• Quality Improvement in Health Care
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• v.11 no.1
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• pp.32-45
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• 2004

Objective : The aim of this study were to measure quality of life(QOL) in liver transplant recipients, to compare QOL between living donor liver transplant recipients and cadaveric liver transplant recipients and to investigate whether SF-36 may be used as a disease-specific instrument in liver transplant recipients. Methods : We conducted a single-center cross-sectional study of 133 LT recipients ages 13 to 65 years, all of whom had had Liver Transplantation(LT) at least 1 months previously. QOL was assessed using a self-completion questionnaire consisting of the Bang Whal Ran(1991) instruments and the 36-Item Short-Form Health Survey(SF-36) health status profile measure. We investigated whether the SF-36 instrument may be used as a disease-specific instrument in LT recipients. Individual scale scores range from 0 to 100, with higher score reflecting better health. Data on demographics, clinical status at pre transplantation 1 day, post transplantation clinical status, and graft function were collected to identify predictors of post transplantation QOL. Results : Standard measures for test-retest reliability, internal consistency, and discriminant and concurrent validity were examined. The reliability of the SF-36, as measured by test-retest correlation(Pearson coefficients: 0.729, p=0.002) and by internal consistency(Cronbach's alpha: 0.9431) exceeded conventional acceptability criteria. The correlation between domain scores of SF-36 and the Bang Whal Ran(l991) was clear and logical in that the clinical characteristics of SF-36 strongly correlated with the clinical component summary score of the Bang Whal Ran(l991)(r = 0.8155, P<.01). SF-36 scale scores were compared between Cadaveric Liver Transplant recipients and Living Donor Liver Transplant recipients. Donor types of post LT did not influence HRQOL(p>0.05). 87% of the liver transplant recipients were satisfied to get LT. Satisfaction of post LT showed significantly greater HRQOL(p<0.001). Conclusion : SF-36 is found reliable and valid. This study indicates thet Donor Type did not influence HRQOL after LT. The information gained from this study will help us to better define expectations and the clinical course after liver transplantation to patients and their families.

• 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.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.33-37
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• 2009

Purpose: Liver transplantation is considered as the treatment of choice in many acute and chronic liver diseases, and it is becoming more common. Since successful microscopic anastomosis of hepatic artery is a crucial requirement of successful liver transplantation, we studied and analyzed the result of hepatic artery anastomosis of liver transplantation in our liver transplantation center. Methods: 145 liver transplantations were performed between February 2005 and May 2008. Male to female ratio of the liver transplantation recipients was 3.4 : 1. Anastomosis of portal vein, hepatic vein and biliary tract was performed by the general surgeon, and anastomosis of hepatic artery was performed by the plastic surgeon under the loupe or microscopic vision. After the hepatic artery was reconstructed, anastomosed site status and flow were checked with Doppler ultrasonography intraoperatively and with contrast enhanced CT or angiography postoperatively if necessary. Results: Out of 145 liver transplantations, cadaveric liver donor was used 37 cases and living donor liver transplantation was performed 108 cases including the 2 dual donor liver transplantations. As for the baseline diseases that resulted in the liver transplantation, there were 57 cases of liver cirrhosis and hepatocellular carcinoma due to hepatitis B, taking up the greatest proportion. Single donor hepatic artery was used in 114 cases, and mean artery diameter was 2.92 mm and mean artery length was 24.25 mm. Hepatic artery was used as the recipient artery in every case except the 8 cases in which gastroepiploic artery was used as alternative. Out of 145 cases of hepatic artery anastomosis, 3 cases resulted in the thrombosis of the hepatic artery, requiring thrombectomy and re - anastomosis. In all 3 cases, thrombosis was found in left hepatic artery and there was no past history of hepatic artery chemoembolization. Conclusion: Incidence of hepatic artery thrombosis after the anastomosis of hepatic artery during liver transplantation was 2.1%, which is considered sufficiently low.

• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.1
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• pp.48-54
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• 2015

Purpose: Metabolic liver disease (MLD) often progresses to life-threatening conditions. This study intends to describe the outcomes of liver transplantation (LTx) for MLD at a living donor-dominant transplantation center where potentially heterozygous carrier grafts are employed. Methods: We retrospectively evaluated the medical records of 54 patients with MLD who underwent LTx between November 1995 and February 2012 at Asan Medical Center in Seoul, Korea. The cumulative graft and patient survival rates were analyzed according to patient age, and living or deceased donor LTx. Recurrence of the original disease was also investigated. Results: The post-transplant cumulative patient survival rates at one, five, and 10 years were 90.7%, 87.5% and 87.5%, and the graft survival rates were 88.8%, 85.5%, and 85.5%, respectively. There were no differences in the patient survival rates according to the recipient age, human leukocyte antigen matching, and living or deceased donor LTx. There were also no differences in the patient survival rates between the MLD and the non-MLD groups for children. Recurrence of the original metabolic disease was not observed in any patient during the follow-up period. Conclusion: Our results suggest that the living donor-dominant transplantation program is well-tolerated in MLD without recurrence of the original MLD using all types of transplantation.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.5 no.1
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• pp.116-125
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• 2005

Orthotopic liver transplantation is the treatment of choice for inherited metabolic diseases. However, the supply of donor organs is limiting and therefore many patients cannot benefit from this therapy. In contrast, hepatocytes can be isolated from a single donor liver. They can be transplanted into several recipients, and this procedure may help overcome the shortage of donor livers. A great deal of work with animal models indicates that hepatocytes transplanted into the liver or spleen can survive, function, and participate in the normal regenerative process. Recent clinical studies suggest that hepatocyte transplantation may be useful for bridging patients to whole organ transplantation and for providing metabolic support during liver failure and for replacing whole organ transplantation in certain inherited metabolic diseases. Nowadays, hepatocytes from various stem cells have been regarded as an another cell source for treatment of inherited metabolic diseases. Although cell therapy using stem cells for inherited metabolic disease patient has been accepted only as an experimental trial yet, hepatocytes from stem cells can solve a lot of obstacles in the treatment of inherited metabolic diseases.

• Korean Journal of Transplantation
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• v.32 no.4
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• pp.84-91
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• 2018

Background: This study examined the outcomes of ABO incompatible living donor liver transplantation (LDLT). The changes in the immunologic factors that might help predict the long term outcomes were also studied. Methods: Twenty-three patients, who underwent ABO incompatible LDLT from 2010 to 2015, were reviewed retrospectively. The protocol was the same as for ABO compatible LDLT except for the administration of rituximab and plasma exchange. The clinical outcomes and immunologic factors, such as isoagglutinin titer and cluster of differentiation 20+ (CD20+) lymphocyte levels were reviewed. Results: The center showed a 3-year survival of 64% with no case of antibody-mediated rejection. When transplantation-unrelated mortalities (for example, traffic accidents and myocardial infarction) were removed from statistical analysis, the 3-year survival was 77.8%. Although isoagglutinin titers continued to remain at low levels, the CD20+ lymphocyte levels recovered to the pre-Rituximab levels at postoperative one year. Conclusions: As donor shortages continue, ABO incompatible liver transplantation is a feasible method to expand the donor pool. On the other hand, caution is still needed until more long-term outcomes are reported. Because CD20+ lymphocytes are recovered with time, more immunologic studies will be needed in the future.

• Korean Journal of Transplantation
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• v.32 no.4
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• pp.108-112
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• 2018

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.

• 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 Critical Care Nursing
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• v.7 no.1
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• pp.33-39
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• 2014

Purpose: The propose of this study was to introduce the clamping protocols for a biliary external drainage tube and trace the results of using clamping protocols to prevent some possible biliary complications or enable their early detection in living-donor liver transplantation. Method: This study was a retrospective study to analyze the cases of 97 subjects who had undergone liver transplantation in a hospital in Seoul, Korea. Clamping protocol 1 was applied to 47 patients, and clamping protocol 2 was applied to 50 patients. Results: In the case of protocol 1, the success rate of the clamping protocol was 74.5%, while that of protocol 2 was 84.0%. However, there was no significant difference in the compiled statistics from authentic sources (p = .246). Conclusions: The difference in the success rate between the two protocols was not significant for the clamping protocols of the biliary external drainage tube. However protocol 2 is suggested for the clamping method due to the simplicity of application. Further study with a large sample size is suggested.