• Title/Summary/Keyword: liver transplantation

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Case report of The liver transplant patient's cerebral infarction treated with Korean Medicine (간이식 환자의 뇌경색에 대한 한의학적 치료 증례보고)

  • Park, Sang Eun
    • Herbal Formula Science
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    • v.24 no.3
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    • pp.225-231
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    • 2016
  • Objectives : Liver cancer usually appears in the setting of underlying liver disease. Liver transplantation has potentials to improve survival for patients with liver cancer. This case report was designed to assess the clinical effect of Korean medicine on liver transplant patient's cerebral infarction.Methods : We provided Chiganpung Granule(Chodeungsan) to a patient who was 58 year old man complained of cognitive impairment and dysarthria. We checked the change of symptoms(K-MMSE, Aphasia Rapid Test) and liver function test and kidney function test.Results : We observed that Chiganpung Granule(Chodeungsan) decreased cognitive impairment and dysarthria. Liver function test and Kidney function test was improved.Conclusions : From the above results, it is considered that Korean medicine treatments is effective on liver transplant patient's cerebral infarction.

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

  • Tsai, Huang-Wen;Hsieh, Fu-Chien;Chang, Chih-Chun;Su, Ming-Jang;Chu, Fang-Yeh;Chen, Kuo-Hsin;Jeng, Kuo-Shyang;Chen, Yun
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.8009-8013
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    • 2015
  • Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were $11.6{\pm}1.8g/dL$ and $11.7{\pm}1.7g/dL$, respectively; and the nadir Hb level post operation and the final Hb level before discharge were $8.3{\pm}1.6g/dL$ and $10.2{\pm}1.6g/dL$, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

Real-World Efficacy and Safety of Everolimus with Low Dose Tacrolimus in Liver Transplantation Recipients (실제 임상현장에서의 간이식 환자 대상 Everolimus와 저용량 Tacrolimus 병용요법의 유효성 및 안전성 평가)

  • Jang, Seoyoun;Kim, Boram;Jeon, Sujeong;Choi, Kyung Suk;Lee, Eunsook;Lee, Ju-Yeun;Lee, Euni;Han, Ho-Seong;Cho, Jai Young
    • Korean Journal of Clinical Pharmacy
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    • v.31 no.1
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    • pp.44-52
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    • 2021
  • Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions: In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Detection of Hepatitis B Virus DNA in Liver Grafts Obtained from HBsAb and HBcAb Positive Organ Donors (HBsAb와 HBcAb가 양성인 장기 공여자의 간조직에서 Hepatitis B Virus DNA의 발현)

  • Jung, Chang-Woo;Jang, Joo-Young;Kim, Kyung-Mo;Lee, Sung-Gyu
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.10 no.2
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    • pp.166-172
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    • 2007
  • Purpose: It has recently been reported that de novo HBV infection following liver transplantation is caused by grafts from HBcAb positive donors, and this phenomenon has been observed in one third of the liver transplant patients in our center. Therefore, we investigated the presence of HBV virus DNA in liver tissues obtained from HBcAb positive donors to determine the mechanism by which de novo HBV infection occurs. Methods: This study was conducted on 6 patients that were HBsAg negative, HBsAb positive, and HBcAb positive who were donors for liver transplantation between November 1997 and November 1998 at Asan Medical Center. We isolated DNA from a portion of liver biopsy tissues that were obtained during the operation, and then identified the surface and core region of HBV DNA using nested PCR. In addition, four children who received liver grafts from these donors were monitored to determine if they became afflicted with non-HBV related diseases while receiving prophylaxis consisting of short-term HBIG treatment and long-term treatment with an antiviral agent. Results: The surface antigen region was identified in all 6 donors and the core antigen region was observed in 4 of the 6 donors. However, no episodes of de novo HBV infection with prophylaxis were observed. Conclusion: The results of this study support the results of previous studies, which indicated that HBV infection may be the main cause of de novo HBV infection in patients that receive HBsAb positive and HBcAb positive donor grafts.

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Segmentation and 3-Dimensional Reconstruction of Liver using MeVisLab (MeVisLab을 이용한 간 영역 분할 및 3차원 재구성)

  • Shin, Min-Jun;Kim, Do-Yeon
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.16 no.8
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    • pp.1765-1772
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    • 2012
  • Success rate of transplantation of body organs improved due to development of medical equipment and diagnostic technology. In particular, a liver transplant due to liver dysfunction has increased. With the development of image processing and analysis to obtain the volume for liver transplantation have increased the accuracy and efficiency. In this thesis, we try to reconstruct the regions of the liver within three dimensional images using the mevislab tool, which is effective in quick comparison and analysis of various algorithms, and in expedient development of prototypes. Liver is divided by applying threshold values and region growing method to the original image, and by removing noise and unnecessary entities through morphology and region filling, and setting of areas of interest. It is deemed that high temporal efficiency, and presentation of diverse range of comparison and analysis module application methods through usage of MeVisLab would make contribution towards expanding of baseline of medical image processing researches.

Fluorescently Labeled Nanoparticles Enable the Detection of Stem Cell-Derived Hepatocytes

  • Ha, Young-Eun;Shin, Jin-Sup;Lee, Dong-Yun;Rhim, Tai-Youn
    • Bulletin of the Korean Chemical Society
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    • v.33 no.6
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    • pp.1983-1988
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    • 2012
  • Stem cell transplantation is emerging as a possible new treatment for liver cirrhosis, and recent animal studies have documented the benefits of stem cell therapy in a hepatic fibrosis model. However, the underlying mechanism of stem cell therapy is still unclear. Among the proposed mechanisms, the cell replacement mechanism is the oldest and most important, in which permanently damaged tissue can be replaced by normal tissue to restore function. In the present study, Cy5.5-labeled superparamagnetic iron oxide (SPIO) was used to label human mesenchymal stem cells. The uptake of fluorescently labeled nanoparticles enabled the detection and monitoring of the transplanted stem cells; therefore, we confirmed the direct incorporation and differentiation of SPIO into the hepatocyte-like transplanted stem cells by detecting human tyrosine aminotransferase (TAT), well-known enzymatic marker for hepatocyte-specific differentiation.

Coronavirus Disease 2019-Liver Injury-Literature Review and Guidelines Based on the Recommendations of Hepatological Societies

  • Pawlowska, Joanna;Lebensztejn, Dariusz M.;Jankowska, Irena
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.24 no.2
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    • pp.119-126
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    • 2021
  • The aim of our paper was to present current knowledge, review literature and available practice guidelines of international hepatological associations regarding the effect of severe acute respiratory syndrome coronavirus 2 coronavirus on the liver, patients with underline liver disease, awaiting on liver transplantation (LTx) or being after LTx in the pandemic coronavirus disease 2019 area.

Pre- and Immediate Post-Kasai Portoenterostomy Shear Wave Elastography for Predicting Hepatic Fibrosis and Native Liver Outcomes in Patients With Biliary Atresia

  • Haesung Yoon;Kyong Ihn;Jisoo Kim;Hyun Ji Lim;Sowon Park;Seok Joo Han;Kyunghwa Han;Hong Koh;Mi-Jung Lee
    • Korean Journal of Radiology
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    • v.24 no.5
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    • pp.465-475
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    • 2023
  • Objective: To evaluate the feasibility of ultrasound shear wave elastography (SWE) for predicting hepatic fibrosis and native liver outcomes in patients with biliary atresia. Materials and Methods: This prospective study included 33 consecutive patients with biliary atresia (median age, 8 weeks [interquartile range, 6-10 weeks]; male:female ratio, 15:18) from Severance Children's Hospital between May 2019 and February 2022. Preoperative (within 1 week from surgery) and immediate postoperative (on postoperative days [PODs] 3, 5, and 7) ultrasonographic findings were obtained and analyzed, including the SWE of the liver and spleen. Hepatic fibrosis, according to the METAVIR score at the time of Kasai portoenterostomy and native liver outcomes during postsurgical follow-up, were compared and correlated with imaging and laboratory findings. Poor outcomes were defined as intractable cholangitis or liver transplantation. The diagnostic performance of SWE in predicting METAVIR F3-F4 and poor hepatic outcomes was analyzed using receiver operating characteristic (ROC) analyses. Results: All patients were analyzed without exclusion. Perioperative advanced hepatic fibrosis (F3-F4) was associated with older age and higher preoperative direct bilirubin and SWE values in the liver and spleen. Preoperative liver SWE showed a ROC area of 0.806 and 63.6% (7/11) sensitivity and 86.4% (19/22) specificity at a cutoff of 17.5 kPa for diagnosing F3-F4. The poor outcome group included five patients with intractable cholangitis and three undergoing liver transplantation who showed high postoperative liver SWE values. Liver SWE on PODs 3-7 showed ROC areas of 0.783-0.891 for predicting poor outcomes, and a cutoff value of 10.3 kPa for SWE on POD 3 had 100% (8/8) sensitivity and 73.9% (17/23) specificity. Conclusion: Preoperative liver SWE can predict advanced hepatic fibrosis, and immediate postoperative liver SWE can predict poor native liver outcomes in patients with biliary atresia.

Study of surgical anatomy of portal vein of liver segments by cast method and its clinical implications

  • Shrikantaiah, Vidya C.;Basappa, Manjaunatha;Hazrika, Sangita;Ravindranath, Roopa
    • Anatomy and Cell Biology
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    • v.51 no.4
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    • pp.232-235
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    • 2018
  • Portal vein provides about three-fourths of liver's blood supply. Portal vein is formed behind the neck of pancreas, at the level of the second lumbar vertebra and formed from the convergence of superior mesenteric and splenic veins. The purpose of this study is to review the normal distribution and variation, morphometry of portal vein and its branches for their implication in liver surgery and preoperative portal vein embolization. It is also helpful for radiologists while performing radiological procedures. A total of fresh 40 livers with intact splenic and superior mesenteric vein were collected from the mortuary of Forensic Department, JSS Medical College and Mysuru Medical College. The silicone gel was injected into the portal vein and different segments were identified and portal vein variants were noted. The morphometry of portal vein was measured by using digital sliding calipers. The different types of portal vein segmental variants were observed. The present study showed predominant type I in 90% cases, type II 7.5% cases, and type III 2.5% cases. Mean and standard deviation (SD) of length of right portal vein among males and females were $2.096{\pm}0.602cm$ and $1.706{\pm}0.297cm$, respectively. Mean and SD of length of left portal vein among males and females were $3.450{\pm}0.661cm$ and $3.075{\pm}0.632cm$, respectively. The difference in the Mean among the males and females with respect to length of right portal vein and left portal vein was found to be statistically significant (P=0.010). Prior knowledge of variations regarding the formation, termination and tributaries of portal vein are very helpful and important for surgeons to perform liver surgeries like liver transplantation, segmentectomy and for Interventional Radiologists.