• 대한이식학회지
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• 제32권4호
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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.

• 성인간호학회지
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• 제25권6호
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• pp.690-700
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• 2013

Purpose: Liver transplantation (LT) is the best treatment for patients with end-stage liver disease and most patients with LT return to their normal life. However, pregnancy and childbirth for women with LT are less common, mainly because it is considered to be dangerous for their health. The purpose of this study was to describe how Korean women after LT experience their pregnancy and childbirth. Methods: This study was designed to explore the experiences of pregnancy and childbirth of women with LT. Data were collected by individual in-depth interviews with four women who were pregnant and gave birth following LT in 2009. All interviews were audio-taped and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. Results: Four themes emerged as a result of analysis: recovery of lost feminity and marriage; fulfilling roles through pregnancy; life-risking pregnancy; and perfect family achieved by childbirth. These themes describe in detail about challenges and concerns the women with LT faced for their pregnancy and childbirth as well as many emotionally touching experiences. Conclusion: The results of this study would support health professionals to be better prepared to help women with LT for pregnancy and childbirth by providing in-depth and insightful information.

• 성인간호학회지
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• 제28권3호
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• pp.279-287
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• 2016

Purpose: The purpose of this study was to identify factors influencing a family's quality of life (QoL) when one member has a liver transplantation. Methods: A total of 98 families were asked questions about characteristics, stress, social support and QoL. The instruments used for this study were the Stress Scale for Families of Liver Transplantation Recipients, the Personal Resources Questionnaire, the Korean version of QoL Simple Type Scale. Data were analyzed by t-test, ANOVA, Pearson's correlation coefficient and multiple regression. Results: The mean scores of stress was $2.58{\pm}0.75$ and of social support was $4.81{\pm}0.87$. The mean of the QoL was $3.39{\pm}0.60$. Quality of life had significant correlations with stress and social support. Using multiple regression analysis, the QoL was significantly influenced by social support, stress and monthly average household income. Conclusion: The results suggest that social support, stress and income should be considered in developing the nursing interventions to improve the QoL of families of patients with liver transplantation.

• 핵의학기술
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• 제27권1호
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• pp.4-6
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• 2023

Technetium-labeled phosphate bone scan was shown to detect bone fractures and bone metastasis in early stage than general radiographs. Therefore, bone scan has become one of the most frequently performed nuclear medicine imaging examination. However, non-osseous radiopharmaceutical uptake on the bone scan are unusual findings. We report a case of diffuse splenic absorption of Tc-99m dicarboxypropane diphosphonate in patients who undergo liver transplantation.

• 한국의료질향상학회지
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• 제11권1호
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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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권1호
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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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권2호
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• pp.147-151
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• 2016

Neonatal hemochromatosis (NH) is a severe neonatal liver injury that is confirmed by extra-hepatic iron accumulation. Although a recent study described treating NH with exchange transfusions and intravenous immunoglobulin, liver transplantation should be considered for patients with severe liver failure that does not respond to other medical treatment. Herein, we report the case of a two-month-old female infant who presented with persistent ascites and hyperbilirubinemia. Her laboratory findings demonstrated severe coagulopathy, high indirect and direct bilirubin levels, and high ferritin levels. Abdominal magnetic resonance imaging presented low signal intensity in the liver on T2-weighted images, suggesting iron deposition. The infant was diagnosed with NH as a result of the clinical findings and after congenital infection and metabolic diseases were excluded. The infant was successfully treated with a living-donor liver transplantation. Living related liver transplantation should be considered as a treatment option for NH in infants.

• Clinical and Experimental Pediatrics
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• 제50권9호
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• pp.841-847
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• 2007

Acute liver failure (ALF) is a very rare but devastating illness in children. Specific treatment to recovery is often not available, and the underlying cause of the liver failure is often unknown and diverse especially in children. Liver transplantation has increased the chance of survival; however it needs an optimal timing to reach the best result which is not familiar to pediatrician. This article discusses the current knowledge of the epidemiology, backgrounds and factors to be considered before establishing the treatment of ALF in children.

• 한국임상약학회지
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• 제30권1호
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• pp.51-58
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• 2020

Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results: A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by -7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusions: Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.37-40
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• 2014

Purpose For living donor liver transplantation, liver segmentation is difficult due to the variability of its shape across patients and similarity of the density of neighbor organs such as heart, stomach, kidney, and spleen. In this paper, we propose an automatic segmentation of the liver using multi-planar anatomy and deformable surface model in portal phase of abdominal contrast-enhanced CT images. Method Our method is composed of four main steps. First, the optimal liver volume is extracted by positional information of pelvis and rib and by separating lungs and heart from CT images. Second, anisotropic diffusing filtering and adaptive thresholding are used to segment the initial liver volume. Third, morphological opening and connected component labeling are applied to multiple planes for removing neighbor organs. Finally, deformable surface model and probability summation map are performed to refine a posterior liver surface and missing left robe in previous step. Results All experimental datasets were acquired on ten living donors using a SIEMENS CT system. Each image had a matrix size of $512{\times}512$ pixels with in-plane resolutions ranging from 0.54 to 0.70 mm. The slice spacing was 2.0 mm and the number of images per scan ranged from 136 to 229. For accuracy evaluation, the average symmetric surface distance (ASD) and the volume overlap error (VE) between automatic segmentation and manual segmentation by two radiologists are calculated. The ASD was $0.26{\pm}0.12mm$ for manual1 versus automatic and $0.24{\pm}0.09mm$ for manual2 versus automatic while that of inter-radiologists was $0.23{\pm}0.05mm$. The VE was $0.86{\pm}0.45%$ for manual1 versus automatic and $0.73{\pm}0.33%$ for manaual2 versus automatic while that of inter-radiologist was $0.76{\pm}0.21%$. Conclusion Our method can be used for the liver volumetry for the pre-surgery planning of living donor liver transplantation.