• Journal of Korean Medical Science
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• v.33 no.51
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• pp.324.1-324.6
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• 2018

Oxysterol $7{\alpha}$-hydroxylase deficiency is a very rare liver disease categorized as inborn errors of bile acid synthesis, caused by CYP7B1 mutations. As it may cause rapid progression to end-stage liver disease even in early infancy, a high index of suspicion is required to prevent fatal outcomes. We describe the case of a 3-month-old boy with progressive cholestatic hepatitis and severe hepatic fibrosis. After excluding other etiologies for his early liver failure, we found that he had profuse urinary excretion of $3{\beta}$-monohydroxy-${\Delta}^5$-bile acid derivatives by gas chromatography/mass spectrometry analysis with dried urine spots on filter paper. He was confirmed to have a compound heterozygous mutation (p.Arg388Ter and p.Tyr469IlefsX5) of the CYP7B1 gene. After undergoing liver transplantation (LT) from his mother at 4 months of age, his deteriorated liver function completely normalized, and he had normal growth and development until the current follow-up at 33 months of age. We report the first Korean case of oxysterol $7{\alpha}$-hydroxylase deficiency in the youngest infant reported to undergo successful living donor LT to date.

• Annals of Surgical Treatment and Research
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• v.95 no.6
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• pp.333-339
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• 2018

Purpose: The purpose of this study was to describe the long-term effects of stenting in patients with hepatic venous outflow obstruction (HVOO), who underwent living donor liver transplantation (LDLT). Methods: Between January 2000 and December 2009, 622 adult patients underwent LDLT at our hospital, and of these patients, 21 (3.3%) were diagnosed with HVOO; among these patients, 17 underwent stenting. The patients were divided into early or late groups according to the time of their HVOO diagnoses (cutoff: 60 days after liver transplantation). Results: The median follow-up period was 54.2 months (range, 0.5-192.4 months). Stent insertion was successful in 8 of 10 patients in the early group and 6 of 7 in the late group. The 5-year primary patency rates were 46% and 20%, respectively. In both groups, patients with recurrent HVOO at the beginning showed kinking confirmed by venography. Patients who carried their stents for more than 3 years maintained long-term patency. There was no significant difference in spleen size between groups; however, when the groups were compared according to whether they maintained patency, spleens tended to be smaller in the patency-maintained group. Conclusion: Unlike stenosis, if kinking is confirmed on venography, stenting is not feasible in the long term for patients with LDLT.

• Korean Journal of Transplantation
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• v.31 no.4
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• pp.200-206
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• 2017

Background: Risk factors for bone avascular necrosis (AVN), a common late complication after kidney transplantation (KT), are not well known. Methods: Patients that underwent living-donor KT at Asan Medical Center between January 2009 and July 2016 were included in this retrospective study to determine the incidence and risk factors for AVN after KT. Results: Among 1,570 patients that underwent living-donor KT, 33 (2.1%) developed AVN during a mean follow-up of 49.8±25.0 months. Additionally, AVN was diagnosed at a mean of 13.9±6.6 months after KT. The mean cumulative corticosteroid dose during the last follow-up in patients without AVN (9,108±3,400 mg) was higher than that that in patients with AVN (4,483±1,114 mg) until AVN development (P<0.01). More patients among those with AVN (n=4, 12.1%) underwent steroid pulse treatment because of biopsy-proven rejections during the first 6 months after KT than patients without AVN (n=68, 4.4%; P=0.04). Female (hazard ratio [HR], 2.29; P=0.04) and steroid pulse treatment during the first 6 months (HR, 2.31; P=0.02) were significant AVN risk factors as revealed by the Cox proportional multivariate analysis. However, no significant differences in rejection-free graft survival rates were observed between the two groups (P=0.67). Conclusions: Steroid pulse treatment within 6 months of KT and being female were independent risk factors for AVN development.

• Journal of Korean Academy of Nursing
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• v.28 no.2
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• pp.291-302
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• 1998

The purpose of this phenomenological study was to understand and describe the essence and the structure of lived experience of people with kidney transplantation. Initially, nine individual interviews were conducted to gather data regarding their subjective experiences. And two focus group interviews were utilized to validate or discard the themes that were emerged from the analysis using Colaizzi's method. Among 17 participants, 13 had living related kidney donations, one living unrelated, and the remaining two cadavor donations. About 130 significant statements were extracted and these were clustered into 11 themes. All participants felt anxiety and fear toward the rejection of transplantation and the complication of immunosuppressive drugs. Although they were initially satisfied with their life after kidney transplantation, most of them lost a self-confidence and experienced loneliness, depression, and despair. Most of the participants also felt guilty for not being able to accomplish their appropriate roles in the family, They also had financial difficulties and social restrictions. However, they overcame these psychosocial distress by exercising, working and sharing love with others. They also could overcome it by living a religious life and by working to help others with kidney transplantations. Most of them felt gratitude toward the donor and did not have a psychological rejection toward the kidney transplanted. The results of the study might help nurses who work with people with kidney transplantations in establishing and implementing an effective nursing intervention by understanding their lived experience.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.1-12
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• 2001

Liver transplantation is widely accepted as an effective therapeutic modality for a variety of irreversible acute and chronic liver diseases for which no satisfactory therapy is available. Following the first unsuccessful efforts at human liver transplantation in 1963, development of the procedure evolved at first slowly and steadily for 20 years and then rapidly over the past two decades. The growth of liver transplantation was facilitated by the conclusion of the national institutes of health consensus development conference in 1983 that liver transplantation is not an experimental procedure but an effective therapy that deserves broader application. The number of liver transplantations increased 2.4-fold(from 1.713 to 4.058) from 1988 to 1996. but the number of patients on the UNOS(united network of organ sharing) liver list increased 12.1-fold(from 616 to 7,467); as would be expected, the number of deaths of listed patients increased 4.9-fold(from 195 to 954), The current supply of donor livers is insufficient to meet this need, and organ donation has been stagnant or increased by only a few percent in recent years. These facts underscore the importance of the appropriate selection of candidates for liver transplantation and the development of operative procedures, such as living donor liver transplant, split liver transplant and auxiliary partial liver transplant.

• Journal of Magnetics
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• v.19 no.3
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• pp.261-265
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• 2014

Three-dimensional computed tomography is an effective tool to estimate the liver volume of living donors for the live liver transplantation. When additional operation is required, magnetic resonance imaging is conducted to determine the safety of the donor. This study compared the accuracy of magnetic resonance imaging and computed tomography in estimating 3D liver volume of 23 male and 7 female donors who underwent both magnetic resonance imaging and computed tomography tests before the transplantation. The analysis was conducted to see whether the liver's estimated total volumes and the left lobe volumes obtained from 3D-magnetic resonance imaging and 3D-computed tomography were identical. Volumes of the right lobe estimated with 3D-magnetic resonance imaging and 3D-computed tomography were compared with the actual volume of the right lobe harvested in the operating room because the volume of the right lobe is an important determinant in the safety of the donor. The total volume of the liver estimated from 3D-magnetic resonance imaging and 3D-computed tomography differed (1238.1904 units and 1402.364 units respectively). The left lobe volume of the liver estimated with 3D-magnetic resonance imaging and 3D-computed tomography also differed (450.530 units and 554.490 units, respectively). The right lobe volume of the liver estimated with 3D-magnetic resonance imaging and 3D-computed tomography were 787.660 units and 847.545 units, respectively, while the actual average right lobe volume of the harvested liver was 678.636 units. 3D-computed tomography has been widely used to estimate the right lobe volume of the donors' liver. However, 3D-magnetic resonance imaging was also very effective in estimating the volume of the liver. Thus, 3D-magnetic resonance imaging is also expected to become an important tool in determining the safety of the donors before transplantation.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.267-277
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• 2018

Purpose: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017. Methods: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81.9%), and into 3 periods based on the number of cases (first 300 cases, middle 300 cases, last 400 cases). Results: Infection was the most common cause of death, accounting for 34.8% (95 of 273). Mortality due to hepatocellular carcinoma recurrence occurred most frequently between 1 and 5 years after transplantation. Mortality rate by graft rejection was highest between 5 and 10 years after transplantation. And mortality by de novo malignancy occurred most frequently after 10 years after transplantation. The patient survival rates for the entire population at 5 and 10 years were 74.7%, and 68.6%, respectively. There was no difference in survival rate between the LDLT and DDLT groups (P = 0.188). Cause of disease, disease severity, case period, and retransplantation had a significant association with patient survival (P = 0.002, P = 0.031, P = 0.003, and P = 0.024, respectively). Conclusion: Surgical techniques and perioperative management for transplant patients have improved and undergone standardization. Controlling perioperative infection and managing patients with HCC as LT candidates will result in better outcomes.

• Progress in Medical Physics
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• v.19 no.3
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• pp.178-185
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• 2008

Living donor liver transplantation is increasingly performed as an alternative to cadaveric transplantation. Preoperative screening of the donor candidates is very important. The quality, size, and vascular and biliary anatomy of the liver are best assessed with magnetic resonance (MR) imaging or computed tomography (CT). In particular, the volume of the potential graft must be measured to ensure sufficient liver function after surgery. Preoperative liver segmentation has proved useful for measuring the graft volume before living donor liver transplantations in previous studies. In these studies, the liver segments were manually delineated on each image section. The delineated areas were multiplied by the section thickness to obtain volumes and summed to obtain the total volume of the liver segments. This process is tedious and time consuming. To compensate for this problem, automatic segmentation techniques have been proposed with multiplanar CT images. These methods involve the use of sequences of thresholding, morphologic operations (ie, mathematic operations, such as image dilation, erosion, opening, and closing, that are based on shape), and 3D region growing methods. These techniques are complex but require a few computation times. We made a phantom for volume measurement with pig and evaluated actual volume of spleen and liver of phantom. The results represent that our semiautomatic volume measurement algorithm shows a good accuracy and repeatability with actual volume of phantom and possibility for clinical use to assist physician as a measuring tool.

• Journal of Korean Academy of Nursing
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• v.25 no.2
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• pp.222-243
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• 1995

The purpose of this study was to present basic data in the nursing practice for the management of living kidney donor by understanding the nature and meaning of kidney donors, experiences. The research subjects were 11 living kidney donors who had donated from Mar 1991 to Feb. 1994 and discharged from the 3 hospitals in Pusan. Data has been collected by Intensive interview with donors. The data analysis has made by phenomenological method of Van Kaam for understanding the phenomenon and meaning of their experiences. The experiences of kidney donors were analyzed into the 4 situations, that is,'motivation of kidney donor', 'decision time to make kidney donation', 'pre-opperation','after donation'. The descriptive expression and common elements were drawn from original data of each situation on the basis of subjects' own words. From each situation, the com-mon elements of kidney donors' experiences were integrated, summarized and described as follows 1. Motivation of kidney donation They wanted to donate their kidney because of empathy of pain on the groung of love to the recipient and with exppectation of successful kidney transplant or as a solution of economic difficulty. 2. Experiences in deciding to make kidney do-nation In deciding to make kidney donation, donors had love toward the recipients. But they experienced conflict too. 3. Experiences before being operated on donated kidney In experiences from deciding to make kidney do nation to preoperation, donors had love toward the recipients. But they also felt anxiety or dissatisfaction. Therefore, they controlled their mind by their faith, support of medical staff or support of society. And they experienced regret for the sociological cognition or financial apprehension. 4. Experiences after kidney donation After kidney donation, donors experienced satis-faction and accompplishment in spite of mental and physical discomfortness, while they felt sense of loss / disappointment, repentance, regret, and apprehension of progress toward their condition. Thus, kidney donors donated their kidney on the ground of empathy and love to the recipient and with expectation of successful kidney transplant. But during the process of kidney donation, they ex perienced conflict, love, anxiety, regret, apprehension of economy. And after donation, they felt sense of satisfaction and accomplishment, while they felt sense of discomfortness, loss / disappointment, re-gret, repentance, or apprehension of progress toward their condition. This result contribute to nurses' role not only for the management of living kidney donors but also for the management of cadaver donors' family.

• Journal of East-West Nursing Research
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• v.15 no.2
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• pp.82-90
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• 2009

Purpose: The purpose of this study was to compare the degree of preoperative anxiety and postoperative pain among volunteer and non-volunteer donors in living liver transplantation. Methods: The 32 volunteer and 32 non-volunteer donors were recruited from a university hospital after obtaining research approval. The data were analyzed by $x^2$, t, ANOVA tests and Pearson's correlation coefficients using SPSS 12.0 program. Results: There were no significant differences in pre-operative anxiety between the two groups. However, the non-volunteer donors had significantly more severe pain for 3 post-operative days, measured by visual analogue scale (VAS) and non-verbal pain behavior scale (non-VPBS), compared to that of the volunteer donors. There was a significant correlation between preoperative state anxiety and postoperative non-VPBS score. Conclusions: These results showed that liver donors who belonged to the non-volunteer group needed much more active postoperative pain management and psychological support than the volunteer group.