatic steatosis, leading to the selection of the right liver for transplantation (left liver GRWR, 0.79; right liver GRWR, 1.65). Successful LDLT was performed using the right liver graft. SWR programs can significantly impact donor liver quality and volume, influencing graft selection for LDLT. Re-evaluation of donor conditions, including hepatic steatosis and volumetry, at the time of surgery is crucial to optimize graft choices and improve post-transplant outcomes.

  • Case Report

    Ann Liver Transplant 2023; 3(2): 118-127


    Abstract : Congenital absence of the portal vein (CAPV) is a rare venous malformation in which the mesenteric venous blood drains directly into the systemic circulation. We report a case of pediatric living donor liver transplantation (LDLT) for CAPV with a portal collateral vein of cavernous transformation. A 3-year-old boy was diagnosed with CAPV at the age of 2 years. Portal hypertension with collateral vein formation was progressed, thus we decided to perform LDLT. The graft was a left lateral section graft from the 35-year-old father of the patient. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT with isolation of two pericholedochal collateral veins. These collateral veins were unified and integrated with an iliac vein homograft using a modified patch-conduit venoplasty. The left lateral section graft was implanted with direct ligation of the coronary and splenorenal collateral veins. However, luminal thrombus was formed within the reconstructed portal vein conduit, thus the conduit was removed and graft portal vein was directly anastomosed with the pericholedochal collateral veins. The patient recovered from the LDLT operation, but the reconstructed portal vein was showed marked anastomotic stenosis. At 40 days after LDLT, percutaneous transhepatic balloon angioplasty was performed and the anastomotic stenosis was expanded. This patient has been doing well for 3 months after the LDLT. In conclusion, given the diverse presentations of portocaval shunt in CAPV patients, it is imperative to tailor the portal vein reconstruction approach based on a comprehensive anatomical assessment both prior to and during liver transplantation operation.

  • Case Report

    Living donor liver transplantation with direct collateral portal vein anastomosis in a pediatric patient with congenital absence of the portal vein

    Jung-Man Namgoong1 , Shin Hwang1 , Gil-Chun Park1 , Do Young Lee1 , Kyung Mo Kim2 , Seak Hee Oh2

    Ann Liver Transplant 2023; 3(2): 128-135


    Abstract : Congenital absence of the portal vein (CAPV) is a rare venous malformation in which the mesenteric venous blood drains directly into the systemic circulation. We report a case of pediatric living donor liver transplantation (LDLT) for CAPV with a portal collateral vein of cavernous transformation. A 12-year-old boy was diagnosed with CAPV at the age of 11 years. Portal hypertension with collateral vein formation was rapidly progressed, therefore, we decided to perform LDLT. The graft was a modified right liver graft from the 41-year-old father of the patient. The recipient hepatectomy was performed according to the standard procedures of pediatric LDLT with isolation of the portal collateral vein. This portal collateral vein was gently manipulated and its branches were used to form a branch patch. A modified right liver graft was implanted with direct ligation of the coronary and splenorenal collateral veins. The patient recovered from the LDLT operation. The reconstructed portal vein was maintained well without hemodynamic abnormality. This patient has been doing well for 2 months after the LDLT. In conclusion, since CAPV patients show various types of portocaval shunt, individualized portal vein reconstruction should be performed after thorough anatomical assessment before and during the liver transplantation operation.

The Korean Liver Transplantation Society

Vol.3 No.2
November 2023

pISSN 2765-5121
eISSN 2765-6098

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Aims and Scope

Annals of Liver Transplantation (Ann Liver Transplant), the official publication of the Korean Liver Transplantation Society, is an international, peer-reviewed open access journal. The journal pursues its advancement through original articles, reviews, case reports, editorials, and letter to editor. The journal is concerned with clinicians and scientists in liver transplantation and also with those in other fields who are interested in liver transplantation. The aim of the journal is to make contribution to saving lives of patients undergoing liver transplantation through active communication and exchange of study information on liver transplantation and provision of education and training on the diseases. The Ann Liver Transplant serves as a platform for debate and reassessment, a trigger of innovation, and a major pedestal for promoting understanding, improving outcomes, and advancing knowledge and technique in liver transplantation.

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