23 results on '"Sin SL"'
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2. High prevalence of de novo metabolic dysfunction-associated fatty liver disease after liver transplantation and the role of controlled attenuation parameter.
- Author
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Mak LY, Chan AC, Wong TC, Dai WC, She WH, Ma KW, Sin SL, Chu KW, Seto WK, Yuen MF, Lo CM, and Fung J
- Subjects
- Humans, Prevalence, Cholesterol, HDL, Non-alcoholic Fatty Liver Disease diagnostic imaging, Non-alcoholic Fatty Liver Disease epidemiology, Liver Transplantation adverse effects, Elasticity Imaging Techniques
- Abstract
Background & Aims: Although non-alcoholic fatty liver disease (NAFLD) remains an uncommon indication for liver transplantation (LT) in the Chinese, the prevalence of NAFLD is increasing. We aimed to determine the prevalence of de novo steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) after LT., Methods: Transient elastography assessment for liver stiffness and controlled attenuation parameter (CAP) were performed after LT in 549 patients at median time of 77 months from LT. CAP was compared with implant liver biopsy, and also validated in 42 patients with post-LT liver biopsy. Longitudinal history including diabetes mellitus (DM), dyslipidemia, hypertension, and immunosuppressive regimen were recorded., Results: The optimal cut-off level of CAP for diagnosing at least mild (≥ S1) and moderate-to-severe steatosis (≥ S2/3) was 266 and 293 dB/m respectively, with AUROC of 0.740 and 0.954 respectively. Using this newly derived cut-off, 28.9% patients have de novo NAFLD, of which 95.6% fulfilled the criteria for MAFLD. After multivariate analysis, BMI (HR 1.34), DM (HR 2.01), hypertension (HR 2.03), HDL-cholesterol (HR 0.25), LDL-cholesterol (HR 1.5) and cryptogenic cirrhosis (HR 4.85) were associated with the development of S2/3 graft steatosis. de novo NAFLD was associated with higher incidence of new-onset hypertension (p < 0.001), graft dysfunction (defined as ALT > 40 U/L; p = 0.008), but not associated with graft fibrosis (defined as liver stiffness > 12 kPa; p = 0.761)., Conclusion: Although NAFLD remains an uncommon primary liver disease indication for LT in Chinese patients, post-transplant de novo graft steatosis is common and the majority is classified as MAFLD. Development of graft steatosis is not associated with an increase in graft fibrosis but was associated with worse metabolic control and graft dysfunction. Routine CAP measurement to detect de novo graft steatosis should be considered after LT regardless of the primary indication of LT., (© 2023. BioMed Central Ltd., part of Springer Nature.)
- Published
- 2023
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3. Impact of Time to Recurrence on Survival Outcome of Salvage Liver Transplantation.
- Author
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Wong PC, She WH, Ma KW, Sin SL, Wong TCL, Dai WC, Cheung TT, Chan ACY, and Lo CM
- Subjects
- Disease-Free Survival, Hepatectomy adverse effects, Humans, Neoplasm Recurrence, Local pathology, Retrospective Studies, Salvage Therapy adverse effects, Treatment Outcome, Carcinoma, Hepatocellular pathology, Liver Neoplasms pathology, Liver Transplantation adverse effects
- Abstract
Background: Salvage liver transplantation (SLT) is the ideal treatment for patients with recurrent hepatocellular carcinoma (HCC) and liver cirrhosis. The optimal timing for offering SLT was controversial. This study aimed at investigating the impact of time to recurrence and other prognostic factors on survival outcome after SLT., Methods: Between May 2000 and April 2019, patients who had undergone hepatectomy or ablation for HCC and later received SLT in Queen Mary Hospital were included. Clinico-pathological data during primary treatment and SLT were retrospectively reviewed. Kaplan-Meier analysis and log-rank test were used to determine overall and disease-free survival after SLT. Prognostic factors affecting overall and disease-free survival were determined by multivariate analysis using Cox regression analysis. P-value of less than 0.05 was considered statistically significant., Results: Fifty-three patients were identified within the specified period including 22 patients in early recurrence group (ER group, time to recurrence within 1 year) and 31 patients in late recurrence group (LR group, time to recurrence more than 1 year). The 1-, 5-, and 10-year overall survival after primary treatment was 100%, 76.6%, and 61.1% in the ER group and 100%, 90%, and 76.4% in the LR group (p = 0.59). There were no statistical differences in overall survival (p = 0.84) and disease-free survival (p = 0.85) after SLT between ER and LR group. Pre-transplant alpha-fetoprotein > = 400 ng/mL (p = 0.007) and macrovascular invasion in explant (p = 0.002) were independent risk factors for shorter overall survival after primary treatment., Conclusion: Time to recurrence after primary treatment of HCC did not affect survival outcome after SLT. With careful patient selection, SLT could be offered to patient with early or late tumor recurrence., (© 2021. The Society for Surgery of the Alimentary Tract.)
- Published
- 2022
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4. The Risk of Going Small: Lowering GRWR and Overcoming Small-For-Size Syndrome in Adult Living Donor Liver Transplantation.
- Author
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Wong TC, Fung JYY, Cui TYS, Sin SL, Ma KW, She BWH, Chan ACY, Chok KSH, Dai JWC, Cheung TT, and Lo CM
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Liver surgery, Liver Transplantation methods, Male, Middle Aged, Organ Size, Retrospective Studies, Young Adult, End Stage Liver Disease surgery, Liver anatomy & histology, Liver Transplantation adverse effects, Living Donors, Transplant Recipients
- Abstract
Objective: The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR)., Background: The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients., Methods: Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%
0.8%)., Results: There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare.There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis., Conclusions: Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.) - Published
- 2021
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5. Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End-Stage Liver Disease and Hepatorenal Syndrome.
- Author
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Wong TC, Fung JY, Pang HH, Leung CK, Li HF, Sin SL, Ma KW, She BW, Dai JW, Chan AC, Cheung TT, and Lo CM
- Subjects
- China epidemiology, Female, Health Services Accessibility organization & administration, Health Services Accessibility statistics & numerical data, Humans, Intention to Treat Analysis, Kidney Function Tests methods, Kidney Function Tests statistics & numerical data, Male, Middle Aged, Perioperative Period adverse effects, Recovery of Function, Retrospective Studies, Risk Assessment, Survival Analysis, Waiting Lists mortality, End Stage Liver Disease epidemiology, End Stage Liver Disease surgery, Hepatorenal Syndrome epidemiology, Hepatorenal Syndrome surgery, Liver Transplantation adverse effects, Liver Transplantation methods, Liver Transplantation mortality, Living Donors statistics & numerical data
- Abstract
Background and Aims: Previous recommendations suggested living donor liver transplantation (LDLT) should not be considered for patients with Model for End-Stage Liver Disease (MELD) > 25 and hepatorenal syndrome (HRS)., Approach and Results: Patients who were listed with MELD > 25 from 2008 to 2017 were analyzed with intention-to-treat (ITT) basis retrospectively. Patients who had a potential live donor were analyzed as ITT-LDLT, whereas those who had none belonged to ITT-deceased donor liver transplantation (DDLT) group. ITT-overall survival (OS) was analyzed from the time of listing. Three hundred twenty-five patients were listed (ITT-LDLT n = 212, ITT-DDLT n = 113). The risk of delist/death was lower in the ITT-LDLT group (43.4% vs. 19.8%, P < 0.001), whereas the transplant rate was higher in the ITT-LDLT group (78.3% vs. 52.2%, P < 0.001). The 5-year ITT-OS was superior in the ITT-LDLT group (72.6% vs. 49.5%, P < 0.001) for patients with MELD > 25 and patients with both MELD > 25 and HRS (56% vs. 33.8%, P < 0.001). Waitlist mortality was the highest early after listing, and the distinct alteration of slope at survival curve showed that the benefits of ITT-LDLT occurred within the first month after listing. Perioperative outcomes and 5-year patient survival were comparable for patients with MELD > 25 (88% vs. 85.4%, P = 0.279) and patients with both MELD > 25 and HRS (77% vs. 76.4%, P = 0.701) after LDLT and DDLT, respectively. The LDLT group has a higher rate of renal recovery by 1 month (77.4% vs. 59.1%, P = 0.003) and 3 months (86.1% vs, 74.5%, P = 0.029), whereas the long-term estimated glomerular filtration rate (eGFR) was similar between the 2 groups. ITT-LDLT reduced the hazard of mortality (hazard ratio = 0.387-0.552) across all MELD strata., Conclusions: The ITT-LDLT reduced waitlist mortality and allowed an earlier access to transplant. LDLT in patients with high MELD/HRS was feasible, and they had similar perioperative outcomes and better renal recovery, whereas the long-term survival and eGFR were comparable with DDLT. LDLT should be considered for patients with high MELD/HRS, and the application of LDLT should not be restricted with a MELD cutoff., (© 2020 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)
- Published
- 2021
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6. The 'Unsigned highway': An alternative route for portal vein anastomosis for non-malignant portal vein thrombosis during pediatric re-transplantation.
- Author
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Chan ACY, Dai WC, Chung PHY, She WH, and Sin SL
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- Anastomosis, Surgical, Child, Humans, Portal Vein diagnostic imaging, Portal Vein surgery, Liver Diseases, Venous Thrombosis diagnostic imaging, Venous Thrombosis etiology, Venous Thrombosis surgery
- Published
- 2021
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7. Tailoring the Venous Outflow for a Modified Right Posterior Section Graft in Living Donor Liver Transplantation.
- Author
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Chan ACY, Dai J, She B, Sin SL, Chu K, and Kotewall N
- Subjects
- Hepatic Veins diagnostic imaging, Hepatic Veins surgery, Humans, Liver diagnostic imaging, Liver surgery, Living Donors, Liver Transplantation adverse effects
- Published
- 2021
- Full Text
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8. Trends in Liver Transplantation for Chronic Hepatitis B in an Era of Highly Potent Antiviral Therapies.
- Author
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Fung J, Mak LY, Chan A, Wong T, Dai WC, Sin SL, She WH, Chu KW, Ma KW, Cheung TT, Seto WK, Yuen MF, and Lo CM
- Subjects
- Antiviral Agents therapeutic use, Hepatitis B virus, Humans, Lamivudine therapeutic use, Treatment Outcome, Hepatitis B, Hepatitis B, Chronic drug therapy, Liver Transplantation adverse effects
- Published
- 2021
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9. Model for End-Stage Liver Disease With Additional Criteria to Predict Short-Term Mortality in Severe Flares of Chronic Hepatitis B.
- Author
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Fung J, Mak LY, Chan AC, Chok KS, Wong TC, Cheung TT, Dai WC, Sin SL, She WH, Ma KW, Seto WK, Lai CL, Lo CM, and Yuen MF
- Subjects
- Antiviral Agents therapeutic use, Female, Guanine therapeutic use, Hong Kong epidemiology, Humans, Male, Middle Aged, Patient Selection, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Severity of Illness Index, Acute-On-Chronic Liver Failure diagnosis, Acute-On-Chronic Liver Failure mortality, End Stage Liver Disease diagnosis, End Stage Liver Disease etiology, End Stage Liver Disease mortality, Guanine analogs & derivatives, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic drug therapy, Hepatitis B, Chronic epidemiology, Hepatitis B, Chronic physiopathology, Liver Function Tests methods, Tenofovir therapeutic use
- Abstract
Background and Aims: The prognosis in severe acute flares of chronic hepatitis B (AFOCHB) is often unclear. The current study aimed to establish the predictive value using the Model for End-Stage Liver Disease (MELD) score for short-term mortality for severe AFOCHB., Approach and Results: Patients with severe AFOCHB with bilirubin > 50 µmol/L, alanine aminotransferase > 10× upper limit of normal, and international normalized ratio > 1.5 were included. All patients were commenced on entecavir and/or tenofovir. Laboratory results and MELD scores were pooled to calculate mortality at four time points (days 7, 14, 21, and 28). A total of 240 patients were included. Median hepatitis B virus DNA was 7.77 log IU/mL (range, 4.11-10.06), and 49 (20.4%) were hepatitis B e antigen-positive. The 7, 14, 21, and 28-day survival was 96.7%, 88.5%, 79.5%, and 72.8%, respectively. Using pooled results derived from 4,201 blood samples, the area under the receiver operating curve for the MELD score to predict day 7, 14, 21, and 28 mortality was 0.909, 0.892, 0.883, and 0.871, respectively. For MELD ≤ 28, mortality at day 28 was low (<25%) compared with > 50% mortality for MELD ≥ 32. For MELD = 28-32, higher day-28 mortality was observed for four criteria: age ≥52 years, alanine aminotransferase > 217 U/L, platelets < 127, and abnormal baseline imaging (all P < 0.001). In this MELD bracket, the 28-day mortality was 0%, 12.1%, 23.8%, 59.4%, and 78.8% for the presence of zero, one, two, three, and four criteria, respectively., Conclusions: MELD score at any time points can accurately predict the short-term mortality. Patients with MELD ≥ 28 should be worked up for liver transplantation, and those with MELD = 28-32 with three to four at-risk criteria, or MELD ≥ 32 should be listed., (© 2020 by the American Association for the Study of Liver Diseases.)
- Published
- 2020
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10. Donor ductal anomaly is not a contraindication to right liver lobe donation.
- Author
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Chok KS, Fung JY, Dai WC, Sin SL, Ma KW, Chan AC, Cheung TT, and Lo CM
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- Adolescent, Adult, Aged, Bile Ducts diagnostic imaging, Child, Cholestasis etiology, Contraindications, Procedure, Female, Graft Survival, Humans, Liver Transplantation adverse effects, Male, Middle Aged, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Young Adult, Bile Ducts abnormalities, Donor Selection, Liver Transplantation methods, Living Donors
- Abstract
Background: Data of living-donor liver transplantation (LDLT) suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in donors. This retrospective study aimed to determine if the occurrence of postoperative biliary stricture in donors or recipients in right-lobe LDLT (RLDLT) is related to donor biliary anatomy type., Methods: We analyzed our RLDLT recipients' clinical data and those of their graft donors. The recipients were divided into 2 groups: with and without postoperative biliary stricture. The 2 groups were compared. The primary endpoints were donor biliary anatomy type and postoperative biliary complication incidence; the secondary endpoints were 1-, 3- and 5-year graft and patient survival rates., Results: Totally 127 patients were included in the study; 25 (19.7%) of them developed biliary anastomotic stricture. In these 25 patients, 16 had type A biliary anatomy, 3 had type B, 2 had type C, 3 had type D, and 1 had type E. In the 127 donors, 96 (75.6%) had type A biliary anatomy, 13 (10.2%) had type B, 6 (4.7%) had type C, 10 (7.9%) had type D, and 2 (1.6%) had type E. Biliary stricture was seen in 2 donors, who had type A biliary anatomy. None of the recipients or donors developed bile leakage. No association between the occurrence of postoperative biliary stricture and donor biliary anatomy type was found (P = 0.527)., Conclusions: The incidence of biliary stricture in donors or recipients after RLDLT was not related to donor biliary anatomy type. As postoperative complications were similar in whatever type of donor bile duct anatomy, donor ductal anomaly should not be considered a contraindication to donation of right liver lobe., (Copyright © 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
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11. Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report.
- Author
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She WH, Chok KSH, Li IWS, Ma KW, Sin SL, Dai WC, Fung JYY, and Lo CM
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- Aged, Antibiotic Prophylaxis, Female, Humans, Immunosuppressive Agents therapeutic use, Mediastinal Emphysema diagnostic imaging, Mediastinal Emphysema drug therapy, Pneumonia, Pneumocystis drug therapy, Subcutaneous Emphysema diagnostic imaging, Subcutaneous Emphysema microbiology, Tomography, X-Ray Computed, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Liver Transplantation adverse effects, Mediastinal Emphysema microbiology, Pneumocystis carinii pathogenicity, Pneumonia, Pneumocystis microbiology, Pneumothorax microbiology
- Abstract
Background: Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4-4%., Case Presentation: A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge., Conclusion: Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.
- Published
- 2019
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12. An Innovative Rescue Surgical Procedure for Early Onset Hepatic Venous Outflow Obstruction After Pediatric Living Donor Liver Transplantation.
- Author
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Chung PHY, Ng KKC, Wong TCL, Sin SL, and Lo CM
- Subjects
- Anastomosis, Surgical methods, Budd-Chiari Syndrome etiology, Female, Hepatic Veins surgery, Humans, Infant, Living Donors, Postoperative Complications etiology, Treatment Outcome, Vena Cava, Inferior surgery, Biliary Atresia surgery, Budd-Chiari Syndrome surgery, Liver Transplantation adverse effects, Postoperative Complications surgery
- Published
- 2018
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13. Partial portal vein arterialization using right gastroepiploic artery: A novel solution for portal hypoperfusion.
- Author
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Au KP, Chok KSH, Sin SL, Fung JYY, Lo CM, and Mok VWK
- Subjects
- Adult, Blood Flow Velocity, Humans, Liver Cirrhosis, Alcoholic surgery, Male, Portal Vein diagnostic imaging, Arteriovenous Shunt, Surgical, Gastroepiploic Artery surgery, Liver Transplantation adverse effects, Portal Vein physiopathology, Portal Vein surgery
- Published
- 2018
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14. Impact of intraoperative blood transfusion on long-term outcomes of liver transplantation for hepatocellular carcinoma.
- Author
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Dai WC, Chok KSH, Sin SL, Chan ACY, Cheung TT, Wong TCL, and Lo CM
- Subjects
- Adult, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Disease-Free Survival, Female, Humans, Liver Neoplasms, Male, Middle Aged, Retrospective Studies, Survival Rate, Treatment Outcome, Blood Transfusion, Carcinoma, Hepatocellular surgery, Intraoperative Care, Liver Transplantation adverse effects, Postoperative Complications epidemiology
- Abstract
Objective: To investigate the impact of intraoperative blood transfusion on the long-term outcomes of liver transplantation for hepatocellular carcinoma., Method: Adult patients who had non-salvage liver transplantation at our centre between January 2005 and December 2012 for hepatocellular carcinomas that were within the University of California, San Francisco criteria and could not be resected or ablated were divided into groups with and without intraoperative blood transfusion. Comparisons were made between groups., Results: Ninety-nine patients were included in the study. Sixty-two (62.6%) patients received intraoperative blood transfusion. Patients without transfusion were younger (54 versus 56 years; P = 0.04) and had a lower Model for End-stage Liver Disease score (11 versus 14; P < 0.001). Most of them had stage-I tumours (64.9 versus 37.1%; P = 0.007) and fewer of them had postoperative complications of grade IIIA or above in the Clavien-Dindo classification (21.6 versus 48.4%; P = 0.008). The groups were comparable in hospital mortality (3.2 versus 2.7%; P = 1.00), 5-year overall survival (90.8 versus 89.2%; P = 0.611) and 5-year disease-free survival (90.5 versus 89.2%; P = 0.835). On multivariate analysis, postoperative complications of grade IIIA or above were associated with worse survival (hazard ratio, 7.108; 95% confidence interval, 1.455-34.712; P = 0.015)., Conclusion: Intraoperative blood transfusion was shown to have no significant impact on the long-term outcomes of liver transplantation for hepatocellular carcinoma, whereas postoperative complications of grade IIIA or above were associated with worse recipient survival., (© 2016 Royal Australasian College of Surgeons.)
- Published
- 2018
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15. Oral Nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B With Preexisting rt204 Mutation.
- Author
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Fung J, Wong T, Chok K, Chan A, Sin SL, Cheung TT, Dai WC, Ng K, Ng K, Man K, Seto WK, Lai CL, Yuen MF, and Lo CM
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- Administration, Oral, Adult, Aged, Antiviral Agents adverse effects, DNA, Viral genetics, Drug Administration Schedule, End Stage Liver Disease diagnosis, End Stage Liver Disease mortality, End Stage Liver Disease virology, Female, Genotype, Graft Survival drug effects, Hepatitis B virus genetics, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic mortality, Hepatitis B, Chronic virology, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Nucleosides adverse effects, Nucleotides adverse effects, Recurrence, Risk Factors, Time Factors, Treatment Outcome, Viral Load, Virus Activation drug effects, Antiviral Agents administration & dosage, Drug Resistance, Viral genetics, End Stage Liver Disease surgery, Hepatitis B virus drug effects, Hepatitis B, Chronic drug therapy, Lamivudine administration & dosage, Liver Transplantation adverse effects, Liver Transplantation mortality, Mutation, Nucleosides administration & dosage, Nucleotides administration & dosage
- Abstract
Background: There is currently limited data regarding the use of oral antiviral therapy alone without hepatitis B immune globulin for chronic hepatitis B patients with preexisting lamivudine (LAM) resistance (LAM-R) undergoing liver transplantation., Methods: This is a cohort study determining the effectiveness and long-term outcome in this group of patients., Results: Fifty-seven consecutive chronic hepatitis B patients with preexisting rt204 LAM-R mutations or virological load refractory to LAM undergoing liver transplantation were included, with a median follow-up of 73 months. Fifty-five (96.5%) patients received a regimen that included the use of nucleotide analogs. The cumulative rate of hepatitis B surface antigen seroclearance at 1, 5, and 10 years was 82%, 88%, and 91%, respectively. At the time of transplantation, 39 (72%) patients had detectable hepatitis B virus (HBV) DNA, with a median of 4.5 log copies/mL. The cumulative rate of HBV undetectability was 91% at 1 year, increasing to 100% by 5 years. After 1 year of liver transplantation, over 90% of the patients had undetectable HBV DNA, and from 8 years onward, 100% had undetectable HBV DNA. The overall long-term survival was excellent, with a 12-year survival of 87%. There was no HBV-related graft loss, and no retransplantation or deaths due to HBV reactivation., Conclusion: Oral antiviral therapy alone without hepatitis B immune globulin is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting LAM resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation.
- Published
- 2017
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16. Long-term outcomes of entecavir monotherapy for chronic hepatitis B after liver transplantation: Results up to 8 years.
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Fung J, Wong T, Chok K, Chan A, Cheung TT, Dai JW, Sin SL, Ma KW, Ng K, Ng KT, Seto WK, Lai CL, Yuen MF, and Lo CM
- Subjects
- Adult, Aged, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular virology, Female, Guanine therapeutic use, Hepatitis B Surface Antigens blood, Hepatitis B, Chronic mortality, Hepatitis B, Chronic virology, Hong Kong epidemiology, Humans, Liver Neoplasms epidemiology, Liver Neoplasms surgery, Liver Neoplasms virology, Liver Transplantation, Male, Middle Aged, Postoperative Complications mortality, Postoperative Complications virology, Recurrence, Retrospective Studies, Treatment Outcome, Viral Load, Young Adult, Antiviral Agents therapeutic use, Guanine analogs & derivatives, Hepatitis B, Chronic drug therapy, Neoplasm Recurrence, Local epidemiology, Postoperative Complications drug therapy
- Abstract
Long-term antiviral prophylaxis is required to prevent hepatitis B recurrence for patients with chronic hepatitis B after liver transplantation. We determined the long-term outcome of 265 consecutive chronic hepatitis B liver transplant recipients treated with entecavir monotherapy without hepatitis B immune globulin. Viral serology, viral load, and liver biochemistry were performed at regular intervals during follow-up. The median duration of follow-up was 59 months. The cumulative rates of hepatitis B surface antigen (HBsAg) seroclearance were 90% and 95% at 1 and 5 years, respectively. At 1, 3, 5, and 8 years, 85%, 88%, 87.0%, and 92% were negative for HBsAg, respectively, and 95%, 99%, 100%, and 100% had undetectable hepatitis B virus (HBV) DNA, respectively. Fourteen patients remained persistently positive for HBsAg, all of whom had undetectable HBV DNA. There was no significant difference in liver stiffness for those who remained HBsAg-positive compared to those who achieved HBsAg seroclearance (5.5 versus 5.2 kPa, respectively; P = 0.52). The overall 9-year survival was 85%. There were 37 deaths during the follow-up period, of which none were due to hepatitis B recurrence., Conclusion: Long-term entecavir monotherapy is highly effective at preventing HBV reactivation after liver transplantation for chronic hepatitis B, with a durable HBsAg seroclearance rate of 92%, an undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years. (Hepatology 2017;66:1036-1044)., (© 2017 by the American Association for the Study of Liver Diseases.)
- Published
- 2017
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17. Lipid profiles of donors and recipients of liver transplant: like father like son.
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Chu KKW, Chan SC, Sin SL, Chan ACY, Chok KSH, Cheng IKP, and Lo CM
- Subjects
- Adolescent, Adult, Aged, Blood Glucose analysis, Body Mass Index, Child, Child, Preschool, Dyslipidemias chemically induced, Dyslipidemias epidemiology, Fasting blood, Fathers, Female, Humans, Immunosuppressive Agents adverse effects, Liver Transplantation trends, Male, Middle Aged, Predictive Value of Tests, Prevalence, Prospective Studies, Retrospective Studies, Tissue Donors, Transplant Recipients, Triglycerides blood, Young Adult, Dyslipidemias complications, Lipids blood, Lipoproteins, HDL analysis, Liver Transplantation statistics & numerical data, Living Donors statistics & numerical data
- Abstract
Background/purpose: Dyslipidemia is common in liver transplant recipients. This retrospective study investigates whether donors play a role., Methods: Prospectively collected data of donors and recipients of deceased-donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT) were reviewed. Total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein (HDL) and fasting glucose were compared between groups. HDL ≥1.6 mmol/L at 2 years after transplant was considered the marker of a favorable post-transplant lipid profile in recipients. Univariate and multivariate analyses were performed to identify predictive factors for this marker., Results: There were 85 DDLTs and 80 LDLTs. LDLT donors were younger (30 vs. 50 years, p < 0.001) and lighter (58.2 vs. 63.4 kg, p = 0.008) and had a lower body mass index (21.2 vs. 23.7, p < 0.001). The DDLT group had more fatty grafts (p = 0.001) and longer cold (375 vs. 103.5 min, p < 0.001) and warm (50.5 vs. 46 min, p = 0.034) ischemia. LDLT donors had lower fasting glucose (4.85 vs. 7.21 mmol/L, p < 0.001) and triglyceride (0.87 vs. 1.22 mmol/L, p = 0.016) but higher HDL (1.58 vs. 1.39 mmol/L, p = 0.022). LDLT recipients also had higher HDL at 1 year (1.48 vs. 1.28 mmol/L, p = 0.026) and 2 years (1.43 vs. 1.21 mmol/L, p = 0.008). Fourteen (16.5%) DDLT recipients and 27 (33.8%) LDLT recipients had HDL ≥1.6 mmol/L at 2 years. On multivariate analysis, donor HDL ≥1.6 mmol/L (RR 4.311, 95% CI 1.666-11.158, p = 0.003) and recipient body mass index <24 (RR 2.753, 95% CI 1.064-7.127, p = 0.037) were the two independent predictive factors., Conclusion: LDLT recipients had better lipid profiles than DDLT recipients. The feature of high HDL level in donors was transferred to recipients.
- Published
- 2017
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18. Liver transplantation: a life-saving procedure following amatoxin mushroom poisoning.
- Author
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Ma KW, Chok KS, Chan CK, Dai WC, Sin SL, Lau FL, Chan SC, and Lo CM
- Subjects
- Acute Disease, Adult, Aged, Amanitins toxicity, Female, Glasgow Coma Scale, Hepatic Encephalopathy etiology, Hong Kong, Humans, Male, Middle Aged, Mushroom Poisoning complications, Hepatic Encephalopathy surgery, Liver Transplantation, Mushroom Poisoning surgery
- Published
- 2017
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19. Simultaneous implantation of bilateral liver grafts in living donor liver transplantation with fusion venoplasty.
- Author
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Chan AC, Chok KS, Sin SL, Dai WC, Cheung TT, Chan SC, and Lo CM
- Subjects
- Humans, Living Donors, Male, Middle Aged, Vascular Surgical Procedures, Liver Transplantation methods
- Published
- 2016
- Full Text
- View/download PDF
20. Development of a highly transparent superamphiphobic plastic sheet by nanoparticle and chemical coating.
- Author
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Wong TI, Wang H, Wang F, Sin SL, Quan CG, Wang SJ, and Zhou X
- Abstract
A highly transparent superamphiphobic plastic sheet was developed. The plastic sheet polymethyl methacrylate (PMMA) was spin-coated on a glass substrate. Synthesized silica nanoparticles were sprayed on PMMA, followed by fluorosilane drop-coating. The results of contact angle measurements show that the developed PMMA sheet has superamphiphobic properties with high advancing contact angles for water (154°), toluene (139°), and silicone oil (132.9°). The amphiphobicity of the plastic sheet can be tuned by the surface coverage of the silica nanoparticles distributed on the PMMA surface. The surface coverage of the nanoparticles on our PMMA sheet is about 20%, and it agrees with our contact angle calculations for the sheet with and without nanoparticles., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
21. Outcomes including liver histology after liver transplantation for chronic hepatitis B using oral antiviral therapy alone.
- Author
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Fung J, Lo R, Chan SC, Chok K, Wong T, Sharr W, Cheung TT, Chan AC, Dai WC, Sin SL, Ng I, Lai CL, Yuen MF, and Lo CM
- Subjects
- Adult, Aged, Biopsy, Female, Fibrosis, Follow-Up Studies, Guanine analogs & derivatives, Guanine therapeutic use, Hepatitis B, Chronic blood, Hepatitis B, Chronic pathology, Humans, Male, Middle Aged, Postoperative Complications blood, Postoperative Complications pathology, Treatment Outcome, Young Adult, Antiviral Agents therapeutic use, DNA, Viral blood, Hepatitis B, Chronic therapy, Liver pathology, Liver Transplantation, Postoperative Complications prevention & control
- Abstract
The outcomes of hepatitis B virus (HBV)-related hepatitis after liver transplantation (LT) without hepatitis B immune globulin (HBIG) is not well documented. This study aims to determine the outcomes of chronic hepatitis B (CHB) patients using an HBIG-free regimen. All biopsies performed 3 months or more after LT in consecutive CHB patients transplanted from 2003 to 2012 were reviewed. None of the patients received HBIG. Results of all liver histologies were reviewed to determine the cause of graft dysfunction. Of the 435 patients transplanted during this period, 263 liver biopsies were performed in 144 patients. Thirty-six patients were positive for hepatitis B surface antigen (HBsAg) with undetectable HBV DNA at the time of biopsy, and none had histological evidence of HBV infection. Of the 263 biopsies, 44 (17%) had evidence of fibrosis. There was a significantly higher rate of fibrosis in those with large duct obstruction compared to those without (51% versus 9%, respectively; P < 0.001). Of the 291 patients without a liver biopsy during the same period, 43 were HBsAg+. Seven patients had evidence of virological rebound, of whom 6 had evidence of rtM204V/I mutation and 1 had recurrence of hepatocellular carcinoma with low-level rebound and wild-type virus. In conclusion, for patients without virological rebound, positive serum HBsAg was not associated with histological evidence of HBV-related hepatitis after LT. To prevent virological rebound, nucleos(t)ide analogues with higher barriers to resistance should be used., (© 2015 American Association for the Study of Liver Diseases.)
- Published
- 2015
- Full Text
- View/download PDF
22. Clinical factors affecting rejection rates in liver transplantation.
- Author
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Au KP, Chan SC, Chok KS, Sharr WW, Dai WC, Sin SL, Wong TC, and Lo CM
- Subjects
- Acute Disease, Adult, Female, Graft Rejection diagnosis, Graft Rejection immunology, Graft Rejection mortality, Humans, Immunosuppressive Agents adverse effects, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Graft Rejection prevention & control, Graft Survival drug effects, Immunosuppressive Agents therapeutic use, Liver Transplantation adverse effects, Liver Transplantation mortality
- Abstract
Background: With improvements in survival, liver transplant recipients now suffer more morbidity from long-term immunosuppression. Considerations were given to develop individualized immunosuppression based on their risk of rejection., Method: We retrospectively analyzed the data of 788 liver transplants performed during the period from October 1991 to December 2011 to study the relationship between acute cellular rejection (ACR) and various clinical factors., Results: Multivariate analysis showed that older age (P=0.04, OR=0.982), chronic hepatitis B virus infection (P=0.005, OR= 0.574), living donor liver transplantation (P=0.02, OR=0.648) and use of interleukin-2 receptor antagonist on induction (P<0.001, OR=0.401) were associated with fewer ACRs. Patients with fulminant liver failure (P=0.004, OR=4.05) were more likely to develop moderate to severe grade ACR., Conclusions: Liver transplant recipients with older age, chronic hepatitis B virus infection, living donor liver transplantation and use of interleukin-2 receptor antagonist on induction have fewer ACR. Patients transplanted for fulminant liver failure are at higher risk of moderate to severe grade ACR. These results provide theoretical framework for developing individualized immunosuppression.
- Published
- 2015
- Full Text
- View/download PDF
23. The friendly incidental portal vein thrombus in liver transplantation.
- Author
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Koh PS, Chan SC, Chok KS, Sharr WW, Wong TC, Sin SL, and Lo CM
- Subjects
- Adolescent, Adult, Aged, Bilirubin blood, Female, Graft Survival, Humans, Liver blood supply, Liver surgery, Male, Middle Aged, Multivariate Analysis, Patient Selection, Platelet Count, Portal Vein physiopathology, Postoperative Complications etiology, Postoperative Period, Severity of Illness Index, Survival Analysis, Thrombectomy, Treatment Outcome, Young Adult, End Stage Liver Disease mortality, End Stage Liver Disease surgery, Liver Transplantation adverse effects, Portal Vein surgery, Venous Thrombosis etiology
- Abstract
Improved outcomes have been shown in liver transplantation (LT) with portal vein thrombosis (PVT). However, PVT is still discovered incidentally during surgery despite careful preoperative imaging. Data are limited comparing the outcomes of incidental PVT with PVT diagnosed via preoperative imaging before LT. This study aims to compare the overall outcomes of patients with PVT. From 2008 to 2012, 369 patients had LT, and 58 patients with PVT were identified. They were divided into those with non-PVT (group 0; n = 311), preoperatively identified PVT (group 1; n = 28), and incidental PVT (group 2; n = 30). The demographics, characteristics, preoperative assessment, and postoperative outcomes were compared. A survival analysis was also performed. Baseline characteristics and preoperative evaluations of all 3 groups were comparable (P > 0.05) except for Model for End-Stage Liver Disease score, tumor status, platelet levels, and serum bilirubin. A multivariate analysis only showed a high serum bilirubin level to be a predictor of PVT (P = 0.004; odds ratio, 3.395; 95% confidence interval, 1.467-7.861). Postoperative outcomes were also comparable (P > 0.05). Compared to group 2, group 1 had more patients with a Yerdel classification of 3 or 4 with more extensive surgical intervention required (P = 0.02). The survival analysis in all 3 groups was comparable with 5-year survival rate of 87.4%, 84.6%, and 91.8% in group 0, 1, and 2, respectively (P = 0.66). In conclusion, recipients with PVT undergoing LT can have similar outcomes as the non-PVT patients even if PVTs were discovered incidentally. Discovery of incidental PVT only requires thrombectomy with no substantial change of treatment strategy, and the outcome is not adversely affected because most incidental PVTs are of a lower Yerdel grade. Preoperative imaging is useful to identify those with a higher Yerdel grade to allow planning of surgical strategy during transplantation., (© 2015 American Association for the Study of Liver Diseases.)
- Published
- 2015
- Full Text
- View/download PDF
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