Kosin Medical Journal

Review article

Alcohol-related liver disease and liver transplantation: Musheer Shafqat, Ji Hoon Jo, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin; Kosin Med J. 2022;37(2):107-118. Published online June 27, 2022; DOI: https://doi.org/10.7180/kmj.22.108

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Abstract PDF PubReader ePub: 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.

Original article

A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography: Kwang Il Seo, Hyunyong Hwang, Byung Cheol Yun, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin, Myunghee Yoon; Kosin Med J. 2022;37(2):146-153. Published online June 24, 2022; DOI: https://doi.org/10.7180/kmj.22.110

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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.

Citations

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Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Journal of Clinical Medicine.2024; 13(2): 381. CrossRef

Case report

Overcoming high pre-transplant isoagglutinin titers using high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab without splenectomy in ABO-incompatible living donor liver transplantation: a case report: Hyung Hwan Moon; Kosin Med J. 2022;37(2):163-168. Published online March 29, 2022; DOI: https://doi.org/10.7180/kmj.21.036

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Abstract PDF PubReader ePub: 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.

Original article

Validation of the association of the cystic duct fibrosis score with surgical difficulty in laparoscopic cholecystectomy: Hyung Hwan Moon, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin; Kosin Med J. 2022;37(1):61-67. Published online March 25, 2022; DOI: https://doi.org/10.7180/kmj.21.049

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Abstract PDF PubReader ePub

Background
The level of surgical difficulty in laparoscopic cholecystectomy might be predictable based on preoperative imaging and intraoperative findings indicative of cholecystitis severity. Several scales for laparoscopic cholecystectomy have been developed, but most are complex, unverified, and not widely adopted. This study evaluated the association of the cystic duct fibrosis score (range, 0–3) with surgical difficulty in laparoscopic cholecystectomy.
Methods
Between July 2018 and November 2018, 163 laparoscopic cholecystectomy cases were retrospectively reviewed at a single center. Patients’ demographics, preoperative laboratory data, operation time, complications, hospital stay, and cholecystitis severity grade were investigated. We also evaluated the associations of the Tokyo Guidelines 2018 and the Parkland grading scale with the cystic fibrosis score.
Results
The cystic duct fibrosis score was associated with preoperative white blood cells (p<0.001), preoperative platelet count (p=0.046), preoperative total bilirubin (p<0.004), preoperative C-reactive protein (p<0.001), operation time (p<0.001), cystic duct ligation time (p=0.002), estimated blood loss (p<0.001), postoperative complication (p=0.004), open conversion (p<0.001), and common bile duct injury (p=0.010). The cystic duct fibrosis score was also correlated with the Tokyo Guidelines 2018 and the Parkland grading scale (p<0.001). The cystic duct ligation time predicted the cystic duct fibrosis score and the Parkland grading scale, but not the Tokyo Guidelines 2018.
Conclusion
As a simple indicator of cholecystitis severity, the cystic duct fibrosis score can predict the surgical difficulty and outcomes of laparoscopic cholecystectomy.

Citations

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Correlation Between Preoperative Ultrasonography and Parkland Grading Scale in Patients Undergoing Laparoscopic Cholecystectomy
Burak Uçaner, Doğuş Durmuş, Mehmet Zeki Buldanlı, Oğuz Hançerlioğulları
Indian Journal of Surgery.2024; 86(1): 160. CrossRef

Case report

Refractory Ascites with Intrahepatic Portal Thrombosis after Living Donor Liver Transplantation Successfully Treated by Splenic Artery Embolization and Apixaban (Case Report): Hyung Hwan Moon; Kosin Med J. 2021;36(2):187-192. Published online December 31, 2021; DOI: https://doi.org/10.7180/kmj.2021.36.2.187

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Abstract PDF PubReader ePub: Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-year-old 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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