Current Status of Laparoscopic Liver Resection in Korea

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.

Two Cases of Pneumocystis Pneumonia after Liver Transplantation Presenting with Different Clinical Manifestations / 대한이식학회지

Pneumocystis carinii pneumonia (PCP), now known as Pneumocystis jirovecii, is a fungal pathogen that causes opportunistic disease, especially pneumonia, in immunocompromised patients. The patients can have a spectrum of illnesses ranging from asymptomatic to fulminant respiratory failure. Here we report two cases with pneumocystis pneumonia after liver transplantation who presented with different clinical features. One patient developed acute respiratory failure requiring mechanical ventilation and expired due to PCP and a superimposed bacterial infection. The other patient was asymptomatic and discovered by regular X-ray check-up. He was successfully treated with trimethoprim/sulfamethoxazole. As shown by our cases, PCP presents with broad clinical manifestations and leads to various clinical courses in liver transplant recipients. Thus, Pneumocystis jirovecii has to be considered a potential pathogen of pneumonia in liver transplant recipients regardless of severity, especially one who is not on prophylactic medications. We consider prophylaxis of PCP in liver transplant recipients in our center.

Clinical Outcome of Pretransplant Renal Dysfunction in Adult Living Donor Liver Transplantation / 대한이식학회지

BACKGROUND: The aim of this study is to analyze the clinical significance of preoperative renal dysfunction in patients with living donor liver transplant (LDLT). METHODS: We analyzed data collected retrospectively from 327 consecutive LDLT performed at Department of Surgery, Catholic University of Korea from Jan. 2000 to Dec. 2007. Based on creatinine clearance rate (CCR) calculated before LDLT, the patients were classified in three groups: normal renal function(CCR > or =70 ml/min, 273 patients, 83.5%), mild renal dysfunction (CCR or =40 ml/min, 38 patients, 11.6%) and severe renal dysfunction (CCR1.5 mg/dl) was up to 46.2%. Even in patient with normal renal function, the incidence of postoperative hemodialysis and renal dysfunction 3 months postoperatively was about 5%. Multivariate analysis showed that preoperative serum creatinine, MELD score and postoperative diabetes predicted postoperative renal dysfunction. There was no statistical difference in survival curve between normal and mild renal dysfunction group but the patient with severe renal dysfunction showed worse survival compare with other groups (P < 0.001). CONCLUSIONS: Our data suggested that the patient with preoperative severe renal dysfunction have had poor recovery of renal dysfunction and high incidence of hemodialysis postoperatively and showed worse survival rate after transplantation.

Acute Necrotizing Pancreatitis after Kidney Transplantation: A Case Report / 대한이식학회지

Acute necrotizing pancreatitis after kidney transplantation is a rare, but serious complication. We report a case of patient who was developed acute pancreatitis after cadaveric kidney transplantation with several causative factors: viral infection (Cytomegalovirus, Varicella zoster virus), usage of immunosuppressant, gallbladder stones, and previous peritoneal dialysis history. Cytomegalovirus infection was suspected as major etiologic factor of this case, but other factors would have a complex effect on development of acute pancreatitis.

Expanded Criteria for Living Donor Liver Transplantation in Patients with Advanced Hepatocellular Carcinoma

PURPOSE: The purpose of this study was to evaluate the possibility of expanding the indication for living donor liver transplantation (LDLT) for treatment of hepatocellular carcinoma (HCC), beyond the Milan criteria without compromising patient survival. METHODS: This was a retrospective study of 5patients (36.4%) that had undergone LDLT, beyond the Milan criteria, among 143 patients with HCC. The study was conducted in patients treated by the Department of Surgery, Catholic University of Korea from Oct 2000 to May 2008. We evaluated the survival curve, prognostic factors for survival and compared survival between our new criteria and Milan criteria. RESULTS: The 5 year patient survival and disease free survival rate in patients treated with LDLT beyond the Milan criteria were 50.2% and 61.9%, respectively. The prognostic factors affecting disease free survival and patient survival included serum AFP level, tumor size, vascular invasion, and tumor cell differentiation on univariate analysis. In multivariate analysis, AFP (200 ng/mL), tumor size (7 cm) and vascular invasion had significant influence on survival and disease free survival. According to our new criteria (size <7 cm, AFP <200 ng/ mL), 88.1% of our patients were included compare to the 63.6% that would have been if limited to the Milan criteria. With both factors met, the survival was comparable to the survival of Milan criteria (63.7% on our criteria and 78.2% on Milan criteria at 5 years) (P =0.103). CONCLUSION: A tumor size <7 cm and an AFP < 200 ng/mL appear to be useful cut-off values, beyond that criteria required by Milan. An analysis according to our criteria showed an acceptable survival outcome. Further verification of these findings by a large volume or prospective study is required for widespread adoption of our new criteria.