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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,...
How-I-Do-It

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.1 No.2, November, 2021

  • Review Article

    Liver transplantation in Wilson’s disease: A systematic review

    Emre Turgut , Cemalettin Aydin , Cuneyt Kayaalp , Sezai Yilmaz

    Ann Liver Transplant 2021; 1(2): 113-122

    https://doi.org/10.52604/alt.21.0018

    Abstract : 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 (PubMed, Scopus, Web of Science) up until November 2018. The results from a total of 791 patients, mentioned in 28 studies, were analyzed. Thirty-nine point six percent of the patients received emergency LT and acute liver failure was more predominant in woman patients (61.7%-38.3%; p<0.0001). Live donations accounted for 36.6% of the transplants with none of these patients experiencing recurrence of disease. 36.4% of the patients displayed neurological symptoms prior to the transplant; however, following the operation these symptoms decreased by 74.2%. Survival rates for 1, 2, 3, 5, 10 years were 84%, 82%, 81%, 81%, and 80%, respectively. Further research into the reasons that acute liver failure in patients suffering from WD is more common among women is needed. Moreover, while mortality rates for up to one-year post-transplant are 16%, this rate is only 4% for the following 1–10 years. As neurological symptoms experienced prior to transplantation decrease by 74.2% after the operation, further studies should be carried out into the factors that determine potential neurological improvement.

  • Review Article

    Ann Liver Transplant 2021; 1(2): 123-128

    https://doi.org/10.52604/alt.21.0027

    Abstract : 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 and transplantation program. The program activities decreased substantially during the most critical weeks of the first COVID-19 wave, but recovered over the next weeks to return to a reasonable level. In France, there was a 28% decrease in the number of organ donations and a 22% decrease in the number of liver transplantation in 2020. In Italy, a 47% reduction in organ donation and a 44% reduction in transplantation during the first 6 weeks of the COVID-19 pandemic compared with one year before. In the United States of America, the overall reduction in deceased donor transplantations since the COVID-19 outbreak was 51.1%, with the highest percentage of reduction in kidney transplantation. The present study revealed that there is a strong association between the increase in COVID-19 infections and a striking reduction in solid organ transplantation procedures. However, further studies are necessary to follow up and validate the results of this study.

  • Review Article

    Ann Liver Transplant 2021; 1(2): 129-134

    https://doi.org/10.52604/alt.21.0022

    Abstract : SARS-CoV-2 infection has resulted in a pandemic with serious consequences for worldwide health care system. Liver transplant recipients manifest immunosuppressed status and are theoretically more vulnerable to infection, suggesting the need to modify the immunosuppressive regimens according to the patient status and the treatments used. This study intended to present the action mechanisms of immunosuppressive agents and show the balance between immunosuppressive effects and antiviral agents in relation to immunosuppressive treatment in patients with COVID-19 infection. In the absence of robust evidence to support general recommendations, experience with other viral infections suggests the benefit of management of immunosuppression without mycophenolate mofetil or mammalian target of rapamycin inhibitors. It is also important to consider the possible drug interactions, especially in the case of tacrolimus, with a few antiviral treatments in the context of COVID-19. The immunosuppressive effect of immunomodulating drugs administered to patients with severe lung disease also should be taken into account. The present study reviews the mechanisms of action of the different immunosuppressive agents, as well as their potential effect on SARS-CoV-2 infection. Guidelines for the management of immunosuppression in liver transplant recipients are suggested.

  • Original Article

    Ann Liver Transplant 2021; 1(2): 135-139

    https://doi.org/10.52604/alt.21.0026

    Abstract : 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, the total number of all deceased organ donors was 6,064 and 5,252 cases of DDLT were performed. The deceased donor and DDLT case numbers were 450 and 391, respectively, in the year 2019, and 478 and 395, respectively, in the year 2020 (p=0.284). The mean number of monthly DDLT was 32.6±5.7 in 2019 and 32.9±4.7 in 2020 (p=0.877). The case numbers of DDLT and LDLT in 2020 were 395 and 1,221, respectively. Forty-one centers performed both DDLT and LDLT, but five centers performed only DDLT and another 10 centers performed only LDLT. The five major LT centers performed 974 cases, which accounted for 60.3% of nation-wide LT volume in 2020, including 45.3% of DDLT and 65.1% of LDLT. Conclusion: The results of this study suggested that national activities of DDLT and LDLT remained stable in Korea in the year 2020, despite of the ongoing COVID-19 pandemic. Further follow-up studies are necessary to validate the results of this study.

  • How-I-Do-It

    Minimal-incision donor right hepatectomy for living donor liver transplantation

    Tae-Yong Ha , Dong-Hwan Jung , Gi-Won Song , Gil-Chun Park , Shin Hwang

    Ann Liver Transplant 2021; 1(2): 140-145

    https://doi.org/10.52604/alt.21.0023

    Abstract : 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 elongated beyond the level of the umbilicus, so a 12-cm-long right subcostal incision was made. The right liver was mobilized with gentle traction. The right hepatic parenchyma was transected according to standard procedures and liver-hanging with a Penrose drain. A 780 g-weighing right liver graft was harvested and pulled out through the skin incision. The liver graft was converted to a modified right liver graft with patch and conduit venoplasties of the outflow veins. Both the recipient and donor recovered uneventfully and have been doing well for 12 years after transplantation. We believe that MIL is a compromise option between conventional skin incision and total laparoscopic hepatectomy regarding cosmetics of the skin incision and donor safety, although it is a demanding procedure for donor surgeons.

  • How-I-Do-It

    Application of a tissue expander to stabilize graft position in liver transplantation

    Woo-Hyoung Kang , Shin Hwang , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Jung-Man Namgoong , Yong-In Yoon , Sung-Gyu Lee

    Ann Liver Transplant 2021; 1(2): 146-152

    https://doi.org/10.52604/alt.21.0024

    Abstract : A small-sized left liver graft may fall into the large right subphrenic fossa, in which such a size mismatch can result in graft hepatic vein outflow obstruction as well as excessive stretching of the reconstructed portal vein. A tissue expander (TE) was used to prevent detrimental dextro-rotation of the liver graft through obliteration of the dead space at the right subphrenic fossa. We herein present our experience regarding TE application in liver transplantation (LT). TEs of various sizes and shapes are commercially available, and the dome-shape TEs with an external connecting tube and an injection port are the most frequently used. The indications for TE application can be classified into four categories: pediatric LT cases using a living-donor or split deceased-donor left-sided liver graft, adult LT cases using a living-donor left liver graft, LT with dual-graft implantation, and unusual conditions such as a recipient with situs inversus. The underlying cause of TE application is basically identical in all four categories, but the technical details of TE application differ from each other. The timing of TE removal depends on the degree of graft regeneration and the amount of water within the TE, which is usually 1 to 3 weeks after LT. We experienced no serious adverse TE-associated complications in more than 100 cases. In conclusion, TE application is simple, safe, and effective to provide mechanical support for the liver graft, and therefore performed readily if indicated.

  • How-I-Do-It

    Technical refinement of inferior vena cava replacement using a synthetic vascular graft in living donor liver transplantation

    Deok-Bog Moon , Shin Hwang , Chul-Soo Ahn , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Young-In Yoon , Sung-Gyu Lee

    Ann Liver Transplant 2021; 1(2): 153-159

    https://doi.org/10.52604/alt.21.0025

    Abstract : The native inferior vena cava (IVC) can be resected during living donor liver transplantation (LDLT) in Budd-Chiari syndrome or advanced hepatocellular carcinoma (HCC). The present study aimed to present the technical details of IVC replacement with synthetic vascular graft interposition. Following laparotomy, the recipient liver was mobilized to expose the IVC. Piggyback or classical total hepatectomy including IVC was performed. In patients with Budd-Chiari syndrome, atrio-caval anastomosis with a vascular graft is necessary, in which clamp slippage should be completely prevented. No-touch en bloc isolation of the native liver is necessary for patients with advanced HCC. The wall of a large-caliber vascular graft is pleated to prevent luminal collapse, suggesting the need for tension to stretch it. The length of a vascular graft should be adjusted meticulously. An adequately interposed vascular graft appears to be rather short under IVC cross-clamping, but elongated and expanded after restoration of the IVC flow. A single right or left liver graft, or even dual-graft can be implanted to the interposed IVC vascular graft. An elliptical excision of the graft wall is mandatory for graft hepatic vein implantation, because an incision at the graft does not expand. In conclusion, IVC replacement with interposition of a synthetic vascular graft expands the indications for LDLT, particularly in patients with Budd-Chiari syndrome and advanced HCC, similar to those of deceased donor liver transplantation.

  • How-I-Do-It

    Wedged-patch venoplasty for graft left portal vein in pediatric living donor liver transplantation

    Jung-Man Namgoong1 , Shin Hwang1 , Tae-Yong Ha1 , Hyunhee Kwon1 , Kyung Mo Kim2 , Seak Hee Oh2

    Ann Liver Transplant 2021; 1(2): 160-164

    https://doi.org/10.52604/alt.21.0020

    Abstract : Portal vein (PV)-size matching is important in preventing anastomotic stenosis in liver transplantation (LT) using a partial liver graft. Reconstruction of small graft PV with size-unmatched recipient PV is challenging, thus we present our surgical technique of wedged-patch venoplasty to enlarge the diameter of graft PV for size-matched reconstruction. On computational simulation, a longitudinal incision was made at the graft PV stump and then a small triangular homograft vein patch was attached. Our simulation showed that a 5-mm incision combined with patch venoplasty could make the diameter of graft PV 30%–50% larger than the native size. We applied this technique to two pediatric patients. The first case was a 4-year-old female patient who underwent second LT because of progressive deterioration of graft function. At the first LDLT operation for biliary atresia, an iliac vein conduit was interposed for PV reconstruction. At the second LT operation, the diameter of interposed PV was 10 mm, but the left liver graft PV was only 7 mm in diameter because of congenital waist. The second case was an 8-year-old female patient who underwent split LT because of intractable recurrent cholangitis following resection of choledochal cyst. The graft PV was small because of type III PV anomaly of the donor liver. We performed wedged venoplasty using an iliac vein homograft patch in these two cases, and no PV complication occurred. In conclusion, our wedged patch venoplasty technique can be applied to small graft PV to cope with PV-size mismatching in LT using a partial liver graft.

  • Case Report

    Emergency living donor liver transplantation under extracorporeal membrane oxygenation in an infant with biliary atresia-polysplenia syndrome

    Jung-Man Namgoong1 , Shin Hwang1 , Gil-Chun Park1 , Hyunhee Kwon1 , Kyung Mo Kim2 , Seak Hee Oh2

    Ann Liver Transplant 2021; 1(2): 165-173

    https://doi.org/10.52604/alt.21.0021

    Abstract : Biliary atresia-polysplenia syndrome (BAPS) is diagnosed in a small number of patients with biliary atresia (BA). We present a case of emergency living donor liver transplantation (LT) successfully performed in an infant with BAPS undergoing extracorporeal membrane oxygenation. The recipient was a 10-month-old boy who did not undergo Kasai portoenterostomy due to rapid progression of liver cirrhosis. Co-existing malformations included heterotopic inferior vena cava without hepatic communication, direct hepatic vein drainage into the right atrium, polysplenia, intestinal malrotation, truncated pancreas, and preduodenal portal vein and annular pancreas. Patient condition deteriorated rapidly after pulmonary hemorrhage, and thus emergency living donor LT was performed after starting veno-venous extracorporeal membrane oxygenation (ECMO) with a pediatric end-stage liver disease score of 32. A left lateral section graft obtained from his father showed a graft-to-recipient weight ratio of 3.2%. The recipient surgery was performed according to standard procedures of pediatric LT. The graft hepatic vein was directly anastomosed with the suprahepatic confluence of the recipient hepatic veins. An external iliac vein homograft was interposed for portal vein reconstruction. Multiple portal collateral veins were ligated and intraoperative portography was performed to secure portal vein inflow. The patient was weaned off ECMO and ventilator were weaned off on 17 days and 65 days respectively after transplantation. The patient stayed at the intensive care unit for 3 months before and after transplantation. Our pediatric patient with BAPS manifested various anatomical malformations. Successful LT requires comprehensive preoperative and intraoperative assessment of these anomalies, adoption of customized reconstruction techniques of LT, and careful posttransplant monitoring.

  • Case Report

    Ann Liver Transplant 2021; 1(2): 174-179

    https://doi.org/10.52604/alt.21.0028

    Abstract : Radiological intervention via percutaneous transhepatic biliary drainage and endoscopic intervention via endoscopic retrograde cholangiopancreatography are the preferred methods to treat liver transplantation (LT)-associated benign biliary stricture (BBS). Magnetic compression anastomosis (MCA) can be applied to reconstruct a refractory or completely obstructing BBS that cannot be resolved with conventional methods. The MCA procedure is divided into four steps: tract formation for magnet delivery, approximation of magnets, removal of the approximated magnets, and maintenance and removal of the internal catheter. We present a patient with BBS, following dual-graft living-donor LT, which was successfully recanalized via MCA with detailed review of technical procedures. In the present case, MCA facilitated the passing of the guidewire through the completely occluded BBS for conventional treatment via long-term endobiliary stenting. MCA is a nonsurgical alternative for treating severe or completely obstructing BBSs that are refractory to conventional endoscopic or percutaneous treatment methods.

  • Case Report

    Portal vein interposition in living donor liver transplantation for a pediatric hepatoblastoma patient with portal vein tumor thrombosis

    Jung-Man Namgoong1 , Shin Hwang1 , Gil-Chun Park1 , Hyunhee Kwon1 , Suhyeon Ha1 , Kyung Mo Kim2 , Seak Hee Oh2

    Ann Liver Transplant 2021; 1(2): 180-186

    https://doi.org/10.52604/alt.21.0030

    Abstract : Liver transplantation is accepted as an effective therapeutic option for unresectable hepatoblastoma. We present a pediatric case of hepatoblastoma patient with portal vein tumor thrombosis (PVTT) that occluded the main portal vein completely despite neoadjuvant chemotherapy. The patient was a 36-month-old 17-kg girl suffering from hepatoblastoma with PVTT, which was partially regressed by neoadjuvant chemotherapy. Viable PVTT remained after left hepatectomy and repetition of systemic chemotherapy due to partial treatment response. To remove the tumor completely, we performed living donor liver transplantation using her mother’s left lateral section graft. The blood flow from the native portal vein was greater than that from the pericholedochal collaterals, thus we used the native portal vein as the source of portal inflow. A cold-stored fresh external iliac vein homograft was anastomosed to the portal vein stump. Graft implantation was performed using standard procedures of pediatric liver transplantation. The patient recovered uneventfully. She has been undergoing scheduled adjuvant chemotherapy to date. Meticulous design for portal vein reconstruction using interposition vein graft with the remaining splanchnic vein stumps resulted in successful portal vein reconstruction with complete removal of PVTT.

  • Case Report

    Ann Liver Transplant 2021; 1(2): 187-193

    https://doi.org/10.52604/alt.21.0019

    Abstract : De novo malignancy sporadically occurs in patients who undergo liver transplantation. We present a case of a 74-year-old patient who underwent pancreaticoduodenectomy (PD) for de novo ampulla of Vater cancer at 15 years after living donor liver transplantation (LDLT) for hepatitis B virus-associated liver cirrhosis. At 15 years after LDLT, elevation of liver enzyme levels led to diagnosis of de novo ampulla of Vater mass. We performed pylorus-resecting PD with extended pancreatic transection. Roux-en-Y choledochojejunostomy was performed to the remnant recipient-side proximal bile duct because active back bleeding from the bile duct stump was identified. The patient recovered uneventfully without complications. The surgical specimen showed a 2 cm-sized moderately differentiated adenocarcinoma arising from a tubular adenoma of the intestinal subtype at the ampulla of Vater. The extent of the tumor was pT1bN0M0, thus being stage IB. Adjuvant chemotherapy was not performed. The patient has been doing well for 3 months. The immunosuppressive regimen was switched from mycophenolate mofetil monotherapy to everolimus monotherapy. Our experience with this case suggests that PD can be eligibly performed after LDLT using duct-to-duct anastomosis.

  • Case Report

    Ann Liver Transplant 2021; 1(2): 194-201

    https://doi.org/10.52604/alt.21.0017

    Abstract : Hepatocellular carcinoma (HCC) during pregnancy is very rare and reported to be associated with inferior prognosis. We herein present a case of a patient who was diagnosed with HCC at the age of 26 years during pregnancy. The patient was infected with hepatitis B virus through vertical transmission. After full-term vaginal delivery, the patient underwent transarterial chemoembolization (TACE) twice and right hepatectomy consecutively. One year later, TACE was repeated and second hepatectomy was performed. Four years later, TACE was repeated and third hepatectomy was performed. Two years later, TACE was repeated and fourth hepatectomy was performed. Two years later, HCC recurred around the left hepatic duct and external beam radiotherapy was performed. Subsequently, biliary stenosis occurred, thus endoscopic retrograde biliary drainage tube was inserted. One year later, her liver function deteriorated with tumor progression and portal vein occlusion. The patient underwent deceased donor liver transplantation using an HBsAg-positive whole liver graft. At posttransplant 6 months, pulmonary metastasis occurred, which was managed with pulmonary metastasectomy twice and radiotherapy. The patient passed away 20 months after transplantation because of HCC progression. The patient had suffered from HCC for 15 years, in which she underwent hepatectomy four times, TACE 10 times, liver transplantation, pulmonary metastasectomy twice, and radiotherapy three times. The patient demonstrated unusual long-term intractable course of HCC recurrence refractory to various locoregional treatments.

  • Case Report

    Fatal systemic herpes simplex virus infection with atypical clinical manifestation early after living donor liver transplantation

    Hye-Sung Jo1 , Pyoung-Jae Park2 , Wan-Joon Kim3 , Hyung Joon Han4 , Young-Dong Yu1 , Dong-Sik Kim1

    Ann Liver Transplant 2021; 1(2): 202-206

    https://doi.org/10.52604/alt.21.0029

    Abstract : Herpes simplex virus (HSV) infection in immunocompromised hosts after liver transplantation could cause visceral dissemination and fatal outcomes. Here, we report a fatal systemic HSV infection with atypical clinical presentation early after living donor liver transplantation. A 45-year-old female patient with chronic alcoholic liver cirrhosis underwent living donor liver transplantation using a left liver graft. The patient was clinically stable, and her liver function was recovering without any problems until postoperative day 12. However, mild erythematous erosive patches developed on both palms and soles. Although various topical steroids were applied and antihistamines were administered, the skin lesions gradually spread to the trunk and worsened with severe pain. Several days after the onset of skin lesions, aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels increased rapidly without specific findings on the CT scan. Therefore, we decided to perform skin and liver biopsies. The patient rapidly deteriorated and was transferred to the intensive care unit while awaiting the biopsy results. The biopsies showed very distinctive features compatible with HSV infection. The HSV IgG assay before liver transplantation was positive. Although we administered high-dose intravenous acyclovir immediately after the pathologic diagnosis, the patient died of severe septic shock on postoperative day 28. The possibility of HSV infection should be considered when atypical skin lesions occurring early after liver transplantation do not respond to antihistamines and steroids. An early diagnosis and the prompt administration of antiviral agents could prevent the fatal dissemination of an HSV infection in liver transplantation recipients.

The Korean Liver Transplantation Society

Vol.1 No.2
November, 2021

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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