Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea.

Between February 1997 and December 2001, 311 adult-to-adult living donor liver transplants (A-A LDLTs) were performed at the Asan Medical Center for patients above 20 years of age. Indications for A-A LDLT were: chronic hepatitis B (203), chronic hepatitis C (5), hepatocellular carcinoma (64), alcoholic cirrhosis (9), cryptogenic cirrhosis (4), secondary biliary cirrhosis (5), primary biliary cirrhosis (1), Wilson' s disease (2), autoimmune hepatitis (1), hepatic tuberculosis (1), cholangiocarcinoma (1), fulminant hepatic failure (14) and primary non-function of cadaveric liver graft (1). Of 311 A-A LDLTs, 36 were of medical high urgency, 20 were for acute and subacute hepatic failure, 15 were for hepato-renal syndrome and 1 was for primary non-function. Recipient age ranged from 27 to 64 years. Donor age ranged from 16 to 62 years. There was no donor mortality. Implanted liver grafts were categorized into seven types: 175 modified right lobe (MRL), 70 left lobe, 32 right lobe, 20 dual grafts, 10 left lobe plus caudate lobe, three extended right lobe and one posterior segment. In MRL, the tributaries of the middle hepatic vein were reconstructed by interpositioning a vein graft. Indication for dual graft implantation was the same as single graft A-A LDLT, and four of 20 were emergency cases. Of 20 dual grafts, 14 received two left lobes, four received a left lobe and a lateral segment, one received a right lobe and a left lobe and one received a lateral segment and a posterior segment. Graft volume ranged from 28% to 83% of the standard liver volume of the recipients. There were 33 (10.6%) in-hospital mortalities (< 4 months) among the 310 patients after 311 A-A LDLTs. Of the 36 patients receiving emergency transplants, 31 survived. These encouraging results justify the expansion of A-A LDLT in coping with increasing demands, even in urgent situations. We have aimed to introduce the establishment of the efficacy of A-A LDLT in various end-stage chronic and acute liver diseases, as well as new technical advances to overcome small graft-size syndrome by using dual-graft implantation and MRL, both of which were first developed in our department.

N.m.r. lipid profiles of cells, tissues and body fluids. Neutral, non-acidic and acidic phospholipid analysis of Bond Elut chromatographic fractions.

Although the advantages of in vitro n.m.r. analysis of cellular lipids have been documented, this purely n.m.r. approach also has drawbacks. Rapid and quantitative separation of total lipids into neutral lipids, non-esterified fatty acids, non-acidic phospholipids and acidic phospholipids using Bond Elut ion-exchange columns as demonstrated here permitted a more quantitative and complete n.m.r. analysis of glycerides, cholesterol, saturated and unsaturated sphingolipids and ether lipids, as well as of diacylcholine and ethanolamine lipids. Acidic lipids were also analysed. The fatty acid compositions of the intact lipids in each of the four Bond Elut fractions were determined from the n.m.r. spectrum of each fraction.

NMR lipid profiles of cells, tissues, and body fluids: proton NMR analysis of human erythrocyte lipids.

One- and two-dimensional high resolution NMR spectroscopy was applied to determine quantitatively and qualitatively the lipids extracted from human erythrocyte membranes. The relative amounts of the major lipids were determined from the spectra of unfractionated lipid extracts. After HPLC fractionation of the lipid extracts and NMR analysis of the fractions, it was possible to determine the features of the component lipids of each lipid class and to compare, especially, the fatty acid types and composition of the individual major glycerophospholipids. The results of this proton NMR analysis were compared to those obtained elsewhere using classical lipid analytical techniques and found to be in substantial agreement.