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Prevention of recurrent hepatitis B infection after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 465-472页

作者： Tiffany CL Wong James YY Fung chung mau lo Department of Surgery Queen Mary Hospital The University of Hong Kong102 Pokfulam Road Department of Medicine Queen Mary Hospital The University of Hong Kong102 Pokfulam Road

BACKGROUND:Recurrence of hepatitis B virus(HBV) infection after liver transplantation can lead to graft loss and a reduction in long-term *** purpose of this review is to summarize the current therapeutic options for preventing HBV recurrence in liver transplant *** SOURCES:Up to January 2013,studies that were published in MEDLINE and EMBASE on prevention of HBV recurrence after liver transplantation were ***:There have been remarkable advancements in the past two decades on the prevention of HBV recurrence after liver transplantation,from the discovery of hepatitis B immune globulin(HBIG) and lamivudine monotherapy to the combination therapy using HBIG and *** the development of newer and stronger antiviral agents,the need for life-long HBIG is *** their low resistance profile,oral antiviral prophylaxis using these new agents alone is sufficient and is associated with excellent ***:Restoration of host HBV immunity with adoptive immunity transfer and vaccination may represent the ultimate strategy to withdraw prophylactic treatment and to achieve a drug free regimen against HBV recurrence after liver transplantation.

关键词： hepatitis B liver transplantation hepatitis B immune globulin antiviral therapy adoptive immunity transfer HBV vaccination

Simplifying living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 9-14页

作者： See Ching Chan chung mau lo Sheung Tat Fan Department of Surgery The University of Hong KongQueen Mary Hospital

BACKGROUND: Living donor liver transplantation is a complex surgical operation. Treatment policies and operative techniques evolved in the last two decades. DATA SOURCES: Our center's experience in living donor liver transplantation was reviewed in conjunction with relevant publications in the literature. RESULTS: The surgical techniques and perioperative surgical therapeutics could be modified towards simplicity. Examples include regular inclusion of the middle hepatic vein without compromising the venous outflow of the donor's remnant left liver. This provides excellent venous outflow, which is crucial for a small-for-size graft. Immunosuppression and hepatitis B suppression are steroid free and hepatitis B immunoglobulin free respectively. CONCLUSION: The most practical way to achieve high graft and recipient survival rates with an acceptably low donor risk is through design of a protocol that simplifies the surgery and postoperative management.

关键词： simplifying right liver living donor liver transplantation

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)—pushing the envelope in modulation of future liver remnant before major hepatectomy

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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 80-82页

作者： Albert C.Y.Chan chung mau lo Department of Surgery Queen Mary HospitalThe University of Hong KongHong KongChina Department of Surgery The University of Hong Kong-Shenzhen HospitalShenzhen 518053China

Insufficient future liver remnant (FLR) is an important factor that precludes patient from upfront major liver resection as it predisposes to post-hepatectomy liver failure and mortality. As such, augmentation of FLR by portal vein embolization (PVE) was the conventional approach to improve the safety profile of major hepatectomy. In recent years, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been popularized as an alternative approach for FLR augmentation (1,2). However, the initial inception of the ALPPS procedure was met by criticism for its high incidence of procedure-related morbidity, such as bile leakage and sepsis (3). In light of this issue, an international registry was set up for collection of cases and experience around the world and soon after that, the first International Expert Meeting was held in Hamburg in 2015 that led to the publication of eight recommendations on terminology of the procedures, indications and techniques for ALPPS (4). Two years later, a pre-congress meeting was held during the EHPBA (European Hepatopancreatobiliary Association) 12th Annual Congress in Mainz, Germany to celebrate the 10th Anniversary of ALPPS (5) since the first case was performed by Prof. Hans Schlitt a decade ago (1). During this meeting, ten different aspects on ALPPS were covered including surgical anatomy, underlying mechanisms, perioperative assessment of liver function, technical approach, indications and its effectiveness in comparison to two-stage hepatectomy.

关键词： hepatectomy ALPPS anatomy

Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 329-333页

作者： Julian Tsang Albert Chan Kenneth Chok Flora Tsang chung mau lo Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation Queen Mary Hospital University of Hong Kong Hong Kong China Division of Cardiothoracic Surgery Queen Mary Hospital University of Hong Kong Hong Kong China

To the Editor： Hepatocellular carcinoma （HCC） remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava （IVC） and right atrium （RA） is an infrequent finding but signifies a pre-terminal event with a dismal prognosis.

关键词： in on as or HCC IVC Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

Emergency re-routing of anterior sector venous outflow for right lobe living donor liver transplantation including the middle hepatic vein

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 325-327页

作者： Kenneth SH Chok See Ching Chan chung mau lo Sheung Tat Fan Department of Surgery Queen Mary Hospital The University of Hong Kong State Key Laboratory for Liver Research

BACKGROUND:Controversy remains over whether the middle hepatic vein should be included in the liver graft in right liver living donor liver *** in the anterior sector of a right liver graft can cause graft malfunction,which is especially devastating in the case of a graft with marginal size in relation to recipient body size on top of poor pre-transplant recipient *** case we report here highlighted the importance of the middle hepatic vein in right liver living donor liver ***:We illustrated the rectification of outflow obstruction of the middle hepatic vein in the anterior sector of right liver graft caused by technical error during *** rectification was performed with emergency re-routing using an artificial ***:Congestion in the anterior sector of the graft improved immediately and the patient’s postoperative liver function test results improved ***:The middle hepatic vein is important for effective drainage of the anterior sector of a right liver *** re-routing technique described in the report can also be applied to cases in which the middle hepatic vein is injured during hepatectomy requiring immediate reconstruction.

关键词： Gore-Tex graft vein graft liver graft cirrhosis hepatitis B infection

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

Resection of T4 hepatocellular carcinomas with adjacent structures, is it justified？

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Hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 52-57页

作者： Kenneth SH Chok Ka Kin Ng Tan To Cheung Albert CY Chan See Ching Chan chung mau lo Department of Surgery The University of Hong Kong

BACKGROUND： T4 hepatocellular carcinoma （HCC） with invasion to adjacent structure（s） may require resection of not only the tumor but also the invaded structure（s）. This study aims to assess whether such combined resection for T4 HCC is justifiable. METHODS： Adult patients with T4 HCC were divided into three groups. Group 1： tumors and invaded adjacent structures were resected together if histopathologically confirmed tumor invasion; group 2： same as group 1 but histopathologically confirmed tumor adhesion; group 3： tumor resection only. Group comparisons were made. RESULTS： Totally 144 patients were included in the study. There were 71, 14 and 59 patients in groups 1, 2 and 3, respec- tively. The groups were comparable in demographics, compli- cation and survival. Ten hospital deaths occurred （5, 0 and 5 in groups 1, 2 and 3, respectively; P=0.533）. The 5-year overall survival （hospital mortality excluded） was 17.8% in group 1, 14.3% in group 2, and 28.9% in group 3 （P=0.191）. The 5-year disease-free survival was 10.4% in group 1 and 14.5% in group 3 （no data for group 2 yet）（P=0.565）. On multivariate analysis, macrovascular invasion and poor differentiation were risk factors for survival whereas combined resection did not impact patients＇ survival. CONCLUSIONS： Combined resection achieved survival outcomes similar to tumor resection only. Patients with tumor invasion and those with tumor adhesion had comparable survival after combined resection. At centers with the required expertise, combined resection should be attempted to treat T4 HCCs with clinically suspected invasion of adjacent structures.

关键词： desmosplastic reaction en-bloc resection hepatocellular carcinoma invasion recurrence

Asia's first combined liver transplant and aortic valve replacement

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 86-87页

作者： chung yeung cheung kenneth s.h.chok oswald j.lee kevin s.lo see ching chan chung mau lo department of surgery queen mary hospitalhong kongChina department of surgery the university of hong konghong kongChina state key laboratory for liver research the university of hong konghong kongChina department of cardiothoracic surgery queen mary hospitalhong kongChina department of anesthesiology queen mary hospitalhong kongChina

To the editor:Liver transplantation is the only cure for patients with endstage liver *** is however an ultra-major surgery which is physiologically challenging to the cardiopulmonary function of the ***,in patients w... 详细信息

关键词： Asia’s first combined liver transplant and aortic valve replacement

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 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