ABSTRACT
High pre-transplant isoagglutinin is a risk factor for antibody-mediated rejection in ABO-incompatible living donor liver transplantation. A 55-year-old man with alcoholic liver cirrhosis underwent ABO-incompatible living donor liver transplantation. The initial isoagglutinin immunoglobulin G titer was 1:1,024. Despite five sessions of plasmapheresis, the isoagglutinin titer was not significantly reduced (from 1:1,024 to 1:512). We decided to perform 11 plasmaphereses and proceed with liver transplantation regardless of the isoagglutinin titer (1:128 at transplantation day). Instead, we planned to administer 0.5 g/kg intravenous immunoglobulin and booster rituximab (200 mg) after transplant. On postoperative day 6, the isoagglutinin titer increased from 1:32 to 1:64, and the patient received plasmapheresis twice. The patient maintained stable liver function without evidence of further complications or rejection. The high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab protocol might be able to overcome a pre-transplant high isoagglutinin titer in ABO-incompatible living donor liver transplantation without splenectomy.
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Background@#Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI. @*Methods@#This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system. @*Results@#In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively. @*Conclusions@#Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.
ABSTRACT
Alcohol-related liver disease (ALD) has become the major cause of liver transplantation (LT) in Korea, and is currently the most common cause of LT in Europe and the United States. Although, ALD is one of the most common indications for LT, it is traditionally not considered as an option for patients with ALD due to organ shortages and concerns about relapse. To select patients with terminal liver disease due to ALD for transplants, most LT centers in the United States and European countries require a 6-month sober period before transplantation. However, Korea has a different social and cultural background than Western countries, and most organ transplants are made from living donors, who account for approximately twice as many procedures as deceased donors. Most LT centers in Korea do not require a specific period of sobriety before transplantation in patients with ALD. As per the literature, 8%–20% of patients resume alcohol consumption 1 year after LT, and this proportion increases to 30%–40% at 5 years post-LT, among which 10%–15% of patients resume heavy drinking. According to previous studies, the risk factors for alcohol relapse after LT are as follows: young age, poor familial and social support, family history of alcohol use disorder, previous history of alcohol-related treatment, shorter abstinence before LT, smoking, psychiatric disorders, irregular follow-up, and unemployment. Recognition of the risk factors, early detection of alcohol consumption after LT, and regular follow-up by a multidisciplinary team are important for improving the short- and long-term outcomes of LT patients with ALD.
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Purpose@#To evaluate the effectiveness of the transradial artery approach (TRA) for treating malfunctioning arteriovenous fistulas (AVFs) in patients on hemodialysis. @*Materials and Methods@#A retrospective analysis was conducted in this single-center study of TRA endovascular procedures in 73 patients (43 male and 30 female; mean age of 67.4 years (range, 42–92 years) with malfunctioning AVFs, between January 2008 and April 2019. Patients’ baseline and lesion characteristics, technical and clinical success, and complications were evaluated, and functional patency was analyzed using the Kaplan-Meier method. @*Results@#Radial artery approaches were successful in all patients. Angioplasty performed using the TRA achieved technical and clinical success rates of 98.6%(72/73) and 91.7%(67/73), respectively. The median primary patency time was 18.8 ± 15.9 months. The primary functional patency rates at 3, 6, and 12 months were 82.1%, 68.6%, and 63.9%, respectively. There were no major complications or adverse events, such as hand ischemia, related to the radial artery approach. @*Conclusion@#In selected cases, the TRA can be used complementary to the transvenous approach to treat malfunctioning AVFs.
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Background/Aims@#Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea. @*Methods@#Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study. @*Results@#A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%. @*Conclusions@#The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15.
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Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-yearold man diagnosed with HBV-LC with massive ascites underwent living donor liver transplantation. After transplantation, more than 1000 ml/day of ascites was steadily drained until two weeks after LT. CT showed intrahepatic Rt. portal vein thrombosis and many remnant collaterals with splenomegaly. We decided to embolize the proximal splenic artery and use apixaban to reduce portal flow and resolve the intrahepatic portal thrombosis. One day after splenic artery embolization, the patient's ascites dramatically decreased. Three days later, he was discharged from the hospital. Three months later, a follow-up liver CT showed resolution of thrombosis and no ascites. Splenic artery embolization was an effective and safe procedure for portal flow modulation in portal hyertension. Apixaban was effective for partial portal vein thrombosis in a liver transplant recipient.
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Background@#Non-HLA antibodies, anti-angiotensin II type 1 receptor antibodies (anti-AT1R) and anti-endothelial cell antibodies (AECA), are known to play a role in allograft rejection. We evaluated the role of both antibodies in predicting post-transplant outcomes in low-risk living donor kidney transplantation (LDKT) recipients. @*Methods@#In 94 consecutive LDKT recipients who were ABO compatible and negative for pre-transplant HLA donor-specific antibodies, we determined the levels of anti-AT1Rs using an enzyme-linked immunosorbent assay and the presence of AECAs using a flow cytometric endothelial cell crossmatch (ECXM) assay with pre-transplant sera. Hazard ratio (HR) was calculated to predict post-transplant outcomes. @*Results@#Pre-transplant anti-AT1Rs (≥11.5 U/mL) and AECAs were observed in 36 (38.3%) and 22 recipients (23.4%), respectively; 11 recipients had both. Pre-transplant anti-AT1Rs were a significant risk factor for the development of acute rejection (AR) (HR 2.09; P=0.018), while a positive AECA status was associated with AR or microvascular inflammation only (HR 2.47; P=0.004) throughout the follow-up period. In particular, AECA (+) recipients with ≥11.5 U/mL anti-AT1Rs exhibited a significant effect on creatinine and estimated glomerular filtration rate (P<0.001; P=0.028), although the risk of AR was not significant. @*Conclusions@#Pre-transplant anti-AT1Rs and AECAs have independent negative effects on post-transplant outcomes in low-risk LDKT recipients. Assessment of both antibodies would be helpful in stratifying the pre-transplant immunological risk, even in low-risk LDKT recipients.
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BACKGROUND: The most effective treatment for end-stage renal disease is kidney transplantation, and the number of kidney transplantations has shown a rapid increase. The aim of this study was to determine graft survival and functional outcome of 1,500 kidney transplant cases in a single center. We also investigated the factors affecting graft failure after kidney transplantation. METHODS: We retrospectively reviewed the clinical data of 1,500 pairs of donors and subsequent recipients who underwent kidney transplantation in Samsung Medical Center, from February 1995 to January 2012. RESULTS: The mean follow-up period was 2,241.5+/-1,609.4 days. There were 851 (56.7%) male recipients; 62 (4.1%) recipients were younger than 19 years old. Eleven (0.7%) cases were ABO blood group incompatible kidney transplant. A total of 531 (35%) deceased and 969 (65%) living donors were included. Among them, 191 (12.7%) recipients were experienced in graft failure. The most common cause of graft loss was chronic allograft nephropathy. One-year, 5-year, 10-year, and 15-year graft survival were 97.3%, 92.8%, 81.6%, and 75.1% (85.2% for living, 75.4% for deceased donor), respectively. Higher incidence of graft failure was observed in recipients who received deceased donor kidneys or experienced a rejection episode. CONCLUSIONS: In our experience, overall 10-year graft survival after kidney transplantation was 81.6%. This report demonstrated that the type of donor (living or deceased) and history of allograft rejection are the only significant factors affecting graft survival.
Subject(s)
Humans , Male , Young Adult , Allografts , Follow-Up Studies , Graft Survival , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Living Donors , Retrospective Studies , Tissue Donors , TransplantsABSTRACT
Mesenteric fibromatosis is a rare benign fibrous tumor that can occur from bowel mesentery of the retroperitoneum. It can infiltrate the surrounding structures and tends to recur locally even after resection but does not have metastatic capability. Mesenteric fibromatosis represents 8% of all intra-abdominal desmoid neoplasm. We experienced a case of mesenteric fibromatosis in a 50-year-old woman with a painless abdominal mass. An exploratory laparotomy was performed, and two large, small bowel mesenteric masses were found which were invading the transverse colon. The segment of the jejunum and transverse colon including the masses were resected widely and the pathologic report confirmed the diagnosis of fibromatosis. We reviewed the features of the mesenteric fibromatosis, that is, clinical, imaging, pathological, immunohistological features, and differential diagnosis and treatment of mesenteric fibromatosis.
Subject(s)
Female , Humans , Middle Aged , Colon, Transverse , Diagnosis, Differential , Fibroma , Fibromatosis, Aggressive , Jejunum , Laparotomy , MesenteryABSTRACT
PURPOSE: Carcinoma of the gallbladder is an aggressive, late-symptomatic disease and most patients are treated at an advanced stage, and these patients have a poor prognosis. During recent years, extended operations that combine a resection of the liver with wide lymph node dissection have improved the long-term survival. The aim of this study is to evaluate the surgical outcome for gallbladder carcinoma based on the presence of lymph node metastasis and the depth of the primary tumor invasion. METHODS: A retrospective analysis was done on 68 patients who underwent a surgical resection of gallbladder carcinoma from 1997 to 2004. The factors that nfluenced the 5-year survival were examined. RESULTS: The overall 5-year survival rate was 49.6%. The lymph node metastasis rate was 40.0% in T2 disease and 61.1% in T3/T4 disease. The 5-year survival rate (5-YSR) for T2 disease was 52.1% for the patients who underwent cholecystectomy with lymph node dissection and hepatic resection, and it was 51.2% for the patients who underwent only simple cholecystectomy. The 5-YSR for T3/T4 disease was 33.3% for the patients who underwent extended cholecystectomy, and it was 12.9% for the palliative cholecystectomy patients. CONCLUSION: The role of radical surgery seems to be limited for patients with more extensive tumor invasion or lymph node metastasis.