Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 62
Filter
1.
Article in English | WPRIM | ID: wpr-897678

ABSTRACT

Background/Aims@#To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. @*Methods@#This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. @*Results@#A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. @*Conclusions@#This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.

2.
Article in English | WPRIM | ID: wpr-897021

ABSTRACT

Purpose@#In this pilot study, using next-generation sequencing and integrated messenger RNA (mRNA) sequencing, we investigated circulating microRNA (miRNA) expression profiling from bile-derived exosomes to identify dysregulated miRNA signatures and oncogenic pathways and determine their effects on targeted mRNAs in cholangiocarcinoma (CCA).Moreover, we explored the possibility that genetic analysis using bile-derived exosomes may replace gene analysis using tissue. @*Methods@#Bile was collected from a patient with perihilar CCA before curative resection. As a control, bile was collected from a patient with a common bile duct stone. Exosomes were isolated from the bile, and we performed next-generation miRNA sequencing using isolated exosomes. To evaluate miRNA-mRNA interactions, mRNA sequencing was performed using bile fluid in both patients. @*Results@#We identified 22 differentially expressed miRNAs. More than 65% of the predicted mRNA targets of those miRNAs were actually differentially expressed between control and CCA bile samples. In functional pathway analysis, targets of 22 miRNAs were primarily enriched in mitogen-activated protein kinase, platelet derived growth factor, vascular endothelial growth factor, epidermal growth factor receptor, and p53 signaling. In particular, in the functional assessment of miRNAmRNA interactions, RAS pathways, including downstream pathways (PI3K-AKT-mTOR and RAS-RAF-MEK-ERK), were determined to be enriched. @*Conclusion@#Circulating miRNAs in bile-derived exosomes provide new information for the development of miRNA analysis in CCA. These miRNAs may represent the oncogenic characteristics of CCA tissue, enabling them to be used instead of tissue samples for the diagnosis of CCA. Further research investigating circulating miRNAs in bile exosomes may lead to more rational, targeted approaches to treatment.

3.
Article in English | WPRIM | ID: wpr-889974

ABSTRACT

Background/Aims@#To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. @*Methods@#This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. @*Results@#A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. @*Conclusions@#This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.

4.
Article in English | WPRIM | ID: wpr-889317

ABSTRACT

Purpose@#In this pilot study, using next-generation sequencing and integrated messenger RNA (mRNA) sequencing, we investigated circulating microRNA (miRNA) expression profiling from bile-derived exosomes to identify dysregulated miRNA signatures and oncogenic pathways and determine their effects on targeted mRNAs in cholangiocarcinoma (CCA).Moreover, we explored the possibility that genetic analysis using bile-derived exosomes may replace gene analysis using tissue. @*Methods@#Bile was collected from a patient with perihilar CCA before curative resection. As a control, bile was collected from a patient with a common bile duct stone. Exosomes were isolated from the bile, and we performed next-generation miRNA sequencing using isolated exosomes. To evaluate miRNA-mRNA interactions, mRNA sequencing was performed using bile fluid in both patients. @*Results@#We identified 22 differentially expressed miRNAs. More than 65% of the predicted mRNA targets of those miRNAs were actually differentially expressed between control and CCA bile samples. In functional pathway analysis, targets of 22 miRNAs were primarily enriched in mitogen-activated protein kinase, platelet derived growth factor, vascular endothelial growth factor, epidermal growth factor receptor, and p53 signaling. In particular, in the functional assessment of miRNAmRNA interactions, RAS pathways, including downstream pathways (PI3K-AKT-mTOR and RAS-RAF-MEK-ERK), were determined to be enriched. @*Conclusion@#Circulating miRNAs in bile-derived exosomes provide new information for the development of miRNA analysis in CCA. These miRNAs may represent the oncogenic characteristics of CCA tissue, enabling them to be used instead of tissue samples for the diagnosis of CCA. Further research investigating circulating miRNAs in bile exosomes may lead to more rational, targeted approaches to treatment.

5.
Article in English | WPRIM | ID: wpr-899769

ABSTRACT

BACKGROUND@#Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.@*METHODS@#Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.@*RESULTS@#The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.@*CONCLUSION@#Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.

6.
Article in English | WPRIM | ID: wpr-892065

ABSTRACT

BACKGROUND@#Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.@*METHODS@#Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.@*RESULTS@#The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.@*CONCLUSION@#Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.

7.
Article in English | WPRIM | ID: wpr-810952

ABSTRACT

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , Cohort Studies , DNA , Follow-Up Studies , Half-Life , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Humans , Immunoglobulins , Korea , Liver Transplantation , Liver , Organ Transplantation , Polymerase Chain Reaction , Recurrence , Transplants
8.
Article in English | WPRIM | ID: wpr-785655

ABSTRACT

There has been controversy regarding the first-line treatment modality for the patients who have small solitary hepatocellular carcinoma (HCC); radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), surgical hepatic resection (HR) and liver transplantation (LT). For selection of treatment modality of HCC, it should be considered of hepatic reservoir function as well as the tumor stage. If the liver function is good enough, HR may be the first choice regardless of the tumor size. However, recent studies comparing RFA with resection showed comparable outcome and similar survival rates. RFA, HR and LT provide good outcome for patients who have small HCCs. RFA would be desired in patients who have below 3.0 cm in size and low alpha-fetoprotein (<200 ng/mL). However, in small HCC with high tumor marker, HR should be considered. Better patient selection for the ‘resection first’ approach and early detection of recurrence can achieve better outcomes of the salvage LT strategy. Another benefit of resection first strategy is that it make possible to do enlist of LT for patients before recurrence at high risk of HCC recurrence after resection on the basis of pathologic aggressiveness, microvascular invasion and/or satellites nodule. They should be applied appropriately according to the tumor size, location, tumor markers and underlying liver parenchymal disease.


Subject(s)
alpha-Fetoproteins , Biomarkers, Tumor , Carcinoma, Hepatocellular , Catheter Ablation , Ethanol , Hepatectomy , Humans , Liver , Liver Transplantation , Patient Selection , Recurrence , Survival Rate
9.
Article in English | WPRIM | ID: wpr-739584

ABSTRACT

PURPOSE: In intrahepatic cholangiocarcinoma (iCCA), genetic characteristics on ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-PET scans are not yet clarified. If specific genetic characteristics were found to be related to FDG uptake in iCCA, we can predict molecular features based on the FDG uptake patterns and to distinguish different types of treatments. In this purpose, we analyzed RNA sequencing in iCCA patients to evaluate gene expression signatures associated with FDG uptake patterns. METHODS: We performed RNA sequencing of 22 cases iCCA who underwent preoperative ¹⁸F-FDG-PET, and analyzed the clinical and molecular features according to the maximum standard uptake value (SUVmax). Genes and biological pathway which are associated with SUVmax were analyzed. RESULTS: Patients with SUVmax higher than 9.0 (n = 9) had poorer disease-free survival than those with lower SUVmax (n = 13, P = 0.035). Genes related to glycolysis and gluconeogenesis, phosphorylation and cell cycle were significantly correlated with SUVmax (r ≥ 0.5). RRM2, which is related to the toxicity of Gemcitabine was positively correlated with SUVmax, and SLC27A2 which is associated with Cisplastin response was negatively correlated with SUVmax. According to the pathway analysis, cell cycle, cell division, hypoxia, inflammatory, and metabolism-related pathways were enriched in high SUVmax patients. CONCLUSION: The genomic features of gene expression and pathways can be predicted by FDG uptake features in iCCA. Patients with high FDG uptake have enriched cell cycle, metabolism and hypoxic pathways, which may lead to a more rational targeted treatment approach.


Subject(s)
Hypoxia , Cell Cycle , Cell Division , Cholangiocarcinoma , Disease-Free Survival , Fluorodeoxyglucose F18 , Gene Expression , Gluconeogenesis , Glycolysis , Humans , Metabolism , Phosphorylation , Positron-Emission Tomography , Sequence Analysis, RNA , Transcriptome
10.
Article in English | WPRIM | ID: wpr-713271

ABSTRACT

PURPOSE: The clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer. METHODS: We conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer. RESULTS: Twenty-eight patients (35.9%) underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival. CONCLUSION: R0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.


Subject(s)
Cholecystectomy , Disease-Free Survival , Gallbladder Neoplasms , Gallbladder , Humans , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Recurrence , Retrospective Studies
11.
Article in Korean | WPRIM | ID: wpr-121466

ABSTRACT

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.


Subject(s)
Aged , Carcinoma, Hepatocellular , Cholangiocarcinoma , Diagnosis , Female , Granuloma , Hepatitis B , Hepatitis , Humans , Liver , Neoplasm Metastasis , Polymerase Chain Reaction , Tuberculosis , Tuberculosis, Hepatic
12.
Article in English | WPRIM | ID: wpr-139060

ABSTRACT

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.


Subject(s)
Carcinoma, Hepatocellular , Cohort Studies , Disease-Free Survival , Hepatectomy , Hepatitis B , Humans , Medical Records , Multivariate Analysis , Prognosis , Prothrombin , Recurrence , Retrospective Studies , Survival Rate , Vitamin K
13.
Article in English | WPRIM | ID: wpr-139057

ABSTRACT

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.


Subject(s)
Carcinoma, Hepatocellular , Cohort Studies , Disease-Free Survival , Hepatectomy , Hepatitis B , Humans , Medical Records , Multivariate Analysis , Prognosis , Prothrombin , Recurrence , Retrospective Studies , Survival Rate , Vitamin K
14.
Article in English | WPRIM | ID: wpr-46328

ABSTRACT

BACKGROUND/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.


Subject(s)
Adult , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/complications , Chemoembolization, Therapeutic , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Liver Neoplasms/complications , Male , Middle Aged , Niacinamide/analogs & derivatives , Phenylurea Compounds/therapeutic use , Portal Vein , Proportional Hazards Models , Retrospective Studies , Severity of Illness Index , Survival Rate , Treatment Outcome , Venous Thrombosis/complications
15.
Article in English | WPRIM | ID: wpr-45802

ABSTRACT

BACKGROUND: Patient adherence to immunosuppressant regimens after organ transplant is crucial to preserve graft function, and simplifying the regimen improves adherence. In this study, our experience of conversion from twice-daily (b.i.d.) to once-daily (q.d.) tacrolimus (TAC) in stable liver transplant recipients is reviewed and the proper conversion regimen is investigated. METHODS: Between November 2011 and August 2012, the regimen was converted in 32 stable liver transplant recipients, and data on the conversions gathered retrospectively from medical records. TAC trough level, dose, and laboratory findings were evaluated at preconversion and 1 to 12 months after conversion. RESULTS: Conversion from b.i.d. to q.d. regimen was based on 1:1 proportion in 16 patients and dose escalation in 16 patients. The mean conversion time after transplant was 56.8 months (range; 21~94). Reconversion to b.i.d. regimen was needed in nine patients. Among these patients, seven patients needed titration due to elevated liver enzyme. The trough level decreased significantly after conversion (from 4.7 to 3.1 ng/mL) in patients with conversion at 1:1 proportion, while increasing slightly without statistical significance (3.7 to 4.0 ng/mL) in patients with dose escalation. At 1 year after conversion, dose adjustment was required to preserve trough level and graft function in 14 patients. CONCLUSIONS: Based on our results, TAC q.d. formulation can be a useful option to improve adherence in stable liver transplant recipients. However, dose titration should be considered for preserving proper trough level in case of low TAC level or TAC single regimen.


Subject(s)
Humans , Immunosuppression Therapy , Liver , Medical Records , Patient Compliance , Retrospective Studies , Tacrolimus , Transplant Recipients , Transplants
16.
Article in English | WPRIM | ID: wpr-53698

ABSTRACT

Despite a low risk of liver failure and preserved liver function, non-cirrhotic hepatocellular carcinoma (HCC) has a poor prognosis. In the current study, we evaluated an active regulator of SIRT1 (AROS) as a prognostic biomarker in non-cirrhotic HCC. mRNA levels of AROS were measured in tumor and non-tumor tissues obtained from 283 non-cirrhotic HCC patients. AROS expression was exclusively up-regulated in recurrent tissues from the non-cirrhotic HCC patients (P=0.015) and also in tumor tissues irrespective of tumor stage (P<0.001) or BCLC stage (P<0.001). High mRNA levels of AROS were statistically significantly associated with tumor stage (P<0.001), BCLC stage (P=0.007), alpha fetoprotein (AFP) level (P=0.013), microvascular invasion (P=0.001), tumor size (P=0.036), and portal vein invasion (P=0.005). Kaplan-Meir curve analysis demonstrated that HCC patients with higher AROS levels had shorter disease-free survival (DFS) in both the short-term (P<0.001) and long-term (P=0.005) compared to those with low AROS. Cox regression analysis demonstrated that AROS is a significant predictor for DFS along with large tumor size, tumor multiplicity, vascular invasion, and poor tumor differentiation, which are the known prognostic factors. In conclusion, AROS is a significant biomarker for tumor aggressiveness in non-cirrhotic hepatocellular carcinoma.


Subject(s)
Adult , Age Distribution , Aged , Biomarkers, Tumor/metabolism , Carcinoma, Hepatocellular/epidemiology , Disease-Free Survival , Female , Humans , Liver Cirrhosis/epidemiology , Liver Neoplasms/epidemiology , Male , Middle Aged , Neoplasm Invasiveness , Nuclear Proteins/metabolism , Prevalence , Reproducibility of Results , Republic of Korea/epidemiology , Risk Factors , Sensitivity and Specificity , Sex Distribution , Transcription Factors/metabolism , Young Adult
17.
Article in English | WPRIM | ID: wpr-70525

ABSTRACT

No abstract available.


Subject(s)
Adult , Humans , Liver , Sarcoma
18.
Article in English | WPRIM | ID: wpr-114857

ABSTRACT

Hepatobiliary fibropolycystic diseases are a unique group of entities involving the liver and biliary tract, which are caused by abnormal embryologic development of the ductal plates at various stages. We experienced strange hepatobiliary fibropolycystic diseases with a complex mass composed of malformed ducts and biliary cysts, which did not belong to, and were different from, previously known malformations. They were unique in imaging and histologic features. We herein report three cases of monosegmental hepatobiliary fibropolycystic disease mimicking a mass.


Subject(s)
Adult , Bile Duct Diseases/diagnosis , Cysts/diagnosis , Diagnostic Imaging/methods , Female , Fibrosis/diagnosis , Gallbladder Diseases/diagnosis , Humans , Liver Cirrhosis/diagnosis , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Male
19.
Article in English | WPRIM | ID: wpr-18372

ABSTRACT

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.


Subject(s)
Adolescent , Hypoxia , Arteriovenous Fistula/etiology , Biliary Atresia/diagnosis , Cyanosis/complications , Dyspnea/complications , Echocardiography, Transesophageal , End Stage Liver Disease/complications , Female , Hepatic Artery/abnormalities , Hepatopulmonary Syndrome/diagnosis , Humans , Liver Transplantation , Osteoarthropathy, Secondary Hypertrophic/complications
20.
Hanyang Medical Reviews ; : 142-149, 2013.
Article in Korean | WPRIM | ID: wpr-77563

ABSTRACT

As a medical doctor, the final goal of any type of research is focused on better treatment or contemporary care of the patient. As a surgeon, the research is focused on improving results in surgical procedure and improving the immediate to long term outcomes. In human beings, hepatobiliary tract and pancreas (HBP) play a major role in digestion, body metabolism and endocrine function. These organs are sophisticated in pathology as well as anatomy and physiology. The surgery of the hepatobiliary and pancreatic organ is very difficult. Therefore, the hepatobiliary surgeon's endeavor to treat patients who have hepatobiliary and pancreatic diseases should be scientific and based on evidence in order to get the best result. Here I describe the topic of ischemia/reperfusion injury of the liver from my experience to establish safe surgical resection of the liver with limited bleeding and ischemia/reperfusion injury. Furthermore, I have added ischemia/reperfusion injury in the cirrhotic mouse model, methodology and brief result that I have achieved.


Subject(s)
Animal Experimentation , Animals , Apoptosis , Digestion , Hemorrhage , Humans , Liver , Liver Cirrhosis , Mice , Pancreas , Pancreatic Diseases , Reperfusion Injury
SELECTION OF CITATIONS
SEARCH DETAIL