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Liver Transplantation for Hepatitis B Virus-related Hepatocellular Carcinoma in Hong Kong

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 283-288页

作者： Ka Wing Ma kenneth Siu Ho Chok James Yan Yue fung Chung Mau Lo Department of Surgery The University of Hong KongHong KongChina State Key Laboratory for Liver Research The University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina

Hepatocellular carcinoma(HCC)is the fifth most common cancer and the third most common cause of cancer-related deaths *** resection is frequently limited in Hong Kong by hepatitis B virus-related cirrhosis,and liver transplantation is the treatment of *** transplanta-tion has been shown to produce superior oncological benefits,when compared to hepatectomy for *** developments in the context of patient selection criteria,modification of organ allocation,bridging therapy,salvage liver transplanta-tion and pharmaceutical breakthrough have improved the survival of HCC *** this article,we will share our experience in transplanting hepatitis B virus-related HCC patients in Hong Kong and discuss the recent progress in several areas of liver transplantation.

关键词： Liver transplantation Hepatitis B Hepatocel ular carcinoma Review

Parents making surgical decisions for their children:a pilot study

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World Journal of Pediatric Surgery 2023年第2期6卷 115-117页

作者： Adrian Chi Heng fung kenneth Kak Yuen Wong Department of Surgery The University of Hong KongHong KongChina

Parents play a key role in medical decision-making for their children,who are limited by their intellectual development in under-standing their own health status and treat-ment plans.1 These decisions are challenging as they may have a lifelong impact on patients'physical and mental well-being,and a signif-icant portion of parents are not satisfied with the informed consent *** factors affecting parental satisfaction with the informed consent process have been identi-fied,including parents'knowledge base,the specific types of decisions and the presence of decisional conflicts.

关键词： children their parents

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

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World Journal of Gastroenterology 2017年第23期23卷 4270-4277页

作者： Wong Hoi She kenneth SH Chok James YY fung Albert CY Chan Chung Mau Lo Department of Surgery the University of Hong Kong Department of Surgery and State Key Laboratory for Liver Research The University of Hong Kong Department of Medicine and State Key Laboratory for Liver Research The University of Hong Kong

AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) *** Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate *** Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed i

关键词： Small for size liver graft Right lobe graft Left lobe graft Living donor liver transplantation

The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma

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Hepatoma Research 2017年第11期3卷 284-293页

作者： James fung kenneth SHChok Department of Medicine The University of Hong KongHong KongChina The Liver Transplant Center Queen Mary HospitalHong KongChina State Key Laboratory for Liver Research The University of Hong KongHong KongChina Department of Surgery The University of Hong KongHong KongChina.

Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) in places where chronic hepatitis B infection is endemic. Oral nucleos(t)ide analog (NA) therapy can reduce the risk of HCC, but cannot completely prevent its development. For HBV-related HCCs, viral inhibition by NAs can preserve or improve liver function, thereby increasing the chance of therapeutic intervention. After surgical resection, NAs can prevent reactivation of HBV, and also reduce the chance of de novo development of HCC in the remnant liver. For those who undergo liver transplantation, NAs are essential to prevent reactivation and graft hepatitis, but is not likely to prevent HCC recurrence, which is due to metastatic disease. The role of NAs for non-curable advanced HCC is less well defined. These include patients undergoing locoregional therapy, chemotherapy, or palliation. Although antiviral therapy can preserve liver function, which may be compromised by HBV, it is unable to prevent disease progression from HCC. At the time of HCC diagnosis, most patients will already be receiving NAs, and these patients should be maintained on therapy. For patients not on antiviral therapy at the time of HCC diagnosis, the decision to commence therapy is often determined by the stage of HCC and life expectancy. Patients undergoing curative therapy, or locoregional therapy/chemotherapy with reasonable life expectancy, should be commenced on antiviral therapy.

关键词： Antiviral therapy hepatitis B virus hepatocellular carcinoma

Emergency ABO-incompatible living donor liver transplant for patients with ultrahigh MELD scores

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 87-89页

作者： Kevin KW Chu kenneth SH Chok James YY fung Albert CY Chan Wing Chiu Dai Chung Mau Lo Department of Surgery Queen Mary Hospital The University of Hong Kong Department of Medicine Queen Mary Hospital The University of Hong Kong

To the Editor:A 49-year-old Chinese man with treatment-naive chronic hepatitis B presented with a one-week history of jaundice when admitted to our *** admission,his bilirubin was 704μmol/L,alanine aminotransferase 180 U/L,international normalized ratio 2.4,creatinine 140μmol/L,and Model for End-stage Liver Disease(MELD)score *** serum HBV DNA was 64.7 IU/mL,and he was commenced on ***,he developed acute-onchronic liver failure on day 28 with grade 2 hepatic encephalopathy and a MELD score of 40(bilirubin 709μmol/L,international normalized ratio 3.3,creatinine 181μmol/L).

关键词： Editor hospital

Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 256-262页

作者： kenneth SH Chok See Ching Chan James YY fung Tan To Cheung Albert CY Chan Sheung Tat Fan Chung Mau Lo Department of Surgery The University of Hong Kong State Key Laboratory for Liver Research The University of Hong Kong Department of Medicine The University of Hong Kong

BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipi

关键词： Model for End-stage Liver Disease living donor liver transplantation survival right-lobe

Donor ductal anomaly is not a contraindication to right liver lobe donation

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 343-347页

作者： kenneth SH Chok James YY fung Wing Chiu Dai Sui Ling Sin Ka Wing Ma Albert CY Chan Tan To Cheung Chung Mau Lo Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina State Key Laboratory for Liver Research The University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Medicine The University of Hong Kong102 Pok Fu Lam RoadHong KongChina

Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in *** retrospective study aimed to determine if the occurrence of postoperative biliary stricture in donors or recipients in rightlobe LDLT(RLDLT)is related to donor biliary anatomy ***:We analyzed our RLDLT recipients’clinical data and those of their graft *** recipients were divided into 2 groups:with and without postoperative biliary *** 2 groups were *** primary endpoints were donor biliary anatomy type and postoperative biliary complication incidence;the secondary endpoints were 1-,3-and 5-year graft and patient survival ***:Totally 127 patients were included in the study;25(19.7%)of them developed biliary anastomotic *** these 25 patients,16 had type A biliary anatomy,3 had type B,2 had type C,3 had type D,and 1 had type *** the 127 donors,96(75.6%)had type A biliary anatomy,13(10.2%)had type B,6(4.7%)had type C,10(7.9%)had type D,and 2(1.6%)had type *** stricture was seen in 2 donors,who had type A biliary *** of the recipients or donors developed bile *** association between the occurrence of postoperative biliary stricture and donor biliary anatomy type was found(P=0.527).Conclusions:The incidence of biliary stricture in donors or recipients after RLDLT was not related to donor biliary anatomy *** postoperative complications were similar in whatever type of donor bile duct anatomy,donor ductal anomaly should not be considered a contraindication to donation of right liver lobe.

关键词： Living donor liver transplantation Right liver donation Biliary complications Cholangiograms Ductal anomaly

Partial portal vein arterialization using right gastroepiploic artery:A novel solution for portal hypoperfusion

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Hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 367-370页

作者： Kin Pan Au kenneth Siu Ho Chok Sui Ling Sin James Yan Yue fung Chung Mau Lo Vivian Way Kay Mok Division of Liver Transplantation Department of SurgeryQueen Mary HospitalThe University of Hong KongPokfulamHong KongChina Division of Plastic and Reconstructive Surgery Department of SurgeryQueen Mary HospitalThe University of Hong KongHong KongChina

To the Editor:Establishing dual arterial and portal inflow is essential for liver transplantation[1].Inadequate portal inflow compromises graft function and graft survival[2].Portal hypoperfusion is usually a conseque... 详细信息

关键词： In PVA Partial portal vein arterialization using right gastroepiploic artery

Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population

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World Journal of Gastrointestinal Oncology 2019年第4期11卷 322-334页

作者： Ka Wing Ma Wong Hoi She Albert Chi Yan Chan Tan To Cheung James Yan Yue fung Wing Chiu Dai Chung Mau Lo kenneth Siu Ho Chok Department of Surgery the University of Hong Kong Department of Surgery and State Key Laboratory for Liver Research the University of Hong Kong Department of Medicine and State Key Laboratory for Liver Research The University of Hong Kong

BACKGROUND Liver transplantation(LT) is regarded as the best treatment for both primary and recurrent hepatocellular carcinoma(HCC). Post-transplant HCC recurrence rate is relatively low but significant, ranging from 10%-30% according to different series. When recurrence happens, it is usually extrahepatic and associated with poor prognosis. A predictive model that allows patient stratification according to recurrence risk can help to individualize post-transplant surveillance protocol and guidance of the use of anti-tumor immunosuppressive *** To develop a scoring system to predict HCC recurrence after LT in an Asian *** Consecutive patients having LT for HCC from 1995 to 2016 at our hospital were recruited. They were randomized into the training set and the validation set in a60:40 ratio. Multivariable Cox regression model was used to identity factors associated with HCC recurrence. A risk score was assigned to each factor according to the odds ratio. Accuracy of the score was assessed by the area under the receiver operating characteristic *** In total, 330 patients were eligible for analysis(183 in training and 147 invalidation). Recurrent HCC developed in 14.2% of them. The median follow-up duration was 65.6 mo. The 5-year disease-free and overall survival rates were78% and 80%, respectively. On multivariate analysis, alpha-fetoprotein > 400 ng/mL [P = 0.012, hazard ratio(HR) 2.92], sum of maximum tumor size and number(P = 0.013, HR 1.15), and salvage LT(P = 0.033, HR 2.08) were found to be independent factors for disease-free survival. A risk score was calculated for each patient with good discriminatory power(c-stat 0.748 and 0.85, respectively,in the training and validation sets). With the derived scores, patients were classified into low-(0–9), moderate-(> 9–14), and high-risk groups(> 14), and the risk of HCC recurrence in the training and validation sets was 10%, 20%, 54%(cstat 0.67) and 4%, 22%, 62%(c-stat 0.811), accordin

关键词： Hepatocellular carcinoma Liver transplantation Post-transplant recurrence Predictive model