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Hepatobiliary & Pancreatic Diseases International 2018年第2期17卷 119-125页

作者： Eung Chang Lee Seong Hoon Kim jae Ryong Shim sang-jae park Center for Liver Cancer National Cancer Center

Background: Plasmapheresis is a desensitization method used prior to ABO-incompatible(ABO-I) living donor liver transplantation. However, studies on its usefulness in the rituximab era are ***: Fifty-six adult patients underwent ABO-I living donor liver transplantation between January2012 and October 2015. A single dose of rituximab(300 mg/m~2) was administered 2 weeks before surgery with plasmapheresis in all patients until February 2014(RP group, n = 26). Patients were administered rituximab only, without plasmapheresis between March 2014 and October 2015(RO group, n = 30).Results: The 6-, 12-and 18-month overall survival rates were 92.3%, 80.8% and 76.9% in the RP group and 96.6%, 85.4% and 85.4% in the RO group, respectively(P = 0.574). When the initial isoagglutinin titers < 16, neither group showed a rebound rise of isoagglutinin titers. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group. There was no difference in time-dependent changes in B cell subpopulations and ABO-I-related ***: Sufficient desensitization for ABO-I living donor liver transplantation can be achieved using rituximab alone. This desensitization strategy does not affect the isoagglutinin titers, ABO-I-related complications and patient survival.

关键词： Desensitization Rituximab Plasmapheresis ABO-incompatibility Living donor Liver transplantation

miR-215 overexpression distinguishes ampullary carcinomas from pancreatic carcinomas

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Hepatobiliary & Pancreatic Diseases International 2015年第3期14卷 325-329页

作者： Dong Ho Choi sang jae park Hark Kyun Kim Department of Surgery Hanyang University School of Medicine Center for Liver Cancer National Cancer Center Biomolecular Function Research Branch National Cancer Center

Distinguishing ampullary carcinoma from pancreatic carcinoma is important because of their different prognoses. microRNAs are differentially expressed according to the tissue of origin. However, there is rare research on the differential diagnosis between the two types of cancers by microRNA in periampullary cancers. The present study was undertaken to compare microRNA profiles between ampullary and pan- creatic carcinomas using microarrays, miR-215 was most significantly overexpressed in ampullary carcinomas; whereas the expressions of miR-134 and miR-214 were significantly lower in ampuUary carcinomas than in pancreatic carcino- mas. When these discriminatory microRNAs were applied to liver metastases, they were correctly predicted for the tissue of origin. Although this study is limited by small sample size, striking difference in microRNA expression and concordant expression of discriminating microRNAs in primary tumors and metastases suggest that these novel discriminatory mi- croRNAs warrant future validation.

关键词： ampulla of Vater pancreatic cancer gene expression

Gastroepiploic arteriovenous shunt as a salvage treatment for hepatic artery occlusion after living donor liver transplantation

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 421-423页

作者： Seong Hoon Kim sang jae park Center for Organ Transplantation National Cancer CenterGyeonggi-doRepublic of Korea

Hepatic artery occlusion(HAO)is a calamitous vascular complication following living-donor liver transplantation(LDLT)leading to graft loss with a high mortality(1).Re-transplantation is considered when revascularizati... 详细信息

关键词： occlusion donor mortality

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第35期23卷 6516-6533页

作者： Eung Chang Lee Seong Hoon Kim sang-jae park Center for Liver Cancer National Cancer Center

AIM To evaluate the differences in outcomes between ABOincompatible(ABO-I) liver transplantation(LT) and ABO-compatible(ABO-C) *** A systematic review and meta-analysis were performed by searching eligible articles published before November 28, 2016 on MEDLINE(Pub Med), EMBASE, and Cochrane databases. The primary endpoints were graft survival, patient survival, and ABO-I-related complications. RESULTS Twenty-one retrospective observational studies with a total of 8247 patients were included in this metaanalysis. Pooled results of patient survival for ABO-I LT were comparable to those for ABO-C LT. However, ABO-I LT showed a poorer graft survival than ABO-C LT(1-year: OR = 0.66, 95%CI: 0.57-0.76, P < 0.001; 3-year: OR = 0.74, 95% CI 0.64-0.85, P < 0.001; 5-yearr: OR =0.75, 95%CI: 0.66-0.86, P < 0.001). Furthermore, ABO-I LT was associated with more incidences of antibody-mediated rejection(OR = 74.21, 95%CI: 16.32-337.45, P < 0.001), chronic rejection(OR =2.28, 95%CI: 1.00-5.22, P = 0.05), cytomegalovirus infection(OR = 2.64, 95%CI: 1.63-4.29, P < 0.001), overall biliary complication(OR = 1.52, 95%CI: 1.01-2.28, P = 0.04), and hepatic artery complication(OR = 4.17, 95%CI: 2.26-7.67, P < 0.001) than ABO-C LT. In subgroup analyses, ABO-I LT and ABO-C LT showed a comparable graft survival in pediatric patients and those using rituximab, and ABO-I LT showed an increased acute cellular rejection in cases involving deceased donor *** Although patient survival in ABO-I LT was comparable to that in ABO-C LT, ABO-I LT was inferior to ABO-C LT in graft survival and several complications. Graft survival of ABO-I LT could be comparable to that of ABO-C LT in pediatric patients and those using rituximab.

关键词： ABO-incompatibility Liver transplantation Graft survival Patient survival Complications

Conversion of twice-daily to once-daily tacrolimus is safe in stable adult living donor liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 374-379页

作者： Seong Hoon Kim Seung Duk Lee Young Kyu Kim sang-jae park Center for Liver Cancer National Cancer Center 111 Jungbalsan-ro Ilsandong-gu Goyang-si Gyeonggi-do 410-769 Korea

Once-daily extended-release tacrolimus （Tac-OD） has been introduced as a useful therapeutic option to increase patient adherence to immunosuppressive therapy. This study aimed to evaluate the safety, efficacy and immunosuppressant adherence of conversion from twice-daily tacrolimus （Tac-BID） to Tac-OD in stable adult living donor liver transplant （LDLT） recipients in a single institution. METHODS： Between February and May 2013, Tac-BID was converted to Tac-OD in recipients followed up for at least 12 months after transplantation and without previous rejection episodes. The switching policy was based on a dose ratio of 1：1 with dose adjustment target trough levels at 3-5 ng/mL. Tacro- limus trough levels, laboratory parameters, metabolic disor- ders, and adverse events were assessed. RESULTS： A total of 229 patients were enrolled in the study. The median age at conversion was 53 years （range 31-73）. The median transplant duration was 35.3 months （range 12.0-95.4）. During a median follow-up of 13.5 months after conversion, 9 patients returned to Tac-BID because of adverse events. No acute rejection episodes were observed. Of 214 patients still on Tac-OD at 12 months, 12 （5.6%） received a reduced dose and 95 （44.4%） required an increased dose over baseline. Overall adherence was 82.2% at the end of follow-up. CONCLUSION： The conversion from Tac-BID to Tac-OD with similar target trough levels after conversion is safe and effec- tive for long-term stable LDLT patients.

关键词： liver transplantation living donor immunosuppressive agents tacrolimus

Right hepatectomy in living donors with previous abdominal surgery

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Hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 33-38页

作者： Seong Hoon Kim Seung Duk Lee Young Kyu Kim sang-jae park Center for Liver Cancer National Cancer Center 111 Jungbalsan-ro Ilsandong-gu Goyang-si Gyeonggi-do 410-769 Korea

BACKGROUND： Few studies have evaluated the impact of previous abdominal surgery （PAS） on living donor right hepatectomy （LDRH）. The aim of this study was to investigate the outcomes of liver transplantation using right lobe grafts of living donors with PAS. METHODS： Data were reviewed from LDRH patients at the authors＇ institution between March 2008 and November 2014. LDRH patients with PAS were divided into two groups according to upper PAS （group 1） or lower PAS （group 2）, and they were compared to those without PAS （group 3） who were matched 1：1 based on age, gender, and body mass index. Periop- erative data, complications by the Clavien classification, and the outcomes with more than 14 months follow-up were compared. RESULTS： Twenty-three （4.9%） of a total of 471 LDRH donors had PAS. Eleven donors were assigned to group 1, 12 to group 2, and 23 to group 3. Intraperitoneal adhesions were found in 20 （87.0%） of 23 donors with PAS, of whom 5 （21.7%） had adhesiolysis-related injuries that happened more commonly in group 1 than in group 2 （P=0.025）. LDRH was successfully completed under upper midline laparotomy in all donors. No donors received perioperative blood transfusion. The peak postoperative AST, ALT, INR, and total bilirubin levels made no difference between the three groups. Compared with group 3, groups 1 and 2 had a longer operative time （P=0.012） and a higher grade I complication rate （P=0.047）. All donors recovered fully to their routine activities. The 23 recipients of grafts from donors with PAS showed good liver function with 1-year graft and patient survivals of 100%. CONCLUSION： A history of PAS is not a contraindication to LDRH in the current era of advanced surgical techniques.

关键词： living donor liver transplantation liver surgery liver function

A new hemostatic clip for endoscopic surgery that can maintain blood flow after clipping

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World Journal of Gastroenterology 2014年第5期20卷 1325-1331页

作者： Kyoung Won Nam sang Bong Lee In Young Kim Kwang Gi Kim sang jae park Department of Biomedical Engineering Hanyang University Biomedical Engineering Branch National Cancer Center Center for Liver Cancer National Cancer Center

AIM: To develop a new hemostatic device for endoscopic surgery that can control the bleeding without completely occluding the bleeding vessel.

关键词： Vessel bleeding Hemostasis Hemostatic clip Laparoscopic surgery Endoscopic surgery

Pushing the frontiers of living donor right hepatectomy

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World Journal of Gastroenterology 2014年第48期20卷 18061-18069页

作者： Seong Hoon Kim Seung Duk Lee Young Kyu Kim sang-jae park Center for Liver Cancer National Cancer Center 111 Jungbalsan-ro Ilsandong-gu Goyang-si Gyeonggi-do 410-769 South Korea

Living donor right hepatectomy (LDRH) is currently the most common donor surgery in adult-to-adult living donor liver transplantation although the morbidity and mortality reported in living donors still contradicts the Hippocratic tenet of “do no harm”. Achieving low complication rates in LDRH remains a matter of major concern. Living donor surgery is performed worldwide as an established solution to the donor shortage. The aim of this study was to assess the current status of LDRH and comment on the future of the procedure; assessment was made from the standpoint of optimizing the donor selection criteria and reducing morbidity based on both the authors’ 8-year institutional experience and a literature review. New possibilities have been explored regarding selection criteria. The safety of living donors with unfavorable conditions, such as low remnant liver volume, fatty change, or old age, should also be considered. Abdominal incisions have become shorter, even without laparoscopic assistance; upper midline laparotomy is the primary incision used in more than 400 consecutive LDRHs in the authors’ institution. Various surgical techniques based on preoperative imaging technology of vascular and biliary anomalies have decreased the anatomical barriers in LDRH. Operative time has been reduced, with low blood loss. Laparoscopic or robotic LDRH has been tried in only a few selected donors. The LDRH-specific, long-term outcomes remain to be addressed. The follow-up duration of these studies should be long enough to address possible late complications. Donor safety, which is the highest priority, is ensured by three factors: preoperative selection, intraoperative surgical technique, and postoperative management. These three focus areas should be continuously refined, with the ultimate goal of zero morbidity.

关键词： Living donor Right hepatectomy Liver transplantation Donor morbidity Donor selection

Pretransplant locoregional therapy for hepatocellular carcinoma:encouraging but insufficient

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Hepatobiliary Surgery and Nutrition 2018年第2期7卷 136-137页

作者： Seong Hoon Kim Eung Chang Lee sang jae park Organ Transplantation Center/Center for Liver Cancer National Cancer CenterGoyang-siGyeonggi-doRepublic of Korea

Despite in the era of liver transplantation(LT)widely performed as an established curative treatment for hepatocellular carcinoma(HCC),the scarcity of liver donors has still been a well-nigh insurmountable barrier to access of ***,the bridging locoregional therapy(LRT)that treats HCC during the waiting time prior to LT emerged as an attractive strategy to reduce the risk of tumor progression and waitlist dropout,which came to an international consensus statement regarding the waitlist management of HCC patients(1).However,the actual advantage for LRT has not been clearly demonstrated in terms of recurrence and survival.

关键词： hepatocellular statement attractive

High-dose hepatitis B immunoglobulin therapy in hepatocellular carcinoma with hepatitis B virus-DNA/hepatitis B e antigen-positive patients after living donor liver transplantation

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World Journal of Gastroenterology 2016年第14期22卷 3803-3812页

作者： Eung Chang Lee Seong Hoon Kim Seung Duk Lee Hyeongmin park Soon-Ae Lee sang-jae park Center for Liver Cancer National Cancer Center

AIM: To investigate the impact of high-dose hepatitis B immunoglobulin(HBIG) on hepatocellular carcinoma(HCC) and hepatitis B virus(HBV) recurrence and overall survival after living donor liver transplantation(LDLT).METHODS: We investigated 168 patients who underwent LDLT due to HCC, and who were HBV-DNA/hepatitis B e antigen(HBe Ag)-positive, from January 2008 to December 2013. After assessing whether the patients met the Milan criteria, they were assigned to the low-dose HBIG group and high-dose HBIG group. Using the propensity score 1:1 matching method, 38 and 18 pairs were defined as adhering to and not adhering to the Milan criteria. For each pair, HCC recurrence, HBV recurrence and overall survival were analyzed by the Kaplan-Meier method and the log rank test according to the HBIG dose. RESULTS: Among those who met the Milan criteria, the 6-mo, 1-year, and 3-year HCC recurrence-free survival rates were 88.9%, 83.2%, and 83.2% in the low-dose HBIG group and 97.2%, 97.2%, and 97.2% in the high-dose HBIG group, respectively(P = 0.042).In contrast, among those who did not meet the Milan criteria, HCC recurrence did not differ according to the HBIG dose(P = 0.937). Moreover, HBV recurrence and overall survival did not differ according to the HBIG dose among those who met(P = 0.317 and 0.190, respectively) and did not meet(P = 0.350 and 0.987, respectively) the Milan criteria. CONCLUSION: High-dose HBIG therapy can reduce HCC recurrence in HBV-DNA/HBe Ag-positive patients after LDLT.

关键词： Hepatitis B immune globulin Hepatocellular carcinoma Hepatitis B virus-DNA Liver transplantation Hepatitis B e antigen