433 results on '"Chul-Soo Ahn"'
Search Results
202. Cytotoxicity of human hepatic intrasinusoidal CD56bright natural killer cells against hepatocellular carcinoma cells
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Gi-Won Song, Nayoung Kim, Eunyoung Tak, Jaeseok Han, Ji-Seok Baek, Shin Hwang, and Chul-Soo Ahn
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Hepatology ,business.industry ,Hepatocellular carcinoma ,Gastroenterology ,Cancer research ,Medicine ,business ,Cytotoxicity ,medicine.disease - Published
- 2019
203. Feasibility of aorta after endarterectomy as middle hepatic vein reconstruction in living donor liver transplantation
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Shin Hwang, Gil-Chun Park, Gi-Won Song, Dong-Hwan Jung, Deok-Bog Moon, Sung-Gyu Lee, Ki-Hun Kim, Tae-Yong Ha, Chul-Soo Ahn, and Jae Hyun Kwon
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Aorta ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.artery ,medicine.medical_treatment ,Gastroenterology ,Medicine ,business ,Living donor liver transplantation ,Vein reconstruction ,Endarterectomy ,Surgery - Published
- 2019
204. 5,000 Living Donor Liver Transplantation at Single Center
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Sung-Gyu Lee, Chul-Soo Ahn, Gil-Chun Park, Young-In Yoon, Dong-Hwan Jung, Tae-Yong Ha, Deok-Bog Moon, Ki-Hun Kim, Shin Hwang, and Gi-Won Song
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,Single Center ,Living donor liver transplantation ,business ,Surgery - Published
- 2019
205. Prolonged occlusion of the hepatoduodenal ligament to reduce risk of bleeding and tumor spread during recipient hepatectomy for living donor liver transplantation
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Sung-Gyu Lee, Deok-Bog Moon, Ki-Hun Kim, Tae-Yong Ha, Chul-Soo Ahn, Jin-Uk Choi, Dong-Hwan Jung, Gi-Won Song, and Shin Hwang
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medicine.medical_specialty ,medicine.anatomical_structure ,Hepatology ,business.industry ,medicine.medical_treatment ,Occlusion ,Gastroenterology ,medicine ,Hepatoduodenal ligament ,Hepatectomy ,Living donor liver transplantation ,business ,Surgery - Published
- 2019
206. Tumor marker-based risk assessment of hepatocellular carcinoma recurrence after liver transplantation
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Ki-Hun Kim, Deok-Bog Moon, Yong-Kyu Chung, Sung-Gyu Lee, Gil-Chun Park, Dong-Hwan Jung, Gi-Won Song, Tae-Yong Ha, Chul-Soo Ahn, and Shin Hwang
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Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Liver transplantation ,medicine.disease ,Hepatocellular carcinoma ,Internal medicine ,medicine ,Risk assessment ,business ,Tumor marker - Published
- 2019
207. Clinical features and prognosis of DIHBS (diffuse intrahepatic biliary stricture) after adult ABO-incompatible living donor liver transplantation
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Dong-Hwan Jung, Deok-Bog Moon, Gi-Won Song, Sung-Gyu Lee, Tae-Yong Ha, Ki-Hun Kim, Gil-Chun Park, Jae Hyun Kwon, Shin Hwang, and Chul-Soo Ahn
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medicine.medical_specialty ,Hepatology ,business.industry ,ABO blood group system ,Internal medicine ,Gastroenterology ,medicine ,Living donor liver transplantation ,business - Published
- 2019
208. Case report of a pancreatic squamoid cyst
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Gil-Chun Park, Ki-Hun Kim, Tae-Yong Ha, Daegwang Yoo, Gi-Won Song, Dong-Hwan Jung, Shin Hwang, Chul-Soo Ahn, Dae Wook Hwang, and Sung-Gyu Lee
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medicine.medical_specialty ,Pathology ,Intraductal papillary mucinous neoplasm ,business.industry ,Case Report ,Pancreatic cancer ,medicine.disease ,Lesion ,medicine.anatomical_structure ,medicine ,Immunohistochemistry ,Cyst ,Radiology ,medicine.symptom ,Pancreas ,Distal pancreatectomy ,business ,Pancreatic squamoid cyst ,Rare disease - Abstract
Squamoid cyst of the pancreas is a very rare disease and it has been proposed only recently as a distinct pathologic lesion. We herein present a case of pancreatic squamoid cyst in a patient who underwent laparoscopic resection. A 60-year-old woman had an abdominal computed tomography (CT) scan for a routine check-up, and a multi-cystic lesion of 1.8-cm in size was incidentally found in the tail of the pancreas. Biochemical laboratory tests were within normal limits. At first, we presumed that the most likely diagnosis of the cystic lesion was an intraductal papillary mucinous neoplasm. To treat this lesion, we performed laparoscopic spleen-saving distal pancreatectomy. The patient showed the usual routine postoperative course and she was discharged 10 days after surgery. On examination of the resected specimen, a well-defined, oligolocular cystic mass was found in the pancreatic tail, without a solid portion. Histologic examination revealed that the cysts had linings ranging from flat squamoid cells to transitional cells with non-keratinization. After immunohistochemical staining, the final diagnosis was confirmed to be squamoid cyst of the pancreas. This lesion appears to be regarded as a benign entity, thus an extended operation should be avoided and resection of the lesion can be performed minimally.
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- 2013
209. Role of the 1-month protocol transarterial chemoinfusion in detecting intrahepatic metastasis after resection of large hepatocellular carcinoma greater than 10 cm
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Gi-Won Song, Young-Joo Lee, Hae-Na Shin, Ki-Hun Kim, Tae-Yong Ha, Sung-Gyu Lee, Chul-Soo Ahn, Deok-Bog Moon, and Shin Hwang
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Univariate analysis ,medicine.medical_specialty ,Tumor size ,business.industry ,Hepatocellular carcinoma ,Transarterial chemoinfusion ,Statistical difference ,medicine.disease ,Gastroenterology ,Surgery ,Resection ,Text mining ,Recurrence ,Internal medicine ,medicine ,Intrahepatic metastasis ,In patient ,Original Article ,business - Abstract
Backgrounds/Aims: Tumor recurrence is very common after hepatic resection of hepatocellular carcinoma (HCC) ≥10 cm. The purpose of this study was to validate the prognostic significance of the preoperative alkaline phosphatase (ALP) level and early intrahepatic metastasis in HCC patients who underwent resection of large HCC. Methods: Clinical data of 100 large HCC patients who underwent liver resection were retrospectively reviewed. All of them underwent protocol transarterial chemoinfusion (TACI) at 1 month. Results: Median tumor diameter was 13.8 cm, and 94% were single lesions. Systematic and non-systematic resections were performed in 91% and 9%, respectively, with R0 resection achieved in 84%. Overall 1-, 3- and 5-year survival rates were 76%, 38.5%, and 30.4%, respectively. Univariate analyses on patient survival revealed that intrahepatic metastasis on 1-month protocol TACI was the only significant risk factor (p=0.002). Mean ALP values according to the intrahepatic metastasis on 1-month protocol TACI were 124.6±76.9 IU/L and 145.1±92.6 IU/L, which did not show a statistical difference (p=0.23). Conclusions: In patients with large HCC, 1-month protocol TACI combined with hepatic resection may contribute to the early detection and timely treatment of potentially preexisting metastatic lesions.
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- 2013
210. Validation of the 8th Edition of the American Joint Committee on Cancer Staging System for Gallbladder Cancer and Implications for the Follow-up of Patients without Node Dissection.
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You-Na Sung, Minjeong Song, Jae Hoon Lee, Ki Byung Song, Dae Wook Hwang, Chul-Soo Ahn, Shin Hwang, and Seung-Mo Hong
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TUMOR classification ,GALLBLADDER cancer ,SURGICAL excision ,LYMPH nodes ,EDITIONS ,CANCER patients - Abstract
Purpose The 8th edition of gallbladder cancer staging in the American Joint Committee on Cancer (AJCC) staging system changed the T and N categories. Materials and Methods In order to validate the new staging system, a total of 348 surgically resected gallbladder cancers were grouped based on the 8th edition of the T and N categories and compared with patients' survival. Results Significant differences were noted between T1b-T2a (p=0.003) and T2b-T3 (p < 0.001) tumors, but not between Tis-T1a, T1a-T1b, and T2a-T2b tumors. However, significant survival differences were observed both by the overall and pair-wise (T1-T2, T2-T3) comparisons (all, p < 0.001) without dividing T1/T2 subcategories. When cases with ≥ 6 examined lymph nodes were evaluated, significant survival differences were observed among the entire comparison (p < 0.001) and pair-wise comparisons of N0-N1 (p=0.001) and N1-N2 (p=0.039) lesions. When cases without nodal dissection (NX) were additionally compared, significant survival differences were observed between patients with N0-NX (p=0.001) and NX-N1 (p < 0.001) lesions. Conclusion The T category in the 8th edition of the AJCC staging system did not completely stratify the prognosis of patients with gallbladder cancer. Modification by eliminating T subcategories can better stratify the prognosis. In contrast, the N category clearly determines patients' survival with ≥ 6 examined lymph nodes. The survival time in patients of gallbladder cancers without nodal dissection is between N0 and N1 cases. Therefore, close postoperative followed up is recommended for those patients. [ABSTRACT FROM AUTHOR]
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- 2020
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211. Hemashield Vascular Graft Is a Preferable Prosthetic Graft for Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation.
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Gil-Chun Park, Shin Hwang, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Chul-Soo Ahn, Deok-Bog Moon, Ki-Hun Kim, Young-In Yoon, Hui-Dong Cho, Jae-Hyun Kwon, Yong-Kyu Chung, Sang-Hyun Kang, I-Ji Jung, Jin-Uk Choi, and Sung-Gyu Lee
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- 2019
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212. Overcoming Hepatic Artery Thrombosis After Living Donor Liver Transplantations: An Experience from Asan Medical Center.
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Gil-Chun Park, Deok-Bog Moon, Sang-Hyun Kang, Chul-Soo Ahn, Shin Hwang, Ki-Hun Kim, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Yong-In Yoon, and Sung-Gyu Lee
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- 2019
- Full Text
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213. Analysis of S Gene Mutation of the Hepatitis B Virus in Adult Liver Transplant Recipients Showing Resistance to Hepatitis B Immunoglobulin Therapy
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J.-M. Namgoong, C.-S. Park, Chul-Soo Ahn, K.-H. Chang, B.-H. Jung, Sang-Hyun Hwang, S.-G. Lee, Sung-Hwa Kang, Y.W. Shin, Hyung-Woo Park, Deok-Bog Moon, Tae-Yong Ha, D.-H. Jung, Gi-Won Song, Yo-Han Park, Kyungeun Kim, Se-Ho Kim, and G.-C. Park
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Adult ,Hepatitis B virus ,HBsAg ,Molecular Sequence Data ,Immunoglobulins ,Drug resistance ,Biology ,Gene mutation ,medicine.disease_cause ,Polymerase Chain Reaction ,Drug Resistance, Viral ,medicine ,Adefovir ,Humans ,Amino Acid Sequence ,DNA Primers ,Transplantation ,Base Sequence ,Sequence Homology, Amino Acid ,Lamivudine ,Entecavir ,Virology ,Liver Transplantation ,HBeAg ,Mutation ,Immunology ,Surgery ,medicine.drug - Abstract
Background A considerable proportion of recipients of liver transplantations who are presented hepatitis B immunoglobulin (HBIG) monotherapy for hepatitis B virus (HBV) prophylaxis develop HBIG resistance. In this study, we investigated the mutation patterns in the major hydrophilic region (MHR) of amino acid sequences 100 to 160. Methods Using the gene sequence analyzer for amino acid sequences 0 to 226 in the S/pre-S region we analyzed blood samples of 15 patients showing HBIG resistance after high-dose HBIG prophylaxis. Results Various mutations in the MHR were observed in 14/15 samples: Gly145Arg mutation in 8/13 Adr subtype and 1/2 Ayw subtype samples (60%). The next most common mutation was Gly165Trp in 8/13 Adr subtype but neither of 2 Ayw subtype samples (53.3%). Concurrent antiviral resistance was noted in 5 patients: lamivudine ( n = 5), or entecavir ( n = 3), but not adefovir, suggesting the occurrence of simultaneous, antiviral cross-resistances. Two patients underwent retransplantation due to the progression of HBV infection despite vigorous antiviral therapy. At diagnosis of HBV recurrence, the mean HBV DNA load was 6.5 × 10 6 copies/mL; 4 patients showed paradoxical coexistence of anti-HBs and HBsAg. Currently, 2 subjects show low-level HBV DNA replication in peripheral blood, although the other 12 had no DNA replication after prolonged antiviral therapy. Conclusions This study suggested that various mutations in the “a” determinant were associated with HBIG resistance. Since treatment failure to rescue antiviral therapy was often associated with delayed detection of HBV recurrence rather than concurrent antiviral resistance, frequent HBV surveillance using more sensitive screening tests, such as HBeAg and HBV DNA polymerase chain reaction assay, seems to be mandatory.
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- 2013
214. Clinical Outcome of Idiopathic Hepatic Parenchymal Infarct Following Living Donor Liver Transplantation
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Sam-Youl Yoon, Deok-Bog Moon, S.-G. Lee, Chul-Soo Ahn, Su Kyung Hwang, D.-H. Jung, G.-C. Park, Gi-Won Song, Yo-Han Park, Hyung-Woo Park, Kyungeun Kim, J.-M. Namgoong, and Tae-Yong Ha
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Transplantation ,medicine.medical_specialty ,business.industry ,Medical record ,medicine.medical_treatment ,Incidence (epidemiology) ,Infarction ,Retrospective cohort study ,medicine.disease ,Liver Transplantation ,Peripheral ,Surgery ,Liver ,Parenchyma ,Living Donors ,Humans ,Medicine ,Plasmapheresis ,business ,Living donor liver transplantation ,Retrospective Studies - Abstract
Purpose The aim of the present study was to examine the clinical course of nonvascular hepatic ischemia following adult living donor liver transplantation (LDLT). Methods This retrospective study reviewed the medical records of 1782 patients who underwent LDLT from January 2003 to September 2010. Nine subjects (0.5%) suffered idiopathic hepatic parenchymal infarcts (IHPI) classified according to the morphology and extent of the infarcted area as peripheral or central. Results Increased levels of liver enzymes were observed in all IHPI patients. Liver cell damage closely correlated with the extent of the infarcted area. Most patients with peripheral-type IHPI showed favoarable spontaneous recovery, occasionally requiring liver support with plasmapheresis or a prolonged period. By contrast, 2 patients with central-type IHPI died due to progressive expansion of the infarcted area with subsequent graft failure. Conclusions In the present study the incidence of IHPI following LDLT was 0.5%. The severity of the infarct depended upon its location and size; central-type IHPI showed a worse prognosis. Thus, special attention should be paid to patients showing a central-type infarction.
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- 2013
215. Differential Function of Natural Killer Cells in the Liver Graft Perfusate of Korean Population
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D.-H. Jung, Gi-Won Song, Su Kyung Hwang, M.K. Jung, Namkug Kim, Pyoung-Jae Park, S.-G. Lee, and Chul-Soo Ahn
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medicine.medical_treatment ,Enzyme-Linked Immunosorbent Assay ,chemical and pharmacologic phenomena ,Biology ,Cell Degranulation ,Potassium Chloride ,Interleukin 21 ,Immunophenotyping ,Republic of Korea ,Living Donors ,medicine ,Humans ,Mannitol ,Transplantation ,Lymphokine-activated killer cell ,Liver Neoplasms ,hemic and immune systems ,Flow Cytometry ,Natural killer T cell ,Liver Transplantation ,Killer Cells, Natural ,Glucose ,Cytokine ,Liver ,Immunology ,Interleukin 12 ,Cytokines ,Surgery ,Cytokine secretion ,Tumor necrosis factor alpha ,Procaine - Abstract
Background Liver perfusate (LP) lymphocytes show unique subsets compared with peripheral blood (PB) lymphocytes. LP natural killer (NK) and NKT cells may display unique cytotoxicity and cytokine production, thus leading to distinct roles in liver transplantation. In this study, we sought to evaluate the functions of graft perfusate NK and NKT cells in clinical liver transplantation. Methods The living donor right lobe graft was initially washed with 1 L of histidine-tryptophan-ketoglutarate solution to collect the perfusate. We also collected donor PB. Lymphocytes separated by the Ficoll-Hypaque density gradient method underwent immunophenotyping using multicolor flow cytometry. To assess cytokine secretion, we performed the enzyme-linked immunosorbent assay. Results There were more NK and NKT cells in LP confirming previous reports. In particular, CD56 bright CD16 low NK cells accounted for approximately 50% of total NK cells compared with 5% to 10% among PB NK cells. In response to cytokine stimulation LP NK cells produce tumor necrosis factor–α at different levels and less interleukin-10 compared with PB NK cells. The major source of interferon-γ production upon stimulation with liver caner cells were CD56 dim NK cells and CD56 − CD3 − cells rather than NKT or T cells. Unlike PB NK cells, LP CD56 bright CD16 low NK cells along with CD56 dim CD16 high NK cells and NKT cells were efficient killers against Korean liver cancer cells. Conclusion LP NK and NKT cells showed unique functions in cytotoxicity and cytokine production.
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- 2013
216. Prognosis of patients with pT1b/T2 gallbladder carcinoma who have undergone laparoscopic cholecystectomy as an initial operation
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Kwang-Min Park, Gi-Won Song, Dong Hwan Jung, Chul Soo Ahn, Ki-Hun Kim, Ye Jong Park, Deok Bog Moon, Jae Hun Lee, Sung-Gyu Lee, Shin Hwang, Tae Yong Ha, Gil Chun Park, and Young-Joo Lee
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Reoperation ,medicine.medical_specialty ,Bile duct ,business.industry ,medicine.medical_treatment ,Gallbladder ,Gallbladder disease ,Extended cholecystectomy ,medicine.disease ,Surgery ,Laparoscopic cholecystectomy ,medicine.anatomical_structure ,Recurrence ,medicine ,Carcinoma ,Cholecystectomy ,Original Article ,Hepatectomy ,Gallbladder cancer ,business ,Gallbladder carcinoma ,Survival rate - Abstract
Backgrounds/Aims: Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation. Methods: After analyzing the institutional profiles of 500 GBC patients who have undergone surgical resection, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gallbladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively. Results: In the LC only group (n=30), mean age of the 16 pT1 patients was 65.7±12.5 years and mean age of the 14 pT2 patients was 66.7±10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6±9.9 years and in 26 pT2 patients, mean age was 59.2±7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reoperation were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hepatectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45). Conclusions: The survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reoperation for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.
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- 2013
217. Anomalous hepatic vein anatomy of left lateral section grafts and customized unification venoplasty for pediatric living donor liver transplantation
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Gil-Chun Park, Sung-Gyu Lee, Gi-Won Song, Dae Yeon Kim, Ki-Hun Kim, Dong-Hwan Jung, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Kyoung-Mo Kim, Jung-Man Namgoong, David C. Cronin, and Tae-Yong Ha
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Transplantation ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Treatment outcome ,Anatomy ,Liver transplantation ,Body weight ,Surgery ,X ray computed ,medicine ,Graft survival ,Complication rate ,business ,Living donor liver transplantation ,Vein reconstruction - Abstract
In liver transplantation, a left lateral section (LLS) graft may have an unusual variant left hepatic vein (LHV) anatomy. This study was designed to analyze the incidence of unusual LHV variants and to determine technical methods for effective reconstruction in infant recipients weighing approximately 10 kg or less. The study comprised 3 parts: an LHV variation analysis, a simulation-based design for the technical modification of graft LHV venoplasty, and its clinical application. The LHV anatomy of 300 potential LLS graft donors was classified into 4 types according to the number and location of the hepatic vein openings: (1) a single opening (n = 218 or 72.7%); (2) 2 large adjacent openings (n = 29 or 9.7%); (3) 2 adjacent openings, 1 large and 1 small (n = 34 or 11.3%); and (4) 2 widely spaced openings (n = 19 or 6.3%). Types 2 and 3 required wedged unification venoplasty, and type 4 required additional vein interposition. In a series of 49 cases using LLS grafts, the graft hepatic vein complication rate was 4.5% at 3 years; stenting was necessary for 1 of the 36 type 1 LHV grafts (2.8%) and for 1 of the 13 type 2-4 LHV grafts (7.7%, P = 0.46). A customized interposition-wedged unification venoplasty technique for coping with type 4 vein variations was developed with a simulation-based approach, and it was successfully applied to a 10-month-old male infant receiving an LLS graft with a type 4 LHV. In conclusion, nearly all LHV variations can be effectively managed with customized unification venoplasty. These venoplasty techniques represent beneficial surgical options as part of graft standardization for hepatic vein reconstruction in pediatric living donor liver transplantation.
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- 2013
218. Analysis of Biliary Stricture after ABO Incompatible Adult Living Donor Liver Transplantation
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Hyoung-Woo Park, Shin Hwang, C.-S. Park, Dong-Hwan Jung, Bo-Hyun Jung, Sung-Gyu Lee, Sung-Hwa Kang, Yo-Han Park, Chul-Soo Ahn, Young-In Yoon, Ki-Hun Kim, Tae-Yong Ha, Jung-Man Namgung, Deok-Bog Moon, Gi-Won Song, and Gil-Chun Park
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Transplantation ,medicine.medical_specialty ,Graft failure ,business.industry ,Incidence (epidemiology) ,Immunology ,Patient survival ,Gastroenterology ,Survival outcome ,Surgery ,Internal medicine ,ABO blood group system ,medicine ,ABO incompatibility ,Living donor liver transplantation ,business - Abstract
Results: There was one mortality (1.3%) and one re-transplantation (due to small-for-size graft syndrome) among 77 cases of ABOi ALDLTs. Overall, 1-, 2-, and 3-year patient survival rates were 94.8%, comparable to ABOc ALDLTs (93.7%, 90.1%, 90.1%, P=0.20). BS occurred in 11 (13.8%) ABOi ALDLT patients. There were no significant differences in 1-, 2-, and 3-year BSFSR between ABOi and ABOc ALDLT patients (87.5% vs. 88.1%, 83.4% vs. 87.5%, and 83.4% vs. 86.4%, P=0.55). Among 10 patients with BS, four patients showed diffuse multiple intrahepatic strictures, which were linked to the death of two patients. Conclusions: The survival outcome of ABOi ALDLT is comparable to ABOc ALDLT. The incidence of BS of ABOi ALDLT was not superior to that of ABOc ALDLT. However, ABO incompatibility is related to the development of diffuse multiple intrahepatic BSs (rarely seen in ABOc ALDLT) and can cause graft failure and patient death.
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- 2012
219. Diagnostic Role of Blood Tumor Markers in Predicting Hepatocellular Carcinoma in Liver Cirrhosis Patients Undergoing Liver Transplantation
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Shin Hwang, Younghwan Kim, Chul-Soo Ahn, Yohan Park, Gil-Chun Park, Gi-Won Song, Sung-Gyu Lee, Ki-Hun Kim, Tae-Yong Ha, Dong-Hwan Jung, and Deok-Bog Moon
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Severity of Illness Index ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Carcinoma ,Biomarkers, Tumor ,Humans ,030212 general & internal medicine ,Protein Precursors ,Hepatitis B virus ,Transplantation ,business.industry ,Liver Neoplasms ,Area under the curve ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Liver Transplantation ,ROC Curve ,030220 oncology & carcinogenesis ,Predictive value of tests ,Hepatocellular carcinoma ,Female ,Prothrombin ,alpha-Fetoproteins ,business ,Biomarkers - Abstract
BACKGROUND The aim of this study was to investigate the diagnostic role of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) in predicting hepatocellular carcinoma (HCC) in patients with advanced liver cirrhosis (LC) awaiting liver transplantation (LT). MATERIAL AND METHODS During a study period of 10 years, 2074 adult LT recipients were identified. They were divided into 2 groups: HCC (n=970; 46.8%) and non-HCC (n=1104; 53.2%). They were stratified into 5 categories according to model for end-stage liver disease (MELD) scores
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- 2016
220. How to Perform Selective Liver Biopsy in Living Liver Donors Using Plain Computed Tomography
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Sun-Kyeong Moon, Gil-Chun Park, Yohan Park, Sung-Gyu Lee, Shin Hwang, Tae-Yong Ha, Chul-Soo Ahn, Dong-Hwan Jung, Ki-Hun Kim, Deok-Bog Moon, and Gi-Won Song
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Biopsy ,Computed tomography ,Liver transplantation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Living Donors ,Humans ,Transplantation ,medicine.diagnostic_test ,business.industry ,Fatty liver ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Liver Transplantation ,Fatty Liver ,Liver ,Liver biopsy ,Liver donors ,030211 gastroenterology & hepatology ,Female ,Radiology ,Living donor liver transplantation ,business ,Tomography, X-Ray Computed - Abstract
Preoperative donor liver biopsy is the criterion standard to verify the quality of a liver. However, it can cause some complications, thus this study was designed to know whether selective liver biopsy is possible or not, and to find a subgroup that does not require preoperative biopsy.We reviewed preoperative images and postoperative outcome in 118 donors from September 2013 to January 2014. Visual grading of steatosis on plain computed tomography (CT) was performed and compared steatosis on preoperative liver biopsy was done within 7 days from the CT scan.Visual grades of plain CT were 1 (n = 50, 42.4%), 2 (n = 47, 39.8%), 3 (n = 13, 11.0%), 4 (n = 7, 5.9%), and 1 (n = 1, 0.8%). Macrovesicular steatosis on liver biopsy according to visual grades were 1 (0.67 ± 1.3%), 2 (1.67 ± 1.8%), 3 (6.23 ± 6.4%), 4 (14.7 ± 16.6), and 5 (30%). Right liver grafts including right lobe, modified right lobe, and extended right lobe were procured in 106 (89.9%) donors, and 16% (17/106) of the donors were visual grades 3, 4, and 5. Eleven donors (64.7%) were accepted for right liver donation after liver biopsy, whereas 6 (35.3%) donors were deemed possible to donate right liver after weight reduction and reevaluation of steatosis. Transient hepatic dysfunction after right hepatectomy was significantly increased according to the increment of visual grade.Preoperative liver biopsy may not be necessary in visual grade 1 or 2 donors, but should be performed for grade 3 and 4 donors based on recipient's urgency so as to decide whether to proceed with right hepatectomy or not.
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- 2016
221. Clinico-pathological correlation of hepatic angiomyolipoma: a series of 23 resection cases
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Dong Hwan, Jung, Shin, Hwang, Seung Mo, Hong, Ki Hun, Kim, Chul Soo, Ahn, Deok Bog, Moon, Abdulwahab A, Alshahrani, and Sung Gyu, Lee
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Adult ,Diagnosis, Differential ,Male ,Carcinoma, Hepatocellular ,Angiomyolipoma ,Liver Neoplasms ,Hepatectomy ,Humans ,Female ,Diagnostic Errors ,Middle Aged ,Aged ,Retrospective Studies - Abstract
Angiomyolipomas are rare neoplasms of mesenchymal origin and are derived from perivascular epithelioid cells. They usually develop in the kidney and rarely in the liver. Due to their rarity, most hepatic angiomyolipomas have been misinterpreted as hepatocellular carcinoma (HCC) or other hypervascular liver tumours on imaging studies. We aimed to assess the clinico-pathological correlation of hepatic angiomyolipoma.We identified 23 patients with hepatic angiomyolipoma through an institutional database search.Of 5680 cases of primary liver tumours, 23 (0.4%) had angiomyolipomas (mean age, 43.6 ± 12.4 years; 16 female patients). Hepatitis B virus infection was noted in four patients, whereas a liver mass was incidentally detected on routine health screening in 13 patients. The preoperative diagnoses, before liver biopsy, included HCC in 14, angiomyolipoma in six, focal nodular hyperplasia in two and hepatic adenoma in one patient. Eventually, the preoperative diagnoses were changed to HCC in 12 and hepatic angiomyolipoma in 11 patients. The tumour size was 5.3 ± 4.6 cm, and 22 patients had a single tumour. All tumours exhibited positive findings for human melanoma black-45 and smooth muscle actin staining. During a follow-up period of 52.2 ± 23.7 months, none of the patients exhibited tumour recurrence or mortality.Hepatic angiomyolipoma is a rare form of primary liver tumour and is often misdiagnosed as other hypervascular tumours. Although angiomyolipoma is benign in nature, it also has malignant potential; hence, resection is indicated if the tumour grows or malignancy cannot be excluded. Surgical resection is a definitive curative treatment of hepatic angiomyolipoma.
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- 2016
222. Portal vein stenting as a significant risk factor for biliary stricture in adult living donor liver transplantation
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Gil-Chun Park, Deok-Bog Moon, Young-In Yun, Chul-Soo Ahn, Min-Ho Shin, Shin Hwang, Gi-Young Ko, Sung-Gyu Lee, Wan-Jun Kim, Seok-Hwan Kim, Woo-Hyoung Kang, Gi-Won Song, Ki-Hun Kim, Dong-Hwan Jung, and Tae-Yong Ha
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,medicine.medical_treatment ,education ,Constriction, Pathologic ,Kaplan-Meier Estimate ,030230 surgery ,Anastomosis ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Living Donors ,Humans ,Vascular Diseases ,Risk factor ,Computed tomography angiography ,Proportional Hazards Models ,Retrospective Studies ,Chi-Square Distribution ,Cholestasis ,Hepatology ,medicine.diagnostic_test ,business.industry ,Portal Vein ,Incidence (epidemiology) ,Endovascular Procedures ,Gastroenterology ,Stent ,Retrospective cohort study ,Perioperative ,Phlebography ,Middle Aged ,equipment and supplies ,Surgery ,Liver Transplantation ,surgical procedures, operative ,Treatment Outcome ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Female ,Stents ,business ,Chi-squared distribution - Abstract
Background Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) recipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its incidence. Methods We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). Results The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. Conclusions Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.
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- 2016
223. Resolution of Hepatic Venous Congestion Following Gradual Occlusion of Middle Hepatic Vein Interposition Graft in Living Donor Liver Transplantation
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Tae Yong Ha, Varvara A. Kirchner, Chul Soo Ahn, Gi-Won Song, Shin Hwang, Deok Bog Moon, Dong Hwan Jung, Ki-Hun Kim, Sung-Gyu Lee, and Gil Chun Park
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Collateral Circulation ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,Liver transplantation ,Hepatic Veins ,Iliac Vein ,030218 nuclear medicine & medical imaging ,Constriction ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Venous congestion ,Occlusion ,Living Donors ,Medicine ,Humans ,Vein ,Retrospective Studies ,Transplantation ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Collateral circulation ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Female ,Vascular Grafting ,business ,Living donor liver transplantation ,Tomography, X-Ray Computed - Abstract
BACKGROUND The middle hepatic vein (MHV) interposition vessel graft (IVG) is often occluded within a few months after living-donor liver transplantation (LDLT). We aimed to assess the mechanisms of resolving the hepatic venous congestion (HVC) that develops after gradual occlusion of the MHV-IVG. MATERIAL AND METHODS This study comprised two parts. Part I involved an assessment of the process of HVC resolution in the remnant right liver after donation of an extended left liver graft (n=100). Part II involved an evaluation of the timing and patterns of gradual MHV-IVG occlusion and HVC resolution in LDLT recipients (n=100). RESULTS In Part I, the analysis of 1-week dynamic computed tomography (CT) showed pre-existing collaterals in 8, appropriate compensation in 44, and HVC in 48 patients. In Part II, reconstruction of a segment V vein (V5) and a segment VIII vein (V8) was the most common reconstruction type (n=65). The patency rates of MHV-IVG were 90% at 3 months, 65% at 6 months, 37% at 12 months, and 18% at 24 months. The patency rate of V5 was inferior to that of V8. CT imaging analysis indicated that extrinsic compression of IVG, development of intrahepatic collaterals, and IVG shrinkage were the main mechanisms underlying late MHV-IVG occlusion. Moreover, the timing of MHV-IVG occlusion was well correlated with that of neo-collateralization. CONCLUSIONS MHV-IVG reconstruction effectively prevents HVC in LDLT. Although gradual MHV-IVG occlusion is well compensated by neo-collateralization, we believe that the patency of the IVG should be maintained for at least 6 months after LDLT.
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- 2016
224. Prognostic effect of transarterial chemoembolization-induced complete pathological response in patients undergoing liver resection and transplantation for hepatocellular carcinoma
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Woo-Hyoung Kang, Shin Hwang, Gi-Won Song, Chul-Soo Ahn, Dong-Hwan Jung, Sung-Gyu Lee, Gil-Chun Park, Deok-Bog Moon, Young-Joo Lee, and Ki-Hun Kim
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,medicine.medical_treatment ,Liver transplantation ,Gastroenterology ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Recurrence ,Internal medicine ,Republic of Korea ,medicine ,Carcinoma ,Humans ,In patient ,Postoperative Period ,Chemoembolization, Therapeutic ,Neoadjuvant therapy ,Aged ,Retrospective Studies ,Transplantation ,Hepatology ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Magnetic resonance imaging ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Magnetic Resonance Imaging ,Liver Transplantation ,Treatment Outcome ,Liver ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Surgery ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Transarterial chemoembolization (TACE)-induced complete pathological response (CPR) is known to improve postresection outcomes of hepatocellular carcinoma (HCC). We aimed to assess the prognostic effects of CPR after preoperative TACE for HCC in patients who underwent hepatic resection (HR) or liver transplantation (LT). The clinical outcomes of patients showing CPR after HR (n = 110) or LT (n = 233) were analyzed. The control groups comprised patients with minimal recurrence risk as naive single HCC ≤ 2 cm for HR (n = 476), and 1 or 2 HCCs ≤ 2 cm for LT (n = 184). Among HR study patients, 1-, 3-, and 5-year tumor recurrence rates were 18.5%, 50.6%, and 58.7% respectively, which were higher than those of controls (P < 0.001). The 1-, 3-, and 5-year patient survival rates were 97.8%, 82.0%, and 69.1%, respectively, which were lower than those of controls (P < 0.001). Among LT study patients, 1-, 3-, and 5-year tumor recurrence rates were 4.1%, 7.9%, and 7.9%, respectively, which were higher than those of controls (P = 0.019). The 1-, 3-, and 5-year patient survival rates were 92.7%, 89.2%, and 86.9%, respectively, which were not different than those of controls (P = 0.11). LT recipients had lower recurrence and higher survival rates compared with HR patients (P < 0.001). The tumor recurrence site was mainly intrahepatic in HR patients. There was no difference between the incidences of extrahepatic recurrence in the HR study group and all-site recurrence in the LT study group (P = 0.61). We concluded that the prognostic effect of TACE-induced CPR for HCC patients appears to be limited to downstaging. LT recipients benefited more from CPR than HR patients. Liver Transplantation 23 781-790 2017 AASLD.
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- 2016
225. Prognostic impact of hepatitis B virus infection in patients with intrahepatic cholangiocarcinoma
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Chul-Soo, Ahn, Shin, Hwang, Young-Joo, Lee, Ki-Hun, Kim, Deok-Bog, Moon, Tae-Yong, Ha, Gi-Won, Song, and Sung-Gyu, Lee
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Adult ,Male ,Databases, Factual ,Middle Aged ,Hepatitis B ,Prognosis ,Antiviral Agents ,Risk Assessment ,Survival Analysis ,Disease-Free Survival ,Cholangiocarcinoma ,Treatment Outcome ,Bile Duct Neoplasms ,Reference Values ,Multivariate Analysis ,Confidence Intervals ,Hepatectomy ,Humans ,Female ,Neoplasm Invasiveness ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies - Abstract
Hepatitis B virus (HBV)-associated intrahepatic cholangiocarcinoma (ICC) was reported to have a favourable prognosis. We investigated the clinicopathological features of patients with HBV-associated ICC and compared post-resection survival outcomes of ICC patients with and without hepatitis B surface antigen (HBsAg) to assess the prognostic impact of HBV infection.A single-institution cohort of 292 patients who underwent macroscopic curative resection for ICC were divided into HBV (n = 37) and non-HBV (n = 255) groups. Their medical records were reviewed retrospectively.In comparison with the clinicopathological features, patient age, proportion of anatomical resection, perineural invasion and lymph node (LN) metastasis were different between the two groups. Antiviral therapy was administered to 15 (40.5%) and 27 (73.0%) patients before and after surgery, respectively. Univariate analyses revealed that risk factors were tumour size5 cm, anatomical resection, perineural invasion, lymphovascular invasion and LN metastasis for tumour recurrence and HBV infection, tumour size5 cm, anatomical resection, perineural invasion, lymphovascular invasion and LN metastasis for patient survival. Multivariate analysis revealed that independent risk factors were tumour size5 cm, perineural invasion and LN metastasis for both tumour recurrence and patient survival. HBV infection showed statistically marginal significances only in univariate analysis, thus not being an independent risk factor.We observed that ICC patients with HBV infection often showed favourable tumour features probably due to early diagnosis, but their post-resection outcomes were not significantly different from those of patients without HBV infection. Therefore, the same treatment and surveillance policies should be applied regardless of HBV serology.
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- 2016
226. Liver Transplantation After Transarterial Chemoembolization and Radiotherapy for Hepatocellular Carcinoma with Vascular Invasion
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Yuri Jeong, Chul-Soo Ahn, Sang Min Yoon, Gi-Won Song, Min-Ho Shin, Shin Hwang, Ki-Hun Kim, Sung-Gyu Lee, Jin-Hong Park, Jong Hoon Kim, and Deok-Bog Moon
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Gastroenterology ,Vascular invasion ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Living Donors ,Medicine ,Humans ,Neoplasm Invasiveness ,Chemoembolization, Therapeutic ,Survival analysis ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Analysis ,Vascular Neoplasms ,Liver Transplantation ,Radiation therapy ,Treatment Outcome ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiotherapy, Adjuvant ,Liver function ,Neoplasm Recurrence, Local ,business ,Living donor liver transplantation - Abstract
The study aims to analyze the oncologic outcomes of living donor liver transplantation (LDLT) after combined transarterial chemoembolization (TACE) and radiotherapy for hepatocellular carcinoma (HCC) with major vascular invasion. We retrospectively reviewed 17 HCC patients with major vascular invasion who underwent LDLT after combined treatment modality between May 2007 and September 2014. The LDLT timing was determined by the surgeons depending on the disease status and liver function. The intrahepatic recurrence-free survival, disease-free survival (DFS), and overall survival (OS) rates were estimated from the date of the LDLT. The median follow-up period was 24.5 months (range, 6.4–66.0 months) after the LDLT. The interval between the combined treatment and the LDLT was a median of 5 months (range, 0.4–65.3 months). On the explanted liver, total necrosis was shown in five patients (29.4 %). The 1- and 3-year DFS rates were 70.6 and 57.8 %, respectively. The 1- and 3-year OS rates were 87.4 and 60.5 %, respectively. The major pattern of failure was distant metastasis (35.3 %), and intrahepatic recurrence occurred in three patients (17.6 %) who experienced distant metastasis. In the selected HCC patients with major vascular invasion, LDLT after combined TACE and radiotherapy showed acceptable oncologic outcomes.
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- 2016
227. Multiplication of Tumor Volume by Two Tumor Markers Is a Post-Resection Prognostic Predictor for Solitary Hepatocellular Carcinoma
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Shin Hwang, Chul-Soo Ahn, Gil-Chun Park, Sung-Gyu Lee, Dong-Hwan Jung, Young-Joo Lee, Gi-Won Song, Deok-Bog Moon, Tae-Yong Ha, and Ki-Hun Kim
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Risk Assessment ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,In patient ,Neoplasm Invasiveness ,Protein Precursors ,Tumor marker ,Aged ,Neoplasm Staging ,Retrospective Studies ,Surrogate endpoint ,business.industry ,Liver Neoplasms ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,digestive system diseases ,Tumor Burden ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Cohort ,Microvessels ,030211 gastroenterology & hepatology ,Surgery ,Female ,Prothrombin ,alpha-Fetoproteins ,business ,Biomarkers ,Cohort study - Abstract
We hypothesized that microvascular invasion (MVI) and post-resection prognosis in patients with solitary hepatocellular carcinoma (HCC) could be predicted using blood tumor markers and tumor volume (TV). We intended to identify a simple surrogate marker of HCC via a combination of clinical variables. This retrospective study used the strictly selected development cohort (n = 1176) and validation cohort (n = 551) containing patients who underwent curative resection of solitary HCC. In the development cohort study, the median values were 13.7 mL for TV, 24.2 ng/mL for α-fetoprotein (AFP), and 75 mAU/mL for des-γ-carboxy prothrombin (DCP); there was no correlation among these three factors (r 2 ≤ 0.237, p 5 cm or TV >50 mL, MVI, satellite nodules, and high DCP. Multiplication of AFP, DCP, and TV (ADV score) resulted in prediction of MVI at a cutoff of 5log with sensitivity of 73.9 % and specificity of 66.7 %. Patient stratifications according to ADV score with cutoffs of 5log alone, 6log and 9log, and its combination with MVI showed significant prognostic differences (all p
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- 2016
228. Portal vein stenting is a significant risk factor for biliary stricture in adult living donor liver transplantation: matched case-control study
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Gi-Won Song, Kyungeun Kim, Young-In Yun, Min-Ho Shin, S.-G. Lee, Chul-Soo Ahn, G.-C. Park, Sang-Hyun Hwang, Deok-Bog Moon, D.-H. Jung, and Tae-Yong Ha
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medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,medicine ,Portal vein ,Case-control study ,Gastroenterology ,Significant risk ,Living donor liver transplantation ,business - Published
- 2016
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229. Successful experiences of ABO-incompatible adult living donor liver transplantation for high-urgency patients in a single institute
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Sunghoon Kim, Gi-Won Song, S.-G. Lee, Sang-Hyun Hwang, Chul-Soo Ahn, Kyungeun Kim, J.-H. Kwon, Tae-Yong Ha, Deok-Bog Moon, D.-H. Jung, and G.-C. Park
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Pediatrics ,medicine.medical_specialty ,Hepatology ,business.industry ,ABO blood group system ,medicine ,Gastroenterology ,Living donor liver transplantation ,business - Published
- 2016
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230. Usability of cryopreserved aorta homografts for middle hepatic vein reconstruction during living donor liver transplantation
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Gi-Won Song, S.-G. Lee, Sunghoon Kim, Kyungeun Kim, Chul-Soo Ahn, G.-C. Park, Deok-Bog Moon, D.-H. Jung, Sang-Hyun Hwang, Tae-Yong Ha, and Woo-Hyoung Kang
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medicine.medical_specialty ,Aorta ,Hepatology ,business.industry ,Gastroenterology ,Usability ,Cryopreservation ,Surgery ,medicine.artery ,medicine ,Radiology ,business ,Living donor liver transplantation ,Vein reconstruction - Published
- 2016
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231. Clinicopathological Features and Long-Term Outcomes of Intraductal Papillary Neoplasms of the Intrahepatic Bile Duct
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Chul-Soo Ahn, Sang Soo Lee, Wan-Joon Kim, Deok-Bog Moon, Dong Wan Seo, Tae-Yong Ha, Do Hyun Park, Myeong-Hwan Kim, Kwang-Min Park, Gi-Won Song, Gil-Chun Park, Sung-Koo Lee, Dong-Hwan Jung, Shin Hwang, Yong-Joo Lee, Ki-Hun Kim, and Sung-Gyu Lee
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Adenoma ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Intrahepatic bile ducts ,Bile Duct Neoplasm ,Malignancy ,Gastroenterology ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Intrahepatic Cholangiocarcinoma ,Aged ,Retrospective Studies ,Papilloma ,business.industry ,Bile duct ,Middle Aged ,medicine.disease ,Prognosis ,medicine.anatomical_structure ,Bile Ducts, Intrahepatic ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Resection margin ,030211 gastroenterology & hepatology ,Surgery ,Female ,Hepatolithiasis ,Neoplasm Recurrence, Local ,business - Abstract
We intended to investigate the clinicopathological features of intrahepatic intraductal papillary neoplasms of the bile duct (IPNB), especially their malignant features and post-resection prognosis. Forty-three patients who met the definition of IPNB and who underwent liver resection between January 2002 and June 2015 were selected from our institutional database of liver resection cases. The mean age was 63.3 ± 6.9 years and 24 were male. Hepatolithiasis was present in addition in 10 of the patients. Left- and right-sided hepatectomies and concurrent bile duct resection (BDR) were performed in 28, 15, and 10 patients, respectively; R0 resection was performed in 37 patients. The mean tumor diameter was 4.1 ± 2.2 cm. Histological tumor grade was low in 4 cases, intermediate in 6, and malignant in 33. There was no cancer-related recurrence or death in the 10 patients with low-grade or intermediate lesions. In the 33 patients with malignant lesions, rates of tumor recurrence and overall survival were 12.5 and 96.2 % at 1 year, 36.4 and 91.3 % at 3 years, and 47.0 and 68.8 % at 5 years, respectively. Multivariate analysis showed that R1 resection was the only prognostic factor for tumor recurrence and patient survival. BDR was performed in only 2 of 6 patients undergoing R1 resection. Intrahepatic IPNB is a rare type of biliary neoplasm that encompasses a histological spectrum ranging from benign disease to invasive malignancy. Long-term survival was anticipated after curative resection. R1 resection reduced survival outcomes; therefore, we suggest that concurrent BDR should be performed if the resection margin of the bile duct is not reliably free of neoplastic involvement.
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- 2016
232. Cytomegalovirus infection-associated fulminant hepatitis in an immunocompetent adult requiring emergency living-donor liver transplantation: report of a case
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Young Dong Yu, Dong Hwan Jung, Chul Soo Ahn, Shin Hwang, Sung-Gyu Lee, Gi-Won Song, Young Il Choi, Gil Chun Park, Ki-Hun Kim, Pyoung Jae Park, Deog Bok Moon, and Tae Yong Ha
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Adult ,Ganciclovir ,Human cytomegalovirus ,medicine.medical_specialty ,Hepatitis, Viral, Human ,medicine.medical_treatment ,Congenital cytomegalovirus infection ,Liver transplantation ,Gastroenterology ,Internal medicine ,Massive Hepatic Necrosis ,Living Donors ,medicine ,Humans ,Fulminant hepatitis ,Hepatitis ,business.industry ,virus diseases ,General Medicine ,medicine.disease ,Liver Transplantation ,Cytomegalovirus Infections ,Immunology ,Female ,Surgery ,Liver function ,Emergencies ,business ,Immunocompetence ,medicine.drug - Abstract
Human cytomegalovirus (CMV) infection is usually self-limiting in healthy adults, but it can lead to significant complications. This report presents the case of an immunocompetent adult with fulminant hepatitis caused by a CMV infection requiring emergency living-donor liver transplantation. A 39-year-old female with persistent fever for 6 weeks was referred for fulminant hepatitis, but the underlying etiology was not identified. Rapid deterioration of consciousness led to an emergency living-donor liver transplant using a modified right lobe graft. She showed increasing CMV antigenemia after surgery and the explant liver pathology showed massive hepatic necrosis with positive staining for CMV protein. Treatment with ganciclovir improved the graft liver function and her general condition recovered. This report presents a rare case of CMV-associated fulminant hepatitis which led to emergency liver transplantation. Although CMV is rare, it should be included in the differential diagnosis of patients with severe hepatitis, even immunocompetent patients, after other more common etiologies have been excluded.
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- 2012
233. Resection of Pulmonary Metastases from Hepatocellular Carcinoma following Liver Transplantation
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Dong-Hwan Jung, Hyeong Ryul Kim, Shin Hwang, Chul-Soo Ahn, Sung-Won Jung, Tae-Yong Ha, Gil-Chun Park, Dong Kwan Kim, Sam-Youl Yoon, Jeong-Man Namgoong, Deog-Bok Moon, Ki-Hun Kim, Gi-Won Song, Yong-Hee Kim, Seung-Il Park, and Sung-Gyu Lee
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Lung Neoplasms ,medicine.medical_treatment ,Liver transplantation ,Gastroenterology ,Young Adult ,Postoperative Complications ,Risk Factors ,Internal medicine ,Carcinoma ,Humans ,Medicine ,Survival rate ,Survival analysis ,Retrospective Studies ,Univariate analysis ,Lung ,business.industry ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Survival Analysis ,Liver Transplantation ,Surgery ,medicine.anatomical_structure ,Hepatocellular carcinoma ,Female ,Metastasectomy ,business ,Algorithms - Abstract
This study was intended to assess the effect of resection of pulmonary metastasis (PM) of hepatocellular carcinoma (HCC) after liver transplantation (LT). No effective treatment modality exists for PM-HCC, and little is known about the posttransplant outcomes of pulmonary metastasectomy (PMT). Of 587 adult LT recipients diagnosed with HCC, 43 had PM-HCC. We retrospectively compared outcomes in 23 patients who underwent PMT and 20 who did not. PMT was precluded in ten patients in the non-PMT group by multiple (usually ≥5) lung nodules, in nine by lung nodules with concurrent or residual extrapulmonary metastasis, and in one by comorbidity. Of the 23 patients in the PMT group, 14 underwent a single session of PMT, 7 underwent 2 sessions each, and 2 underwent 3 sessions each, for a total of 34 sessions. There were no surgery-related deaths or complications. After first PMT, 41 nodules, each 0.2–2.5 cm in diameter, were observed: 1–5 nodules per patient. Every available treatment was provided to patients with post-PMT recurrence and those in the non-PMT group to control pulmonary and extrapulmonary metastases. Patient survival rates before PM diagnosis did not differ between the two groups (p = 0.141). However, 2 year post-PM survival rate was significantly greater in the PMT group (30.6% vs. 0%, p = 0.007), resulting in a significantly greater overall 5 year survival rate (44.7% vs. 12.8%, p = 0.017). Univariate analysis showed no risk factor significantly associated with patient survival after PMT. PMT should be performed for resectable PM-HCC because it may provide a chance of long-term survival.
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- 2012
234. Absence of Benefit of Transcatheter Arterial Chemoembolization (TACE) in Patients with Resectable Solitary Hepatocellular Carcinoma
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Chul-Soo Ahn, Han Chu Lee, Dong Ii Gwon, Deok-Bog Moon, Tae-Yong Ha, Ju Hyun Shim, Young-Suk Lim, Jeong-Heon Choi, Ki-Hun Kim, Gi-Young Ko, Shin Hwang, Young-Joo Lee, Gi-Won Song, Dong-Hwan Jung, Kang Mo Kim, and Sung-Gyu Lee
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Antineoplastic Agents ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Catheterization, Peripheral ,Republic of Korea ,Carcinoma ,medicine ,Hepatectomy ,Humans ,Infusions, Intra-Arterial ,Chemoembolization, Therapeutic ,Transcatheter arterial chemoembolization ,Survival rate ,Neoplasm Staging ,business.industry ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Prognosis ,Cardiac surgery ,Survival Rate ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiology ,business ,Abdominal surgery - Abstract
This study aimed to assess the prognostic impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival outcomes in patients undergoing resection of small solitary hepatocellular carcinoma (HCC). Enrolled patients had undergone macroscopic curative resection of solitary 2–5 cm HCC with (n = 105) or without (n = 830; control group) preoperative TACE. TACE group was divided into subgroups A (n = 68, 1–2 TACEs within 12 months), B (n = 23, ≥3 TACEs within 12 months), and C (n = 14, TACE prior to 12 months). The number of TACE sessions was 1.8 ± 1.6. In TACE A-C subgroups, pathological response of tumor necrosis >50 % at median post-TACE period after final TACE was observed in 41 (60.3 %) at 1.9 months, 10 (43.5 %) at 2.1 months, and 2 (14.3 %) at 18.9 months, respectively. The 5-year tumor recurrence and patient survival rates were 62.8 and 70.4 % in TACE group and 51.4 and 83.4 % in control group, respectively (p ≤ 0.003). Median periods of postoperative tumor recurrence in TACE A-C subgroups and control group were 35, 13, 14, and 55 months, respectively (p
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- 2015
235. Effectiveness of external drainage of the bile duct in pancreaticoduodenectomy: a single surgeon's experience
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Jong-Hee Yoon, Do Hyun Park, Dong-Hwan Jung, Sung-Gyu Lee, Ki-Hun Kim, Shin Hwang, Yo-Han Park, Sang Soo Lee, Hyo-Jun Lee, Jung-Man Namgoong, Gil-Chun Park, Deok-Bog Moon, Tae-Yong Ha, Sung-Koo Lee, Myung-Hwan Kim, Dong Wan Seo, Sam-Youl Yoon, Chul-Soo Ahn, Cheon-Soo Park, Sung-Won Jung, Hyung-Woo Park, and Gi-Won Song
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Pancreatic duct ,medicine.medical_specialty ,Bile duct ,business.industry ,medicine.medical_treatment ,Anastomosis ,Pancreaticoduodenectomy ,Single surgeon ,Surgery ,Jejunum ,medicine.anatomical_structure ,Pancreaticojejunostomy ,Pancreatic juice ,medicine ,Original Article ,business ,Leakage ,External drainage - Abstract
Backgrounds/Aims The rates of surgery-related complications during and after pancreaticoduodenectomy (PD) remain very high, reaching up to 41%. They were primarily caused by leakage of pancreatic juice. We evaluated the effectiveness of external drainage of the bile duct using a pigtail drain to prevent pancreatic leakage in patients undergoing PD. Methods We evaluated 79 patients who underwent PD using a single-layer continuous suture between the pancreatic parenchyma and jejunum after duct-to-mucosa anastomosis by a single surgeon from April 2005 to December 2008. Of the 79, 44 underwent external drainage (ED) of the bile duct using a pigtail drain, performed in the intraoperative field via a retrograde transhepatic approach, whereas 35 did not undergo ED. Results Age, sex distribution, number of total complications, pancreatic duct size, pancreatic texture and duration of hospital stay did not differ between patients who did and did not undergo ED. In groups with or without ED, 0 and 4 patients, respectively, showed leakage of pancreatic juice and the difference was statistically significant (p=0.02). Conclusions The fact that none of the patients who underwent external drainage experienced pancreatic leakage, suggests that external drainage of the bile duct with a pigtail drain to decompress the jejunum and to drain pancreatic and bile juice is useful in preventing the complications of pancreatic leakage.
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- 2011
236. Successful ABO Incompatible Adult Living Donor Liver Transplantation with New Simplified Protocol without Local Infusion Therapy and Splenectomy
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Sung-Won Jung, Dong Hwan Jung, Gil Chun Park, Jung Man Namgung, Tae Yong Ha, Shin Hwang, Sung-Gyu Lee, Chul Soo Ahn, Gi-Won Song, Sam Yeol Yoon, Ki-Hun Kim, and Deok Bog Moon
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Immunology ,Significant difference ,Group ii ,Splenectomy ,Graft function ,Surgery ,Infusion therapy ,ABO blood group system ,Medicine ,Graft survival ,business ,Living donor liver transplantation - Abstract
Results: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 ± 0.4 (0.9∼28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. Conclusions: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.
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- 2011
237. Posttransplantation prophylaxis with primary high-dose hepatitis B immunoglobulin monotherapy and complementary preemptive antiviral add-on
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Chul-Soo Ahn, Tae-Yong Ha, Han Chu Lee, Young-Suk Lim, Heung-Bum Oh, Dong-Hwan Jung, Sung-Gyu Lee, Shin Hwang, Ki-Hun Kim, Deok-Bog Moon, Young-Hwa Chung, and Gi-Won Song
- Subjects
Hepatitis B virus ,Transplantation ,medicine.medical_specialty ,Hepatology ,Combination therapy ,Exacerbation ,business.industry ,medicine.medical_treatment ,Lamivudine ,Entecavir ,Liver transplantation ,medicine.disease_cause ,Hepatitis B immunoglobulin ,Gastroenterology ,Surgery ,Internal medicine ,medicine ,Adefovir ,business ,medicine.drug - Abstract
A considerable proportion of liver transplantation recipients who receive hepatitis B immunoglobulin (HBIG) monotherapy for hepatitis B virus (HBV) prophylaxis develop resistance to HBIG. We retrospectively assessed the efficacy of HBV prophylaxis in 1524 patients who received primary high-dose HBIG monotherapy (n = 1463) or with a preemptive antiviral add-on as secondary combination therapy (n = 61). At a median follow-up time of 57 months, 106 (7.3%) patients receiving HBIG monotherapy experienced HBV recurrence, with a 10-year HBV recurrence rate of 9.8%, compared to none of the patients receiving preemptive combination therapy (P = 0.047). Thirteen patients (12.3%) with HBV recurrence failed antiviral therapy, leading to death or retransplantation. Response rates to rescue therapy before and after use of adefovir/entecavir were 44.4% and 91.8%, respectively. Acute exacerbation was not associated with treatment failure, but required prolonged treatment. Of 84 surviving patients with HBV recurrence, 44 (52.4%) showed no evidence of blood HBV DNA. The Gly145Arg mutation was found in 11 of 15 (73.3%) patients, whereas 25 of 71 (35.2%), 2 of 29 (6.9%), and 4 of 8 (50%) patients were resistant to lamivudine, adefovir, and entecavir, respectively. In conclusion, our finding of a 10-year HBV recurrence rate of 9.8% in patients receiving high-dose HBIG monotherapy indicates that this treatment is effective but requires complementary measures. Strict surveillance following HBIG monotherapy is necessary to enhance responses to rescue antiviral therapy. Preemptive conversion to combination therapy has a complementary role in prophylaxis with primary high-dose HBIG monotherapy, especially for patients at high risk of HBV recurrence.
- Published
- 2011
238. Side-to-End Renoportal Anastomosis Using an Externally Stented Polytetrafluoroethylene Vascular Graft for a Patient with a Phlebosclerotic Portal Vein and a Large Spontaneous Splenorenal Shunt
- Author
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Gil Chun Park, Chul Soo Ahn, Deok Bog Moon, Young Dong Yu, Tae Yong Ha, and Sung-Gyu Lee
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Biocompatible Materials ,Liver transplantation ,Anastomosis ,Inferior vena cava ,Renal Veins ,Blood Vessel Prosthesis Implantation ,Blood vessel prosthesis ,Living Donors ,medicine ,Humans ,Vascular Diseases ,Superior mesenteric vein ,Polytetrafluoroethylene ,Sclerosis ,Portal Vein ,business.industry ,Anastomosis, Surgical ,Great saphenous vein ,Middle Aged ,medicine.disease ,Thrombosis ,Blood Vessel Prosthesis ,Liver Transplantation ,Surgery ,Stenosis ,surgical procedures, operative ,medicine.vein ,Splenic Vein ,Stents ,Radiology ,business - Abstract
Adequate portal flow to a transplanted liver graft is important for good graft function after both deceased donor whole liver transplantation and living donor partial liver transplantation. Particularly in living donor liver transplantation (LDLT), adequate portal flow enables the partial liver graft to regenerate rapidly and to satisfy the recipient’s increased metabolic demands during the posttransplant period. When severe portal vein stenosis or thrombosis with hepatofugal collateral vessels is present due to advanced cirrhosis, conventional anastomosis between the portal veins (PVs) of the donor and recipient may provide inadequate portal flow to the graft. Various techniques have made liver transplantation feasible, including thrombectomy, plasty using autologous saphenous vein and/or stent placement in the recipient PV, and interposition of a venous graft between the graft PV and the recipient’s superior mesenteric vein. These procedures, owever, cannot be performed when PV thrombosis has ropagated to the superior mesenteric vein, or when disection of the superior mesenteric vein is difficult due to epeated episodes of spontaneous bacterial peritonitis. Patients with obliterated PV due to phlebosclerosis and arge splenorenal shunt (SRS), a special type of PV thromosis, are not uncommon, but it is technically challenging o restore PV flow to the graft using conventional PV reonstruction techniques. This problem has been solved in eceased donor whole liver transplantation by end-to-end ype renoportal anastomosis, using an interposition graft of adaveric iliac vein between the left renal vein (LRV) of the ecipient and the graft PV. In addition, LDLT has been
- Published
- 2011
239. Prevalence and Treatment of New-Onset Diabetes Mellitus After Liver Transplantation in Korean Children: A Single-Center Study
- Author
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S.-G. Lee, Jung-Man Namgung, J.M. Cho, Tae-Yong Ha, Seok-Hee Oh, Gi-Won Song, Chul-Soo Ahn, Kyung Mo Kim, Dae Yeon Kim, Kyungeun Kim, Sang-Hyun Hwang, and Deok-Bog Moon
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Liver transplantation ,Single Center ,New onset diabetes ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,medicine ,Humans ,Child ,Transplantation ,Korea ,business.industry ,Insulin ,Medical record ,Infant ,Immunosuppressive regimen ,medicine.disease ,Tacrolimus ,Liver Transplantation ,Child, Preschool ,Female ,Surgery ,business - Abstract
The aim of this study was to investigate the prevalence, clinical characteristics, and management of new-onset diabetes mellitus (NODM) in Korean children with liver transplantation (LT). We retrospectively analyzed the medical records of 200 pediatric patients (5 months to 17 years old) who underwent LT at Asan Medical Center between January 1994 and December 2010; 26 pediatric patients who died at the maximal follow-up after LT or who were lost to follow-up were excluded from the study. Among these 174 children, NODM after LT developed in 18. The median interval time at the presentation of NODM after LT was 15 days (range, 1 day to 16.0 years), whereas the median patient age of NODM diagnosis was 10 years (range, 1.1 to 17.0 years). Insulin treatment with reduction in tacrolimus dosage, steroid tapering, and conversion from tacrolimus to cyclosporine with or without mycophenolate mofetil is highly effective in NODM after LT. In conclusion, careful diabetes mellitus monitoring and modification of immunosuppressive regimen should be required in pediatric patients after LT.
- Published
- 2014
240. Renoportal anastomosis for dual-graft living donor liver transplantation using an artificial graft and a left renal vein-connected inferior vena cava cuff
- Author
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Chul-Soo Ahn, Hyung-Woo Park, Gi-Won Song, Dong-Hwan Jung, Deok-Bog Moon, Jung-Man Namkoong, Ki-Hun Kim, Sung-Hwa Kang, F.A.C.S. Sung-Gyu Lee M.D., Tae-Yong Ha, Yo-Han Park, Bo-Hyun Jung, Shin Hwang, and Gil-Chun Park
- Subjects
Transplantation ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Left renal vein ,Liver transplantation ,Anastomosis ,Inferior vena cava ,Surgery ,Artificial graft ,medicine.vein ,Cuff ,Renoportal anastomosis ,Medicine ,business ,Living donor liver transplantation - Published
- 2014
241. Right Lobe Estimated Blood-free Weight for Living Donor Liver Transplantation: Accuracy of Automated Blood-free CT Volumetry—Preliminary Results
- Author
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Jeong Ik Park, Hyung Jin Won, Ho Lee, Ki-Hun Kim, Chul-Soo Ahn, Yong Moon Shin, Kyoung Won Kim, Jeongjin Lee, Deok-Bog Moon, Sung-Gyu Lee, Woo Kyoung Jeong, Shin Hwang, Tae-Yong Ha, Dong-Hwan Jung, and Gi-Won Song
- Subjects
Adult ,Male ,medicine.medical_treatment ,Pilot Projects ,Liver transplantation ,Sensitivity and Specificity ,Imaging, Three-Dimensional ,Living Donors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ct volumetry ,Blood Volume ,business.industry ,Reproducibility of Results ,Organ Size ,Lobe ,Liver Transplantation ,Absolute deviation ,Blood donor ,medicine.anatomical_structure ,Liver ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Tomography, X-Ray Computed ,Living donor liver transplantation ,Nuclear medicine ,business - Abstract
To determine the relative accuracy of automated blood-free to blood-filled computed tomographic (CT) volumetry for estimation of right-lobe weight in living donor liver transplantation.This retrospective study was approved by the institutional review board; informed consent was waived. Between October 1, 2008, and April 30, 2009, 88 live liver donors (54 men, 34 women; mean age, 26.1 years +/- 6.9 [standard deviation]) who underwent CT and had their right lobes procured in the study institution were included. Automated measurement of blood-filled volume (V(BFill)) and blood-free volume (V(BFree)) of the right lobe was performed by using 16-row multidetector CT performed with 5-mm intervals. Actual hepatic weight was measured blood free during surgery. Percentage blood volume, %V(B), was calculated as follows: %V(B) = V(BFill) - V(BFree)/V(BFill) . 100. Pearson tests were performed to determine correlation coefficients between V(BFill)/1.22 or V(BFree) and weight. Percentage deviation and percentage absolute deviation of V(BFree) from weight were compared with those of V(BFill)/1.22 by using a paired t test or Wilcoxon rank sum test. Regression analysis was performed between V(BFree) and weight.Mean V(BFill), V(BFree), and weight were 789.0 mL +/- 126.4, 713.9 mL +/- 114.4, and 717.8 g +/- 110.4. Percentage blood volume varied from 6.5% to 19.8% (mean, 9.5%). Compared with weight, the correlation coefficient was slightly higher with V(BFree) (r = 0.9140) than with V(BFill)/1.22 (r = 0.8909). Mean percentage deviation and percentage absolute deviation were significantly smaller with V(BFree) (-0.4% +/- 6.3, 5.0% +/- 3.8; P.001) than with V(BFill)/1.22 (-9.8% +/- 6.5, 10.2% +/- 7.3; P.001). The equation relating V(BFree) and weight, W, was as follows: W = (0.8815 . V(BFree)) + 88.5117, with R(2) of 0.8355 (P.001).At automated CT volumetry in live liver donors, the percentage blood volume varies. The V(BFree) is more accurate than is V(BFill)/1.22 in estimation of hepatic weight.
- Published
- 2010
242. Comparison between Cadaveric Whole Liver and Live Donor Partial Liver Transplantation in High Risk Patients with MELD Score more than 40
- Author
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Sung-Gyu Lee, Deok Bok Moon, Gi-Won Song, Gil Chun Park, Shin Hwang, Dong Hwan Jung, Tae Yong Ha, Ki-Hun Kim, and Chul Soo Ahn
- Subjects
Transplantation ,medicine.medical_specialty ,High risk patients ,Live donor ,business.industry ,medicine.medical_treatment ,Whole liver ,medicine ,Liver transplantation ,business ,Cadaveric spasm ,Surgery - Published
- 2018
243. Pegylated Interferon-Based versus Direct-Acting Antiviral-Based Preemptive Treatment of HCV After Adult Living Donor Liver Transplantation
- Author
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Sang-Hyun Kang, Dong-Hwan Jung, Yong-Kyu Chung, Ki-Hun Kim, Gi-Won Song, Jae Hyun Kwon, Gil-Chun Park, Chul-Soo Ahn, Deok-Bog Moon, Shin Hwang, Tae-Yong Ha, and Su-Min Ha
- Subjects
Transplantation ,business.industry ,Pegylated interferon ,Medicine ,Pharmacology ,Living donor liver transplantation ,business ,Direct acting ,medicine.drug - Published
- 2018
244. Does Calcineurin Inhibitor Plus Mycophenolate Mofetil Combination Therapy Decrease the Risk of Late Acute Rejection after Liver Transplantation?
- Author
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Gi-Won Song, Dong-Hwan Jung, Chul-Soo Ahn, Young-Dong Yu, Sung-Gyu Lee, Nam-Kyu Choi, Gil-Chun Park, Ki-Hun Kim, Young-Il Choi, Shin Hwang, P.J. Park, Deok-Bog Moon, Jeong-Ik Park, Tae-Yong Ha, and Kwan-Woo Kim
- Subjects
Calcineurin ,Transplantation ,medicine.medical_specialty ,Combination therapy ,business.industry ,medicine.medical_treatment ,Immunology ,Urology ,medicine ,Liver transplantation ,business ,Mycophenolate - Abstract
Does Calcineurin Inhibitor Plus Mycophenolate Mofetil Combination Therapy Decrease the Risk of Late Acute Rejection after Liver Transplantation? Kwan-Woo Kim, M.D., Sung-Gyu Lee, M.D., Shin Hwang, M.D., Ki-Hun Kim, M.D., Chul-Soo Ahn, M.D., Deok-Bog Moon, M.D., Tae-Yong Ha, M.D., Gi-Won Song, M.D., Dong-Hwan Jung, M.D., Nam-Kyu Choi, M.D., Jeong-Ik Park, M.D., Gil-Chun Park, M.D., Young-Dong Yu, M.D., Pyung-Jae Park, M.D. and Young-Il Choi, M.D.
- Published
- 2010
245. Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts
- Author
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Young Dong Yu, Dong Il Gwon, Kyu Bo Sung, Gil Chun Park, Sung-Gyu Lee, Ki-Hun Kim, Dong Hwan Jung, Nam Kyu Choi, Chul Soo Ahn, Kyoung Won Kim, Deok Bog Moon, Gi-Won Song, Tae Yong Ha, Kwan Woo Kim, Gi Young Ko, and Shin Hwang
- Subjects
Transplantation ,medicine.medical_specialty ,Right hepatic vein ,Hepatology ,business.industry ,medicine.medical_treatment ,Context (language use) ,Liver transplantation ,medicine.disease ,Inferior vena cava ,Lobe ,Surgery ,Stenosis ,medicine.anatomical_structure ,medicine.vein ,medicine ,Radiology ,business ,Living donor liver transplantation - Abstract
The incidence of clinically significant right hepatic vein (RHV) stenosis after adult living donor liver transplantation has been higher than expected. In this study, an assessment of the risk factors for the development of RHV stenosis in this context was undertaken. Hepatic anatomy, surgical techniques, and the incidence of RHV stenosis 1 year after transplantation were evaluated retrospectively in 225 recipients of right lobe grafts. These patients underwent independent RHV reconstruction, which was facilitated by the application of computed tomography morphometry and computational simulation analyses. Three types of preparation of the orifice of the graft RHV and 7 types of preparation for venoplasty of the recipient RHV were used. The frequency of high, middle, and low sites of RHV insertion into the inferior vena cava (IVC) was 56.0%, 36.4%, and 7.6%, respectively, for donors, and 26.7%, 58.7%, and 14.7%, respectively, for recipients. Nine patients (4%) developed RHV stenosis of early onset that required stent insertion during the first 2 postoperative weeks; in 12 patients (5.3%), RHV stenosis of delayed onset occurred. Inappropriate matching of RHV sites of insertion correlated with the incidence of stenosis of early onset (P = 0.039). Technical refinements to avoid adverse consequences of inappropriate ventrodorsal matching of RHV sites of insertion include making the recipient RHV orifice wide and enlarging the recipient IVC by a customized incision and patch venoplasty after anatomical assessment of the RHV and IVC of the graft and recipient. Liver Transpl 16:639-648, 2010. © 2010 AASLD.
- Published
- 2010
246. Impact of preoperative management in patients older than 80 years requiring cholecystectomy
- Author
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Dakyum Shin, Song Cheol Kim, Shin Hwang, Gi-Won Song, Dong-Hwan Jung, Ki-Hum Kim, Deok-Bog Moon, Chul-Soo Ahn, Tae-Yong Ha, Dae Wook Hwang, Young-Joo Lee, Ki Byung Song, and Seok-Hwan Kim
- Subjects
medicine.medical_specialty ,business.industry ,Preoperative care ,Medical record ,medicine.medical_treatment ,Mortality rate ,Perioperative ,Gallbladder Stone ,Surgery ,ASA score ,Anesthesiology ,medicine ,Original Article ,Cholecystectomy ,General Materials Science ,In patient ,business ,Aged - Abstract
Backgrounds/Aims Elderly patients aged >80 yr have high morbidity and mortality rates after biliary surgery, especially in emergency operations. We conducted this study to determine the effect of preoperative management on the outcome of elderly patients undergoing cholecystectomy. Methods The medical records of 452 elderly (≥80 yr old) patients who underwent cholecystectomy from January 1997 to December 2015 were reviewed retrospectively. We divided the patients into 2 groups: intervention (preoperative biliary drainage) and non-intervention groups. We evaluated the effects of preoperative management on the American Society of Anesthesiology (ASA) score and perioperative outcomes. Results Among the preoperative biliary drainage intervention group (n=286), 48 patients (51.7%) were diagnosed as having gallbladder stone combined with common bile duct stone. On admission, the proportion of patients with ASA score ≥3 and WBC counts were significantly higher in the intervention group than in the non-intervention group (p
- Published
- 2018
247. Management of very late peritoneal metastasis of hepatocellular carcinoma 10 years after liver transplantation: Lessons from two cases
- Author
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Gil-Chun Park, Su-Min Ha, Shin Hwang, Chul-Soo Ahn, Sung-Gyu Lee, Deok-Bog Moon, Ki-Hun Kim, Gi-Won Song, Yohan Park, Tae-Yong Ha, Abdulwahab A Alshahrani, and Dong-Hwan Jung
- Subjects
Sorafenib ,medicine.medical_specialty ,Peritoneal metastasis ,Hepatocellular carcinoma ,medicine.medical_treatment ,Case Report ,030230 surgery ,Liver transplantation ,Gastroenterology ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,medicine ,General Materials Science ,Tumor marker ,Everolimus ,business.industry ,Resection ,medicine.disease ,digestive system diseases ,Sirolimus ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Recurrence of hepatocellular carcinoma (HCC) 10 years after liver transplantation (LT) is very rare. Here, we present two cases of peritoneal metastasis of HCC that occurred 10 and 12 years after LT. A 77-year-old male who had undergone deceased-donor LT 10 years earlier showed slow progressive elevation of tumor marker levels over 6 months. Close observation with frequent imaging studies and monthly tumor marker analyses revealed a solitary peritoneal seeding mass. Imaging studies revealed that the mass was highly likely to be metastatic HCC. After excision of the mass, all tumor markers returned to the normal range. Over past 10 months, the patient has received everolimus monotherapy and half-dose sorafenib, and has shown no evidence of HCC recurrence. In the second case, marginally elevated tumor marker levels were detected in a 65-year-old male who had undergone living-donor LT 12 years earlier. After observation for 3 months, follow-up studies revealed a peritoneal seeding mass. Thorough imaging studies revealed that the mass was highly likely to be metastatic HCC. Two mass lesions were excised, and the patient was administered low-dose calcineruin inhibitor, sirolimus, and full-dose sorafenib. Subsequently, the tumor marker levels increased again and growth of new peritoneal seeding nodules was observed; therefore, sorafenib was stopped after 2 years of administration. During 6 years since HCC recurrence diagnosis, the patient has experienced slowly growing tumors, but has been doing well. For very late peritoneal metastasis of HCC, the therapeutic modalities include surgical resection if possible, everolimus monotherapy, and long-term use of sorafenib.
- Published
- 2018
248. A clinical assessment of mycophenolate drug monitoring after liver transplantation
- Author
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Gil Chun Park, Dong Hwan Jung, Young Dong Yu, Sung-Gyu Lee, Pyoung Jae Park, Chul Soo Ahn, Deok Bog Moon, Nam Kyu Choi, Young Il Choi, Ki-Hun Kim, Shin Hwang, Tae Yong Ha, Gi-Won Song, and Kwan Woo Kim
- Subjects
Transplantation ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Urology ,Immunosuppression ,Liver transplantation ,Mycophenolate ,Mycophenolic acid ,Tacrolimus ,Surgery ,surgical procedures, operative ,Pharmacokinetics ,Therapeutic drug monitoring ,medicine ,Dosing ,business ,medicine.drug - Abstract
Hwang S, Lee S-G, Ahn C-S, Kim K-H, Moon D-B, Ha T-Y, Song G-W, Jung D-H, Choi N-K, Kim K-W, Yu Y-D, Park G-C, Park P-J, Choi Y-I. A clinical assessment of mycophenolate drug monitoring after liver transplantation. Clin Transplant 2010 DOI: 10.1111/j.1399-0012.2009.01166.x © 2010 John Wiley & Sons A/S. Abstract: Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF). Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it. Methods: A series of short-term prospective studies on TDM for MPA and/or tacrolimus was performed at a large-volume center. Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus–MMF therapy (n = 270), MMF-minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus–MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF-minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF-minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%. Conclusion: MPA TDM-based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation.
- Published
- 2010
249. Outcome comparison of liver transplantation for hepatitis A-related versus hepatitis B-related acute liver failure in adult recipients
- Author
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Chul-Soo Ahn, Deok-Bog Moon, Dong-Hwan Jung, Young-Suk Lim, Sung-Gyu Lee, Shin Hwang, Ki-Hun Kim, Gi-Won Song, Gil-Chun Park, and Tae-Yong Ha
- Subjects
Adult ,Male ,Hepatitis B virus ,medicine.medical_specialty ,Multivariate analysis ,viruses ,medicine.medical_treatment ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Transplantation ,business.industry ,fungi ,digestive, oral, and skin physiology ,Liver failure ,virus diseases ,Hepatitis A ,Liver Failure, Acute ,Hepatitis B ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Surgery ,Survival Rate ,Treatment Outcome ,Pancreatitis ,Acute pancreatitis ,Female ,030211 gastroenterology & hepatology ,Hepatitis A virus ,business ,Follow-Up Studies - Abstract
Hepatitis A virus (HAV) can cause acute liver failure (ALF). This study compares outcomes between liver transplantation (LT) for HAV-related ALF (HAV-ALF) and LT for Hepatitis B virus (HBV)-related ALF (HBV-ALF). Of 3,616 adult LTs performed between January 2005 and December 2014, we performed LT for HAV-ALF recipients (n = 29) and LT for HBV-ALF recipients (n = 34). HAV-ALF group included 18 males and 11 females with mean age of 33.1 years. Graft survival rates in HAV-ALF and HBV-ALF were 65.5% and 88.0% (1 year) and 65.5% and 84.0% (5 years) (P = 0.048). Patient survival rates in HAV-ALF and HBV-ALF were 69.0% and 88.0% (1 year) and 69.0% and 84.0% (5 years) (P = 0.09). Multivariate analyses demonstrated that acute pancreatitis and HAV recurrence were independent risk factors of graft and patient survival. Posttransplant outcome was poorer in patients with HAV-ALF than in those with HBV-ALF. This weakens LT's appropriateness in HAV-ALF patients with pancreatitis. HAV recurrence after LT for HAV-ALF is common and often fatal, thus HAV recurrence should be monitored vigilantly, beginning early post-transplant. This article is protected by copyright. All rights reserved.
- Published
- 2017
250. Effectiveness of Plasmapheresis as a Liver Support for Graft Dysfunction Following Adult Living Donor Liver Transplantation
- Author
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Dong-Hwan Jung, Shin Hwang, Yu-Sun Min, Seog-Woon Kwon, P.J. Park, Young-Il Choi, Young-Dong Yu, Tae-Yong Ha, Kwan-Woo Kim, Gil-Chun Park, Deok-Bog Moon, Suk-Kyung Hong, Geum Borae Park, Ki-Hun Kim, Jeong-Ik Park, Nam-Kyu Choi, Sung-Gyu Lee, Chul-Soo Ahn, Kyu-Hyouck Kyoung, and Gi-Won Song
- Subjects
Transplantation ,medicine.medical_specialty ,Graft dysfunction ,Bilirubin ,business.industry ,medicine.medical_treatment ,Immunology ,Surgery ,Liver graft ,chemistry.chemical_compound ,chemistry ,medicine ,Plasmapheresis ,Living donor liver transplantation ,business - Abstract
1 , Seog-Woon Kwon, M.D. 2 , Gil-Chun Park, M.D. Conclusions: The results of this study implicate that PP has a beneficial effect on the recovery of liver graft function, especially during the early posttransplant period. We suggest to perform active application of PP therapy for liver recipients showing severe graft dysfunction of total bilirubin greater than 15∼20 mg/dL.
- Published
- 2009
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