Clinical and Molecular Hepatology

"Liver transplantation"

Review

Post-Transplant Hepatocellular Carcinoma: Balancing Immunosuppression and Immune Checkpoint Inhibitors: Tomoharu Yamada, Ryosuke Tateishi, Mitsuhiro Fujishiro; Received October 15, 2025 Accepted January 24, 2026 Published online February 2, 2026; DOI: https://doi.org/10.3350/cmh.2025.1179 [Accepted]

Abstract
PDF

Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and hepatocellular carcinoma (HCC). Advances in surgical techniques and immunosuppressive regimens have markedly improved early post-transplant survival. However, long-term outcomes remain compromised by HCC recurrence, chronic rejection, metabolic complications, and de novo malignancies. Recurrence of HCC after LT remains a major clinical challenge, with available prognostic models providing limited accuracy in risk stratification. Simultaneously, systemic therapies for unresectable HCC have rapidly advanced, particularly with immune checkpoint inhibitors (ICIs), providing new opportunities and unique challenges in transplant settings. With ICIs carrying a risk of acute and potentially fatal rejection and lacking controlled data on efficacy or safety in the post-transplant setting, tyrosine kinase inhibitors currently represent a standard option for post-transplant recurrence. Novel biomarkers, such as donor-derived cell-free DNA and the gut microbiome, are emerging as potential tools to refine risk stratification and guide immunosuppression. Furthermore, innovative immunotherapies, including oncolytic viruses and mRNA vaccines, are being explored as tumor-specific approaches. Collectively, these advances may reshape future management of LT recipients.

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Research Letter

Non-infectivity of hepatitis B virus under nucleoside analog therapy revealed through auxiliary partial orthotopic liver transplantation: Xiaojie Chen, Guiwen Guan, Lin Wei, Jidong Jia, Xiangmei Chen, Fengmin Lu, Zhijun Zhu; Clin Mol Hepatol 2025;31(3):e263-e267.
Published online May 8, 2025; DOI: https://doi.org/10.3350/cmh.2025.0393

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Correspondences

Liver Transplantation

Correspondence to editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Soon Kyu Lee, Jong Young Choi; Clin Mol Hepatol 2025;31(2):e161-e162.
Published online February 13, 2025; DOI: https://doi.org/10.3350/cmh.2025.0121

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Liver Transplantation

Correspondence to letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Soon Kyu Lee, Jong Young Choi; Clin Mol Hepatol 2025;31(2):e212-e214.
Published online February 10, 2025; DOI: https://doi.org/10.3350/cmh.2025.0100

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Editorial

Liver Transplantation

Intrapatient variability of tacrolimus trough level may be not the cause, but an indirect parameter of comorbidities: Editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”: Jongman Kim; Clin Mol Hepatol 2025;31(2):589-591.
Published online January 24, 2025; DOI: https://doi.org/10.3350/cmh.2025.0076

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Correspondence to editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”
Soon Kyu Lee, Jong Young Choi
Clinical and Molecular Hepatology.2025; 31(2): e161. CrossRef

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Original Article

Liver Transplantation

Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation: Soon Kyu Lee, Ho Joong Choi, Young Kyoung You, Pil Soo Sung, Seung Kew Yoon, Jeong Won Jang, Jong Young Choi; Clin Mol Hepatol 2025;31(1):131-146.
Published online October 2, 2024; DOI: https://doi.org/10.3350/cmh.2024.0451

Background/Aims
This study aimed to identify the risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD) following liver transplantation (LT), with a specific focus on tacrolimus levels and intrapatient variability (IPV).
Methods
Among the 1,076 patients who underwent LT between 2000 and 2018, 952 were included in the analysis. The tacrolimus doses and levels were recorded every 3 months, and the IPV was calculated using the coefficient of variability. The cumulative incidence rates of CKD and ESRD were calculated based on baseline kidney function at the time of LT. The impact of tacrolimus levels and their IPV on the development of CKD and ESRD was evaluated, and the significant risk factors were identified.
Result
s: Within a median follow-up of 97.3 months, the 5-year cumulative incidence rates of CKD (0.58 vs. 0.24) and ESRD (0.07 vs. 0.01) were significantly higher in the acute kidney injury group than in the normal glomerular filtration rate (GFR) group. In the normal GFR group, the tacrolimus levels were identified as a risk factor for CKD, with a level of ≤4.5 ng/mL suggested as optimal for minimizing the risk of CKD. Furthermore, the IPV of tacrolimus levels and doses emerged as a significant risk factor for CKD development in both groups (p<0.05), with tenofovir disoproxil fumarate also being a risk factor in HBV-infected patients. The IPV of tacrolimus levels was also a significant factor in ESRD development (p<0.05).
Conclusions
This study elucidated the optimal tacrolimus trough level and highlighted the impact of IPV on the CKD and ESRD development post-LT.

Citations

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Intrapatient variability of tacrolimus trough level may be not the cause, but an indirect parameter of comorbidities: Editorial on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development foll
Jongman Kim
Clinical and Molecular Hepatology.2025; 31(2): 589. CrossRef
Correspondence to letter to the editor on “Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation”
Soon Kyu Lee, Jong Young Choi
Clinical and Molecular Hepatology.2025; 31(2): e212. CrossRef
Clinical significance and gene prediction of a novel classification system based on tacrolimus concentration-to-dose ratio in the early post-liver transplant period
Junwei Fan, Peihao Wen, Liyun Yuan, Yan Xia, Shijie Hu, Xiaoqing Zhang, Zhihai Peng
Frontiers in Pharmacology.2025;[Epub] CrossRef
Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades
Alejandro Muñoz-Serrano, María Jesús Citores, Andrea Gutiérrez-Villanueva, Víctor Moreno-Torres, Jorge V López-Ibor, Natalia Vicente, Valentín Cuervas-Mons
World Journal of Transplantation.2025;[Epub] CrossRef

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Review

Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation: Meng Sha, Jun Wang, Jie Cao, Zhi-Hui Zou, Xiao-ye Qu, Zhi-feng Xi, Chuan Shen, Ying Tong, Jian-jun Zhang, Seogsong Jeong, Qiang Xia; Clin Mol Hepatol 2025;31(Suppl):S285-S300.
Published online August 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0323

Abstract
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Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

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Soon Sun Kim, Hyung Seok Kim, Jae Youn Cheong, Jung Woo Eun
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Journal of Hepatocellular Carcinoma.2025; Volume 12: 2907. CrossRef
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Annals of Liver Transplantation.2024; 4(2): 40. CrossRef

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Original Article

Liver Transplantation

Ischemia-free liver transplantation improves the prognosis of recipients using functionally marginal liver grafts: Shuai Wang, Xiaohong Lin, Yunhua Tang, Yichen Liang, Min Zhang, Zhonghao Xie, Yiwen Guo, Yuqi Dong, Qiang Zhao, Zhiyong Guo, Dongping Wang, Xiaoshun He, Weiqiang Ju, Maogen Chen; Clin Mol Hepatol 2024;30(3):421-435.
Published online April 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0139

Background/Aims
The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation.
Methods
Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles.
Result
s: FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012).
Conclusions
FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.

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Ischemia-free liver transplantation improves long-term outcomes in a 5-year follow-up study
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Revista do Colégio Brasileiro de Cirurgiões.2025;[Epub] CrossRef
Ischemia-free Liver Transplantation: 7-y Experience From a Single-center Cohort in China
Qingze Meng, Honghui Chen, Jiahao Li, Meiting Qin, Jinbo Huang, Mingxi Zhang, Chengzhi Wang, Jitian He, Ruilin Cai, Huadi Chen, Yongqi Yang, Tielong Wang, Yefu Li, Maogen Chen, Weiqiang Ju, Dongping Wang, Zhiyong Guo, Yunhua Tang, Xiaoshun He, Qiang Zhao
Transplantation.2025;[Epub] CrossRef
The impact of ischemia-free liver transplantation on improving the prognosis of recipients using functionally marginal liver grafts: Editorial on “Ischemia-free liver transplantation improves the prognosis of recipients using functionally marginal liver g
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Clinical and Molecular Hepatology.2024; 30(4): 702. CrossRef

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Editorial

Steatotic liver disease

How to optimize the outcome of liver transplantation for non-alcoholic fatty liver disease: Byeong Geun Song, Dong Hyun Sinn; Clin Mol Hepatol 2023;29(2):411-413.
Published online March 6, 2023; DOI: https://doi.org/10.3350/cmh.2023.0058

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Jianlin He, Weizhu Chen, Sisi Chen, Menglei Shi, Ling Lin, Yiping Zhang, Bihong Hong
Journal of Functional Foods.2024; 112: 105998. CrossRef
Liver transplantation for alcohol-related liver disease in Korea: The need for patient management guidelines
Soon Kyu Lee
Annals of Liver Transplantation.2024; 4(2): 40. CrossRef

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1 Web of Science
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Reviews

Hepatic neoplasm

Clinical practice guidelines and real-life practice on hepatocellular carcinoma: A the Hong Kong perspective: Rex Wan-Hin Hui, Lung-Yi Mak, Tan-To Cheung, Victor Ho-Fun Lee, Wai-Kay Seto, Man-Fung Yuen; Clin Mol Hepatol 2023;29(2):217-229.
Published online December 28, 2022; DOI: https://doi.org/10.3350/cmh.2022.0399

Abstract
PDF

Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.

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Gongzheng Wang, Wei Chen, Zhuoshuai Liang, Feier Ding, Jin Cui, Zijian Shen, Fan Lin, Xiujuan Li, Ximing Wang, Xinya Zhao
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Qi Liu, Renjie Zhang, Weixi Shen
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Rex Wan-Hin Hui, Lung-Yi Mak, Wai-Kay Seto, Man-Fung Yuen
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Rex Wan-Hin Hui, Keith Wan-Hang Chiu, I-Cheng Lee, Chenlu Wang, Ho-Ming Cheng, Jianliang Lu, Xianhua Mao, Sarah Yu, Lok-Ka Lam, Lung-Yi Mak, Tan-To Cheung, Nam-Hung Chia, Chin-Cheung Cheung, Wai-Kuen Kan, Tiffany Cho-Lam Wong, Albert Chi-Yan Chan, Yi-Hsia
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Steatotic liver disease

Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management: Sara Battistella, Francesca D’Arcangelo, Marco Grasso, Alberto Zanetto, Martina Gambato, Giacomo Germani, Marco Senzolo, Francesco Paolo Russo, Patrizia Burra; Clin Mol Hepatol 2023;29(Suppl):S286-S301.
Published online December 28, 2022; DOI: https://doi.org/10.3350/cmh.2022.0392

Abstract
PDF

Non-alcoholic fatty liver disease (NAFLD) is currently the fastest growing indication to liver transplantation (LT) in Western Countries, both for end stage liver disease and hepatocellular carcinoma. NAFLD/non-alcoholic steatohepatitis (NASH) is often expression of a systemic metabolic syndrome; therefore, NAFLD/NASH patients require a multidisciplinary approach for a proper pre-surgical evaluation, which is important to achieve a post-transplant outcome comparable to that of other indications to LT. NAFLD/NASH patients are also at higher risk of post-transplant cardiovascular events, diabetes, dyslipidemia, obesity, renal impairment and recurrent NASH. Lifestyle modifications, included diet and physical activity, are key to improve survival and quality of life after transplantation. A tailored immunosuppressive regimen may be proposed in selected patients. Development of new drugs for the treatment of recurrent NASH is awaited.

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Microbiome and metabolomics in alcoholic liver disease: Raja Ganesan, Ki Tae Suk; Clin Mol Hepatol 2022;28(3):580-582.
Published online July 1, 2022; DOI: https://doi.org/10.3350/cmh.2022.0171

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Liver fibrosis, cirrhosis, and portal hypertension

Management of refractory ascites: Florence Wong; Clin Mol Hepatol 2023;29(1):16-32.
Published online June 9, 2022; DOI: https://doi.org/10.3350/cmh.2022.0104

Abstract
PDF

The development of refractory ascites in approximately 10% of patients with decompensated cirrhosis heralds the progression to a more advanced stage of cirrhosis. Its pathogenesis is related to significant hemodynamic changes, initiated by portal hypertension, but ultimately leading to renal hypoperfusion and avid sodium retention. Inflammation can also contribute to the pathogenesis of refractory ascites by causing portal microthrombi, perpetuating the portal hypertension. Many complications accompany the development of refractory ascites, but renal dysfunction is most common. Management starts with continuation of sodium restriction, which needs frequent reviews for adherence; and regular large volume paracentesis of 5 L or more with albumin infusions to prevent the development of paracentesisinduced circulatory dysfunction. Albumin infusions independent of paracentesis may have a role in the management of these patients. The insertion of a covered, smaller diameter, transjugular intrahepatic porto-systemic stent shunt (TIPS) in the appropriate patients with reasonable liver reserve can bring about improvement in quality of life and improved survival after ascites clearance. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. Patients with refractory ascites should be referred for liver transplant, as their prognosis is poor. In patients with refractory ascites and concomitant chronic kidney disease of more than stage 3b, assessment should be referred for dual liver-kidney transplants. In patients with very advanced cirrhosis not suitable for any definitive treatment for ascites control, palliative care should be involved to improve the quality of life of these patients.

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Prediction models of hepatocellular carcinoma recurrence after liver transplantation: A comprehensive review: Sang Jin Kim, Jong Man Kim; Clin Mol Hepatol 2022;28(4):739-753.
Published online April 26, 2022; DOI: https://doi.org/10.3350/cmh.2022.0060

Liver transplantation (LT) is one of the most effective treatments for hepatocellular carcinoma (HCC). Although LT eliminates HCC and greatly reduces recurrence, some patients experience recurrence after LT. Criteria and models for screening patients with a high probability of HCC recurrence after LT, starting with the Milan criteria, have been published. These models have changed over time, but a standard has not been established. We summarized HCC prediction models after LT by focusing on the application of radiologic, serologic, and pathologic factors and recent trends. This review will look at studies that are based on living donor LT and deceased donor LT, as well as studies that downstaging procedures have been performed preoperatively. This ultimately aims to help make decisions for evaluating the HCC state and selecting candidates for LT according to the circumstances of each transplantation center.

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Snapshot

Liver Transplantation

Current status and outcome of liver transplantation in South Korea: Ho Joong Choi; Clin Mol Hepatol 2022;28(1):117-119.
Published online December 7, 2021; DOI: https://doi.org/10.3350/cmh.2021.0381

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Editorial

Hepatic neoplasm

Can hepatocellular carcinoma recurrence be prevented after liver transplantation?: Jong Man Kim; Clin Mol Hepatol 2021;27(4):562-563.
Published online September 23, 2021; DOI: https://doi.org/10.3350/cmh.2021.0276

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Everolimus Personalized Therapy: Second Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Satohiro Masuda, Florian Lemaitre, Markus J. Barten, Stein Bergan, Maria Shipkova, Teun van Gelder, Sander Vinks, Eberhard Wieland, Kirsten Bornemann-Kolatzki, Mercè Brunet, Brenda de Winter, Maja-Theresa Dieterlen, Laure Elens, Taihei Ito, Kamisha Johnso
Therapeutic Drug Monitoring.2025; 47(1): 4. CrossRef
Association between the early high level of serum tacrolimus and recurrence of hepatocellular carcinoma in ABO-incompatible liver transplantation
Ji Won Han, Jong Young Choi, Eun Sun Jung, Ji Hoon Kim, Hee Sun Cho, Jae-Sung Yoo, Pil Soo Sung, Jeong Won Jang, Seung Kew Yoon, Ho Joong Choi, Young Kyoung You
World Journal of Gastrointestinal Surgery.2023; 15(12): 2727. CrossRef
Optimal imaging criteria and modality to determine Milan criteria for the prediction of post-transplant HCC recurrence after locoregional treatment
Nieun Seo, Dong Jin Joo, Mi-Suk Park, Seung-seob Kim, Hye Jung Shin, Yong Eun Chung, Jin-Young Choi, Myoung Soo Kim, Myeong-Jin Kim
European Radiology.2022; 33(1): 501. CrossRef

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Original Articles

Liver Transplantation

Cost-effectiveness and long-term outcomes of liver transplantation using hepatitis B core antibody-positive grafts with hepatitis B immunoglobulin prophylaxis in Korea: Kyeong Deok Kim, Ji Eun Lee, Jong Man Kim, Okjoo Lee, Na Young Hwang, Jinsoo Rhu, Gyu-Seong Choi, Kyunga Kim, Jae-Won Joh; Clin Mol Hepatol 2021;27(4):603-615.
Published online September 8, 2021; DOI: https://doi.org/10.3350/cmh.2021.0137

Background/Aims
Hepatitis B core antibody (anti-HBc)-positive donors are used as an extended donor pool, and current guidelines recommend the usage of nucleos(t)ide analogues (NAs) as prophylaxis for preventing de novo hepatitis B virus infection (DNH). We analyzed the long-term outcomes of a large cohort of liver transplantation (LT) patients receiving anti-HBc-positive grafts and evaluated the risk of DNH when hepatitis B immunoglobulin (HBIG) monotherapy was used as prophylaxis. We also compared the cost-effectiveness of HBIG and NAs.
Methods
We retrospectively reviewed 457 patients with anti-HBc-positive grafts and 898 patients with anti-HBc-negative grafts who underwent LT between January 2001 and December 2018. We compared recipient characteristics according to the anti-HBc status of the donor, and compared the costs of using NAs for the rest of the patient’s life and using HBIG to maintain hepatitis B surface antibody titers above 200 IU/L.
Result
s: The 1-, 5-, and 10-year patient survival rates were 87.7%, 73.5%, and 67.7%, respectively, in patients with anti-HBc-positive grafts, and 88.5%, 77.4%, and 70.3%, respectively, in patients with anti-HBc-negative grafts (P=0.113). Among 457 recipients with anti-HBc-positive grafts, 117 (25.6%) were non-HBV recipients. The overall incidence of DNH was 0.9%. When using HBIG under insurance coverage, the cumulative cost was lower compared with using NA continuously without insurance coverage in Korea.
Conclusions
Anti-HBc-positive grafts alone do not affect patient survival or graft survival. HBIG monoprophylaxis has good outcomes for preventing DNH, and the patient’s long-term cost burden is low in Korea because of the national insurance system in this cohort.

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The Brazilian Journal of Infectious Diseases.2024; 28(6): 104384. CrossRef
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Chee-Chien Yong, Yu-Hung Lin, Wendell Z. Espinosa, I-Hsuan Chen, Shih-Ho Wang, Yi-Chia Chan, Chao-Long Chen, Chih-Che Lin
International Journal of Surgery.2024; 110(10): 6702. CrossRef
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Karan K. Shah, Melanie Wyld, James A. Hedley, Karen M.J. Waller, Nicole De La Mata, Angela C. Webster, Rachael L. Morton
Transplantation.2023; 107(9): 2028. CrossRef

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Liver Transplantation

Impact of everolimus on survival after liver transplantation for hepatocellular carcinoma: Incheon Kang, Jae Geun Lee, Sung Hoon Choi, Hyun Jeong Kim, Dai Hoon Han, Gi Hong Choi, Myoung Soo Kim, Jin Sub Choi, Soon Il Kim, Dong Jin Joo; Clin Mol Hepatol 2021;27(4):589-602.
Published online July 23, 2021; DOI: https://doi.org/10.3350/cmh.2021.0038

Background/Aims
This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC).
Methods
The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated.
Result
s: The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001).
Conclusions
Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.

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Liver Transplantation

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry: Jong Man Kim, Deok Gie Kim, Jihyun Kim, Keunsung Lee, Kwang-Woong Lee, Je Ho Ryu, Bong-Wan Kim, Dong Lak Choi, Young Kyoung You, Dong-Sik Kim, Yang Won Nah, Koo Jeong Kang, Jai Young Cho, Geun Hong, Hee Chul Yu, Ju Ik Moon, Dongho Choi, Shin Hwang, Myoung Soo Kim; Clin Mol Hepatol 2021;27(3):451-462.
Published online February 2, 2021; DOI: https://doi.org/10.3350/cmh.2020.0292

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.
Result
s: 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.

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Changes in the epidemiology and management of bacterial infections in cirrhosis: Salvatore Piano, Marta Tonon, Paolo Angeli; Clin Mol Hepatol 2021;27(3):437-445.
Published online January 28, 2021; DOI: https://doi.org/10.3350/cmh.2020.0329

Abstract
PDF

Patients with cirrhosis are susceptible to develop infections because of immune dysfunction, changes in microbiome and increase in bacterial translocation from the gut to systemic circulation. Bacterial infections can worse the clinical course of the disease, triggering the development of complications such as acute kidney injury, hepatic encephalopathy, organ failures and acute on chronic liver failure. In recent years, the spread of multi drug resistant bacteria made more challenging the management of infections in patients with cirrhosis. Hence, the mortality rate associated to sepsis is increasing in these patients. Therefore, the optimization of the management of infections has a high priority in cirrhosis. Herein we reviewed the recent changes in the epidemiology and the management of bacterial infections in patients with liver cirrhosis.

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Alcohol-related cirrhosis: The most challenging etiology of cirrhosis is more burdensome than ever: Marta Tonon, Salvatore Piano; Clin Mol Hepatol 2021;27(1):94-96.
Published online December 3, 2020; DOI: https://doi.org/10.3350/cmh.2020.0305

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Reviews

Liver Transplantation

Liver graft from donation after circulatory death donor: Real practice to improve graft viability: Koji Hashimoto; Clin Mol Hepatol 2020;26(4):401-410.
Published online July 10, 2020; DOI: https://doi.org/10.3350/cmh.2020.0072

Abstract
PDF

Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while ex vivo machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.

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Ayato Obana, Miho Akabane, Khalid Mumtaz, Kejal Shah, Matthew Hamilton, Rithin Punjala, Austin Schenk, Navdeep Singh, Sylvester Black, Kenneth Washburn, Musab Alebrahim
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Amelia J. Hessheimer, Eva Flores, Jordi Vengohechea, Constantino Fondevila
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Riley Kahan, Nader Abraham, Min Zhang, Valery Novokhatny, Isaac Alderete, Paul Cray, Fengming Chen, Qimeng Gao, Greta Cywinska, Ryan Neill, Kentaro Nakata, Ahmed Hassan, Caroline Rush, Jude Penaflor, Justin J. Pollara, Matthew G. Hartwig, Benjamin Hughes,
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An extensive evaluation of hepatic markers of damage and regeneration in controlled and uncontrolled donation after circulatory death
Giuseppina Basta, Fabio Melandro, Serena Babboni, Serena Del Turco, Rudina Ndreu, Francesco Torri, Caterina Martinelli, Beatrice Silvestrini, Adriano Peris, Chiara Lazzeri, Fabio Guarracino, Riccardo Morganti, Paolo Maremmani, Pietro Bertini, Paolo De Sim
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Michael B Brown, Apolonia E Abramowicz, Peter J Panzica, Garret Weber
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Raphael P. H. Meier, Miguel Nunez, Shareef M. Syed, Sandy Feng, Mehdi Tavakol, Chris E. Freise, John P. Roberts, Nancy L. Ascher, Ryutaro Hirose, Garrett R. Roll
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Comparison of Biliary Complications Rates After Brain Death, Donation After Circulatory Death, and Living-Donor Liver Transplantation: A Single-Center Cohort Study
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Davide Ghinolfi, Fabio Melandro, Francesco Torri, Caterina Martinelli, Valentina Cappello, Serena Babboni, Beatrice Silvestrini, Paolo De Simone, Giuseppina Basta, Serena Del Turco
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17 Web of Science
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Hepatic neoplasm

Appropriate treatment modality for solitary small hepatocellular carcinoma: Radiofrequency ablation vs. resection vs. transplantation?: Keun Soo Ahn, Koo Jeong Kang; Clin Mol Hepatol 2019;25(4):354-359.
Published online April 22, 2019; DOI: https://doi.org/10.3350/cmh.2018.0096

Abstract
PDF

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.

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Original Article

Liver Transplantation

Evaluation of bioenergetic and mitochondrial function in liver transplantation: Rui Miguel Martins, João Soeiro Teodoro, Emanuel Furtado, Anabela Pinto Rolo, Carlos Marques Palmeira, José Guilherme Tralhão; Clin Mol Hepatol 2019;25(2):190-198.
Published online March 22, 2019; DOI: https://doi.org/10.3350/cmh.2018.0087

Abstract
PDF

Background/Aims
We measured changes in mitochondrial function and bioenergetics that occur during ischemia/ reperfusion in fresh liver samples of patients undergoing liver transplantation. These variations correlated with markers of liver function and clinical outcome. Ischemia/reperfusion injury related to liver transplantation affects mitochondrial function and bioenergetics. Experimental studies were conducted to identify the role of bioenergetics and mitochondrial dysfunction. To the best of our knowledge, no investigation of these two factors’ impacts on liver transplantation has been performed.
Methods
This was a prospective study of 28 patients who underwent liver transplantation. We measured parameters of mitochondrial function and bioenergetics in biopsies performed during the procedure.
Result
s: We observed a statistically significant reduction in mitochondrial membrane potential, an increase in lag phase, and decreases in mitochondrial respiration and adenosine triphosphate content (P<0.010). Higher postoperative aminotransferase peaks correlated with worse mitochondrial function; mitochondrial respiration correlated with arterial lactate (P<0.010).
Conclusions
There is a relationship between mitochondrial function and ischemia/reperfusion injury. The future use of these clinical markers as prognostic factors may allow early identification of post-transplant liver failure and may indicate the need to perform a new transplant.

Citations

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Ischaemia–Reperfusion Injury in Organ Transplantation: Role of Coenzyme Q10
David Mantle, Neve Cufflin, Tyler T. Purcell, Iain P. Hargreaves
Journal of Clinical Medicine.2025; 14(18): 6486. CrossRef
The Predictive Value of Graft Viability and Bioenergetics Testing Towards the Outcome in Liver Transplantation
Andras T. Meszaros, Annemarie Weissenbacher, Melanie Schartner, Tim Egelseer-Bruendl, Martin Hermann, Jasmin Unterweger, Christa Mittelberger, Beatrix A. Reyer, Julia Hofmann, Bettina G. Zelger, Theresa Hautz, Thomas Resch, Christian Margreiter, Manuel Ma
Transplant International.2024;[Epub] CrossRef
ZLN005, a PGC-1α Activator, Protects the Liver against Ischemia–Reperfusion Injury and the Progression of Hepatic Metastases
Celine Tohme, Tony Haykal, Ruiqi Yang, Taylor J. Austin, Patricia Loughran, David A. Geller, Richard L. Simmons, Samer Tohme, Hamza O. Yazdani
Cells.2024; 13(17): 1448. CrossRef
Preservation of Mitochondrial Health in Liver Ischemia/Reperfusion Injury
Ivo F. Machado, Carlos M. Palmeira, Anabela P. Rolo
Biomedicines.2023; 11(3): 948. CrossRef
Shaping of Hepatic Ischemia/Reperfusion Events: The Crucial Role of Mitochondria
João S. Teodoro, Rui T. Da Silva, Ivo F. Machado, Arnau Panisello-Roselló, Joan Roselló-Catafau, Anabela P. Rolo, Carlos M. Palmeira
Cells.2022; 11(4): 688. CrossRef
Development of a Multivariable Prediction Model for Citrate Accumulation in Liver Transplant Patients Undergoing Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation
Xin Xin, Jing Tang, Hui-Miao Jia, Tian-En Zhang, Yue Zheng, Li-Feng Huang, Qi Ding, Jun-Cong Li, Shu-Yan Guo, Wen-Xiong Li
Blood Purification.2022; 51(2): 111. CrossRef
Mitochondrial respiration during normothermic liver machine perfusion predicts clinical outcome
Andras T. Meszaros, Julia Hofmann, Madita L. Buch, Benno Cardini, Theresia Dunzendorfer-Matt, Florian Nardin, Michael J. Blumer, Margot Fodor, Martin Hermann, Bettina Zelger, Giorgi Otarashvili, Melanie Schartner, Annemarie Weissenbacher, Rupert Oberhuber
eBioMedicine.2022; 85: 104311. CrossRef
Hepatic31P‐magnetic resonance spectroscopy identified the impact of melatonin‐pretreated mitochondria in acute liver ischaemia‐reperfusion injury
Sheung‐Fat Ko, Yi‐Ling Chen, Pei‐Hsun Sung, John Y. Chiang, Yi‐Ching Chu, Chung‐Cheng Huang, Chi‐Ruei Huang, Hon‐Kan Yip
Journal of Cellular and Molecular Medicine.2020; 24(17): 10088. CrossRef

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Review

Alcohol-related liver disease

Severe acute alcoholic hepatitis and liver transplant: A never-ending mournful story: Aiman Obed, Abdalla Bashir, Steffen Stern, Anwar Jarrad; Clin Mol Hepatol 2018;24(4):358-366.
Published online October 24, 2018; DOI: https://doi.org/10.3350/cmh.2018.0044

Abstract
PDF

Severe acute alcoholic liver disease (SAAH) unresponsive to medical therapy shows one-year-mortality rates of up to 90%. Most transplant centers request six months of alcohol abstinence prior to transplantation, the so-called “6-month rule.” This regulation is not based on strong evidence, repeatedly making it a topic of controversial debates. The majority of patients with SAAH will die before fulfilling the 6-month rule. Therefore, liver transplantation (LT) protocols are becoming more flexible towards the rigid abstinence regulation, especially concerning SAAH patients. We conducted a literature review regarding LT in SAAH and its outcomes, including post-transplant mortality and recidivism. We studied available data on PubMed from 2011 and onwards whilst including articles dealing with genetic components, medical therapy and historic snapshots of alcoholism. Emerging studies recommend LT in SAAH not responding to medical therapies even without realizing the required abstinence period, since the majority of these patients would die within 6 months. SAAH without response to medical therapy has one-year-mortality rates of up to 90%. The 6-month rule is not based on strong evidence and is repeatedly a topic of controversial debates. There is genetic linkage to alcoholism and medical therapy is not as effective as estimated, yet. The 6-months-regulation has not shown to evidently decrease the risk of recidivism post-LT, which is a lifesaving treatment in SAAH patients. Insisting on rigid sobriety rules results in excluding patients with a low risk of recidivism from being transplanted. Moreover, the genetic linkage of alcoholism must be recognized.

Citations

Citations to this article as recorded by

Early liver transplantation for severe alcohol-associated hepatitis: A single-center experience
A Asgharpour, RK Sterling, E Smirnova, N Duong, K Houston, H Khan, Keller Nicole, S Matherly, J Wedd, H Lee, MS Siddiqui, V Patel, S Bullock, S Weinland, V Kumaran, S Lee, A Sharma, D Imai, A Kahn, M Levy, D Bruno
Journal of Liver Transplantation.2023; 12: 100184. CrossRef
Trasplante en la enfermedad hepática por alcohol
Jessica Paola Neira-Moreno
Hepatología.2021; : 199. CrossRef
Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea
Tae Jin Kwon, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Dong Hyun Sinn, Seung Woon Paik
Korean Journal of Transplantation.2021; 35(1): 24. CrossRef
Early Liver Transplantation for Severe Alcoholic Hepatitis
Jessica L. Mellinger, Jonathan G. Stine
Digestive Diseases and Sciences.2020; 65(6): 1608. CrossRef
Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope
Khushboo S. Gala, Vatsalya Vatsalya
Cells.2020; 9(3): 524. CrossRef
Das „framing“ der sechsmonatigen Karenzregel in der Lebertransplantation. Ein Beispiel für sprachlich vermittelte Deutungsmuster zur Eingrenzung des Indikationsgebietes
Nadia Primc
Ethik in der Medizin.2020; 32(3): 239. CrossRef

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4 Web of Science
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Original Article

Liver Transplantation

Fatigue and weakness hinder patient social reintegration after liver transplantation: So Hyun Kang, YoungRok Choi, Ho-Seong Han, Yoo-Seok Yoon, Jai Young Cho, Sungho Kim, Kil Hwan Kim, In Gun Hyun, Ahmed Shehta; Clin Mol Hepatol 2018;24(4):402-408.
Published online October 8, 2018; DOI: https://doi.org/10.3350/cmh.2018.0028

Background/Aims
With improvements in the survival of liver transplantation (LT) recipients, the focus is shifting to patient quality of life (QOL), and employment is an important factor in aiding the social reintegration of LT patients. This study aims to evaluate the current employment status of liver graft recipients and various factors that may hinder reemployment.
Methods
Fifty patients above age 18 who underwent either living or deceased donor LT at a single center from March 2009 to July 2016 were interviewed during their visit to the outpatient clinic. The internally developed questionnaire consisted of 10 items. The Karnofsky Performance Scale and EQ-5D were used to evaluate patient function and QOL.
Result
s: A total of 25 (50%) patients returned to work after transplantation (the working group), and 21 (84%) patients in the working group returned to work within the first year after transplantation. In the non-working group (n=25), 17 (68%) answered that their health was the reason for unemployment. Fatigue and weakness were the most frequent symptoms.
Conclusions
The data shows that as many as 50% of total patients returned to work after receiving LT. Fatigue and weakness were the most common complaints of the unemployed group, and resolving the causes of these symptoms may help to increase the employment rate.

Citations

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Does Weekend Discharge Affect Readmission and Survival in Liver Transplant Patients? Insights From a Cohort Study
Ayato Obana, Miho Akabane, Hannah Chi, Nolan Ladd, Matthew Yoder, Lily Kaufman, Rithin Punjala, Kejal Shah, Matthew Hamilton, Ashley Limkemann, Austin Schenk, Navdeep Singh, Black Slyvester, Khalid Mumtaz, Kenneth Washburn, Musab Alebrahim
Clinical Transplantation.2025;[Epub] CrossRef
Burden, stress and depression in caregivers of cirrhosis patients before and after liver transplantation
Adriano Virches, Mariana B Claudino, Maria C Miyazaki, Eliane T Miyazaki, Renato F Silva, Rita C Silva, Heitor B Farias, Neide A Domingos, Randolfo Santos Jr, Patricia S Fucuta
World Journal of Transplantation.2025;[Epub] CrossRef
Factors Associated with Returning to Work in Liver Transplantation Survivors: A Cross-sectional Study
Yuxin Rao, Saxiao Tang, Feicui Lv, Li Dong, Li Ji, Zhiru Li, Ruijie Bao, Jingyun Wu, Fangyan Lu
Asian Nursing Research.2025; 19(2): 193. CrossRef
Predictors of return to work status among patients with autoimmune encephalitis at one year post-discharge: a prospective observational study
Yejie Peng, Linxue Hu, Yuhui Wang, Yan Liang, Dezhi Chen
BMC Neurology.2025;[Epub] CrossRef
Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant
Meghan E. Willoughby, Jacob L. Ramsey-Morrow, Kyle A. Littell, Flora M. Hammond
Archives of Rehabilitation Research and Clinical Translation.2024; 6(2): 100332. CrossRef
Determination of Hopelessness and Fatigue Levels in Kidney Transplant Patients
Kübra Arslan, Ezgi Seyhan Ak
SN Comprehensive Clinical Medicine.2024;[Epub] CrossRef
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Sofie Leunis, Marieke Vandecruys, Véronique Cornelissen, Amaryllis H. Van Craenenbroeck, Sabina De Geest, Diethard Monbaliu, Stefan De Smet
Kidney and Dialysis.2022; 2(2): 298. CrossRef
The mediating effect of social functioning on the relationship between social support and fatigue in middle-aged and young recipients with liver transplant in China
Dan Zhang, Junling Wei, Xiaofei Li
Frontiers in Psychology.2022;[Epub] CrossRef
Fatigue after heart transplantation – a possible barrier to self‐efficacy
Matilda Almgren, Pia Lundqvist, Annette Lennerling, Anna Forsberg
Scandinavian Journal of Caring Sciences.2021; 35(4): 1301. CrossRef
Impact of biliary complications on quality of life in live-donor liver transplant recipients
Reginia Nabil Guirguis, Ehab Hasan Nashaat, Azza Emam Yassin, Wesam Ahmed Ibrahim, Shereen A Saleh, Mohamed Bahaa, Mahmoud El-Meteini, Mohamed Fathy, Hany Mansour Dabbous, Iman Fawzy Montasser, Manar Salah, Ghada Abdelrahman Mohamed
World Journal of Hepatology.2021; 13(10): 1405. CrossRef
Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant
Pil Soo Sung, Ji Won Han, Changho Seo, Joseph Ahn, Soon Kyu Lee, Hee Chul Nam, Ho Joong Choi, Young Kyoung You, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon
Frontiers in Pharmacology.2021;[Epub] CrossRef
Effect of Music on Fatigue, Comfort, and Vital Signs in Patients After Liver Transplant Surgery
Bilsev Demir, Gürkan Kapιkιran, Meral Özkan
Holistic Nursing Practice.2021; 35(3): 150. CrossRef
Health-related quality of life, workability, and return to work of patients after liver transplantation
Christian Fazekas, Daniela Kniepeiss, Nora Arold, Franziska Matzer, Jolana Wagner-Skacel, Peter Schemmer
Langenbeck's Archives of Surgery.2021; 406(6): 1951. CrossRef
Effects of acupoint massage combined with relaxation therapy on patients with postoperative fatigue syndrome after lumbar surgery
Qiuhui Zheng, Rongyun Wang, Yanan Shi, Qiuhua Sun
Medicine.2021; 100(19): e25849. CrossRef
Rehabilitation for social reintegration in liver transplant patients
Jong Man Kim
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Editorial

Liver Transplantation

Clinical implication of hepatic volumetry for living donor liver transplantation: Woo Kyoung Jeong; Clin Mol Hepatol 2018;24(1):51-53.
Published online March 22, 2018; DOI: https://doi.org/10.3350/cmh.2018.1003

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The Effect of Portal Vein Variants on the Margin of Error in Graft Volume Calculation in Living Donor Right Lobe Liver Transplantation
Feyza Sönmez Topcu, Veysel Ersan, Emrah Şahin, Adem Tunçer, Hasret Ayyıldız Civan, Abuzer Dirican, Bülent Ünal
Transplantation Proceedings.2025; 57(9): 1773. CrossRef
Multivariable linear model for predicting graft weight based on 3-dimensional volumetry in regards to body weight change of living liver donor: an observational cohort study
Seungwook Han, Jinsoo Rhu, Soyoung Lim, Gyu-seong Choi, Jong Man Kim, Jae-Won Joh
Annals of Surgical Treatment and Research.2024; 107(2): 91. CrossRef
Accuracy and Efficiency of Right-Lobe Graft Weight Estimation Using Deep-Learning-Assisted CT Volumetry for Living-Donor Liver Transplantation
Rohee Park, Seungsoo Lee, Yusub Sung, Jeeseok Yoon, Heung-Il Suk, Hyoungjung Kim, Sanghyun Choi
Diagnostics.2022; 12(3): 590. CrossRef

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Reviews

Alcohol-related liver disease

Role of liver transplantation in severe alcoholic hepatitis: Ravi Daswani, Ashish Kumar, Praveen Sharma, Vikas Singla, Naresh Bansal, Anil Arora; Clin Mol Hepatol 2018;24(1):43-50.
Published online January 10, 2018; DOI: https://doi.org/10.3350/cmh.2017.0027

Abstract
PDF

Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.

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Young Jin Yoo, Jinhee Lee, Deok-Gie Kim, Minyu Kang, Hwa-hee Koh, Eun-Ki Min, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo
Annals of Hepatology.2025; 30(1): 101779. CrossRef
Role of inflammation in alcoholic liver diseases and its management
Uday Sanglodkar
International Journal of Research in Medical Sciences.2025; 13(11): 5047. CrossRef
S2k-Leitlinie Lebertransplantation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)
Thomas Berg, Niklas F. Aehling, Tony Bruns, Martin-Walter Welker, Tobias Weismüller, Jonel Trebicka, Frank Tacke, Pavel Strnad, Martina Sterneck, Utz Settmacher, Daniel Seehofer, Eckart Schott, Andreas Anton Schnitzbauer, Hartmut H. Schmidt, Hans J. Schli
Zeitschrift für Gastroenterologie.2024; 62(09): 1397. CrossRef
Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency
Thomas G. Cotter, Burhaneddin Sandıkçı, Sonali Paul, Anuhya Gampa, Jennifer Wang, Helen Te, Anjana Pillai, Kapuluru G. Reddy, Diego di Sabato, Ester C. Little, Vinay Sundaram, John Fung, Michael R. Lucey, Michael Charlton
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Jacqueline H. Becker, Eyal Shemesh, Akhil Shenoy, Ailie Posillico, Christopher S. Knight, Se-Kang Kim, Sander S. Florman, Thomas Schiano, Rachel A. Annunziato
Progress in Transplantation.2021; 31(1): 4. CrossRef
Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea
Tae Jin Kwon, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Dong Hyun Sinn, Seung Woon Paik
Korean Journal of Transplantation.2021; 35(1): 24. CrossRef
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William Carey
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Liver Transplantation
Erin Maynard
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Integration of an Addiction Team in a Liver Transplantation Center
Hélène Donnadieu‐Rigole, Laura Jaubert, José Ursic‐Bedoya, Bertrand Hanslik, Thibault Mura, Lucie Gamon, Stéphanie Faure, Francis Navarro, Pascal Perney, Astrid Herrero, Georges‐Philippe Pageaux
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Predictors of 90-day mortality in patients with severe alcoholic hepatitis: Experience with 183 patients at a tertiary care center from India
Ravi Daswani, Ashish Kumar, Shrihari Anil Anikhindi, Praveen Sharma, Vikas Singla, Naresh Bansal, Anil Arora
Indian Journal of Gastroenterology.2018;[Epub] CrossRef
Severe acute alcoholic hepatitis and liver transplant: A never-ending mournful story
Aiman Obed, Abdalla Bashir, Steffen Stern, Anwar Jarrad
Clinical and Molecular Hepatology.2018; 24(4): 358. CrossRef

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Autoimmune liver disease

Current epidemiology and clinical characteristics of autoimmune liver diseases in South Korea: Sook-Hyang Jeong; Clin Mol Hepatol 2018;24(1):10-19.
Published online January 5, 2018; DOI: https://doi.org/10.3350/cmh.2017.0066

Abstract
PDF

Autoimmune liver diseases including autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are rare diseases. The aim of this review is to examine the epidemiology and clinical characteristics of AIH and PBC in South Korea. There were 4,085 patients registered as AIH in the Rare Intractable Disease Registry of Korea between 2009-2013, with a median age of 56 years and female-to male ratio of 6.4. The age-adjusted incidence and prevalence of AIH were 1.07/100,000/year and 4.82/100,000 persons, respectively. Among the patients, 1.1% underwent liver transplantation, and case fatality was 2.18%. Liver cirrhosis at diagnosis was accompanied in 23%; liver biopsy was performed in 75.2%, and prednisolone therapy or prednisolone and azathioprine combination therapy was done in 73% with a remission rate of 86%. There were 2,824 patients with PBC (≥20 years) registered in Korea between 2009-2013 with a median age of 57 years and female-to male ratio of 6.2. The age-adjusted incidence and prevalence of PBC were 0.86/100,000/year and 4.75/100,000 persons, respectively. Among the patients, 2.5% underwent liver transplantation, and case fatality was 2.2% with a 5-year transplantation-free survival of 95.4%. Ursodeoxycholic acid (UDCA) was prescribed in 90% of the patients with a UDCA inadequate response rate of 30%. In conclusion, AIH and PBC are rare but mostly treatable diseases if diagnosed in the early stages. However, scarce data, low awareness, delayed diagnosis and non-availability of 2nd line therapeutics are important issues to be solved. Therefore, governmental support for research and drug development and nationwide cooperative studies are warranted.

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Wenhui Ren, Zilong Wang, Xinyue Liu, Xin Liu, Danli Ma, Qian Jin, Jian Wang, Jiajun Feng, Huiying Rao, Xiaoxiao Wang, Rui Huang
BMC Gastroenterology.2025;[Epub] CrossRef
Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea
Youngjae Park, Jennifer Jooha Lee, Ji Hyeon Ju, Wan-Uk Kim, Sung-Hwan Park, Seung-Ki Kwok
International Journal of Molecular Sciences.2025; 26(12): 5734. CrossRef
Autoimmune hepatitis: current concepts in epidemiology, diagnosis, and management
Brian J. Wentworth, Kwang Il Seo
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Epidemiology of autoimmune liver disease in Korea: evidence from a nationwide real-world database
Jihye Lim, Hwa Jung Kim
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Igor G. Bakulin, Svetlana A. Burlakova, Ekaterina V. Skazyvaeva, Maria I. Skalinskaya
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Ja Kyung Kim
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Jeong Han Kim
The Korean Journal of Gastroenterology.2023; 81(2): 66. CrossRef
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Ji Yoon Kwak, Hyun-gyu Kim, Ji Hee Han, Hankyu Jeon, Ra Ri Cha, Sang Soo Lee
Hepatology Communications.2023;[Epub] CrossRef
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Hyejung Jang, Nayoung Han, Christine E. Staatz, Jae-Hwan Kwak, In-hwan Baek
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Jae Hyun Yoon, Chung Hwan Jun, Jeong Han Kim, Eileen L. Yoon, Byung Seok Kim, Jeong Eun Song, Ki Tae Suk, Moon Young Kim, Seong Hee Kang
Journal of Korean Medical Science.2021;[Epub] CrossRef
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Liver International.2019; 39(5): 985. CrossRef
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Sung Won Chung, Jeong‐Hoon Lee, Minseok Albert Kim, Galam Leem, Sun Woong Kim, Young Chang, Hyo Young Lee, Jun Sik Yoon, Jun Yong Park, Yun Bin Lee, Eun Ju Cho, Su Jong Yu, Yoon Jun Kim, Jung‐Hwan Yoon
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Etiopathogenesis of autoimmune hepatitis
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Journal of Autoimmunity.2018; 95: 133. CrossRef

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Original Article

Liver Transplantation

Resection plane-dependent error in computed tomography volumetry of the right hepatic lobe in living liver donors: Heon-Ju Kwon, Kyoung Won Kim, Bohyun Kim, So Yeon Kim, Chul Seung Lee, Jeongjin Lee, Gi Won Song, Sung Gyu Lee; Clin Mol Hepatol 2018;24(1):54-60.
Published online August 1, 2017; DOI: https://doi.org/10.3350/cmh.2017.0023

Abstract
PDF

Background/Aims
Computed tomography (CT) hepatic volumetry is currently accepted as the most reliable method for preoperative estimation of graft weight in living donor liver transplantation (LDLT). However, several factors can cause inaccuracies in CT volumetry compared to real graft weight. The purpose of this study was to determine the frequency and degree of resection plane-dependent error in CT volumetry of the right hepatic lobe in LDLT.
Methods
Forty-six living liver donors underwent CT before donor surgery and on postoperative day 7. Prospective CT volumetry (V_P) was measured via the assumptive hepatectomy plane. Retrospective liver volume (V_R) was measured using the actual plane by comparing preoperative and postoperative CT. Compared with intraoperatively measured weight (W), errors in percentage (%) V_P and V_R were evaluated. Plane-dependent error in V_P was defined as the absolute difference between V_P and V_R. % plane-dependent error was defined as follows: |V_P–V_R|/W∙100.
Result
s: Mean V_P, V_R, and W were 761.9 mL, 755.0 mL, and 696.9 g. Mean and % errors in V_P were 73.3 mL and 10.7%. Mean error and % error in V_R were 64.4 mL and 9.3%. Mean plane-dependent error in V_P was 32.4 mL. Mean % plane-dependent error was 4.7%. Plane-dependent error in V_P exceeded 10% of W in approximately 10% of the subjects in our study.
Conclusions
There was approximately 5% plane-dependent error in liver V_P on CT volumetry. Plane-dependent error in V_P exceeded 10% of W in approximately 10% of LDLT donors in our study. This error should be considered, especially when CT volumetry is performed by a less experienced operator who is not well acquainted with the donor hepatectomy plane.

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Radiomics Beyond Radiology: Literature Review on Prediction of Future Liver Remnant Volume and Function Before Hepatic Surgery
Fabrizio Urraro, Giulia Pacella, Nicoletta Giordano, Salvatore Spiezia, Giovanni Balestrucci, Corrado Caiazzo, Claudio Russo, Salvatore Cappabianca, Gianluca Costa
Journal of Clinical Medicine.2025; 14(15): 5326. CrossRef
The Effect of Portal Vein Variants on the Margin of Error in Graft Volume Calculation in Living Donor Right Lobe Liver Transplantation
Feyza Sönmez Topcu, Veysel Ersan, Emrah Şahin, Adem Tunçer, Hasret Ayyıldız Civan, Abuzer Dirican, Bülent Ünal
Transplantation Proceedings.2025; 57(9): 1773. CrossRef
Optimizing accuracy: a comparative analysis of preoperative liver volumetry in living donor liver transplantation from a surgeon’s perspective – a retrospective cohort study
EunJin Choi, Seok-Hwan Kim
International Journal of Surgery.2025; 111(11): 8149. CrossRef
3-D reconstruction in liver surgery: a systematic review
Filippo Banchini, Patrizio Capelli, Anis Hasnaoui, Gerardo Palmieri, Andrea Romboli, Mario Giuffrida
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Fully automated assessment of the future liver remnant in a blood-free setting via CT before major hepatectomy via deep learning
Tingting Xie, Jingyu Zhou, Xiaodong Zhang, Yaofeng Zhang, Xiaoying Wang, Yongbin Li, Guanxun Cheng
Insights into Imaging.2024;[Epub] CrossRef
Accuracy of preoperative liver volumetry in living donor liver transplantation—A systematic review and meta-analysis
Mika S. Buijk, Marcel Dijkshoorn, Roy S. Dwarkasing, Alicia C. Chorley, Robert C. Minnee, Markus U. Boehnert
Journal of Liver Transplantation.2023; 10: 100150. CrossRef
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Kazuhiro Takahashi, Masahiko Gosho, Jaejeong Kim, Osamu Shimomura, Yoshihiro Miyazaki, Kinji Furuya, Yoshimasa Akashi, Tsuyoshi Enomoto, Shinji Hashimoto, Tatsuya Oda
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CT and MR imaging evaluation of living liver donors
Federica Vernuccio, Susan A. Whitney, Kadiyala Ravindra, Daniele Marin
Abdominal Radiology.2021; 46(1): 17. CrossRef
Estimation of the Right Posterior Section Volume in Live Liver Donors: Semiautomated CT Volumetry Using Portal Vein Segmentation
So Yeong Jeong, Jeongjin Lee, Kyoung Won Kim, Jin Kyoo Jang, Heon-Ju Kwon, Gi Won Song, Sung Gyu Lee
Academic Radiology.2020; 27(2): 210. CrossRef
Reproducibility and reliability of computed tomography volumetry in estimation of the right‐lobe graft weight in adult‐to‐adult living donor liver transplantation: Cantlie’s line vs portal vein territorialization
Heon‐Ju Kwon, Kyoung Won Kim, Jin Kyoo Jang, Jeongjin Lee, Gi‐Won Song, Sung‐Gyu Lee
Journal of Hepato-Biliary-Pancreatic Sciences.2020; 27(8): 541. CrossRef
Liver Graft Volume Estimation by Manual Volumetry and Software-Aided Interactive Volumetry: Which is Better?
Birkan Bozkurt, Ertan Emek, Turkmen Arikan, Ozgur Ceyhan, Pinar Yazici, Tolga Sahin, Elmar Mammadov, Ayfer Serin, Nagihan Inan Gurcan, Yildiray Yuzer, Yaman Tokat
Transplantation Proceedings.2019; 51(7): 2387. CrossRef
Clinical implication of hepatic volumetry for living donor liver transplantation
Woo Kyoung Jeong
Clinical and Molecular Hepatology.2018; 24(1): 51. CrossRef
MRI in donor candidates for living donor liver transplant: Technical and practical considerations
Bohyun Kim, So Yeon Kim, Kyoung Won Kim, Hye Young Jang, Jong Keon Jang, Gi Won Song, Sung Gyu Lee
Journal of Magnetic Resonance Imaging.2018; 48(6): 1453. CrossRef

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Case Report

Benign liver tumors and cystic disease of liver

Living-donor liver transplantation for giant hepatic hemangioma with diffuse hemangiomatosis in an adult: a case report: Ju Hyun Lee, Chang Jin Yoon, Young Hoon Kim, Ho-Seong Han, Jai Young Cho, Haeryoung Kim, Eun Sun Jang, Jin-Wook Kim, Sook-Hyang Jeong; Clin Mol Hepatol 2018;24(2):163-168.
Published online July 19, 2017; DOI: https://doi.org/10.3350/cmh.2017.0002

Abstract
PDF

Hepatic hemangioma represents the most common benign primary hepatic neoplasm. Although most such tumors are small and asymptomatic, giant hepatic hemangioma is frequently symptomatic, and requires intervention. Moreover, diffuse multiple hepatic hemangiomatosis occupying almost the entire liver is extremely rare in adults, and the optimal management for this condition is unclear. We report a case of a rapidly growing, symptomatic giant hepatic hemangioma with diffuse hepatic hemangiomatosis in a 50-year-old female patient who was treated by living-donor liver transplantation. This case shows malignant behavior of a benign hemangioma that required liver transplantation. Although this case could not meet the criteria for transplantation according to the MELD (model for end-stage liver disease) score system, it should be considered as an exceptional indication for deceased-donor liver allocation. Further studies of the mechanism underlying hemangioma growth are warranted.

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Manejo quirúrgico de hemangiomas hepáticos gigantes
Luis Manuel Barrera-Lozano, Jaime Alberto Ramírez Ramírez, Cristian Leonardo Muñoz, Sebastián Cerquera-Cajamarca, Jorge Iván Gutiérrez-Montoya
Revista Colombiana de Cirugía.2025; 40(2): 245. CrossRef
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Sowmiya Velusamy, Souradeep Dutta, Debasis Naik, Vishnu Prasad Nelamangala Ramakrishnaiah
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Ya-Nan Ge, Yan Shao, Shu-Chen Dong, Xing-Bin Ma, Wei Wang
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Young Cheol Shin, Eun Ju Cho, Hee Young Na, Jai Young Cho, Ho-Seong Han, Yoon Jin Lee, Haeryoung Kim, Sangmi Jang, Gwang Hyeon Choi, Eun Sun Jang, Jin-Wook Kim, Sook-Hyang Jeong
The Korean Journal of Internal Medicine.2023; 38(6): 818. CrossRef
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Cheon-Soo Park, Yong-Kyu Chung
Annals of Liver Transplantation.2023; 3(2): 69. CrossRef
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Clinics and Research in Hepatology and Gastroenterology.2022; 46(2): 101789. CrossRef
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Hassan Aziz, Zachary J. Brown, Azarakhsh Baghdadi, Ihab R. Kamel, Timothy M. Pawlik
Journal of Gastrointestinal Surgery.2022; 26(9): 1998. CrossRef
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Yun Zhao, Xiu-Ping Li, Yuan-Yuan Hu, Ji-Chang Jiang, Li-Jin Zhao
Frontiers in Medicine.2022;[Epub] CrossRef
Autologous Partial Liver Transplantation for a Symptomatic Giant Hepatic Hemangioma. A Case Report
Ayato Obana, Yoshinobu Sato
Transplantation Proceedings.2022; 54(10): 2787. CrossRef
Liver Transplantation for Rapidly Progressive Giant Hepatic Hemangioma With Diffuse Hemangiomatosis
Sadhana Shankar, Ashwin Rammohan, Venugopal H. Kulaseharan, Rathnavel Kanagavelu, Mettu S. Reddy, Mohamed Rela
Experimental and Clinical Transplantation.2021; 19(10): 1106. CrossRef
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M. Isabel González-Nieto, Luz Adriana Escobar Hoyos
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Ana Ostojic, Anna Mrzljak, Danko Mikulic
World Journal of Hepatology.2021; 13(9): 1098. CrossRef
Orthotopic liver transplantation for Management of a Giant Liver Hemangioma: a case report and review of literature
Hesameddin Eghlimi, Peyman Arasteh, Nazanin Azade
BMC Surgery.2020;[Epub] CrossRef
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Wenfang Dong, Bin Qiu, Haifeng Xu, Leren He
European Journal of Gastroenterology & Hepatology.2019; 31(9): 1079. CrossRef

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Original Article

Liver Transplantation

Influence of ultrasound contrast agents on spectral Doppler analysis in recipients of liver transplantation: Young Seo Cho, Kyoung Won Kim, Hye Young Jang, Bo Hyun Kim, Jeongjin Lee, Gi Won Song, Sung Gyu Lee, Dagvasumberel Munkhbaatar; Clin Mol Hepatol 2017;23(3):224-229.
Published online July 4, 2017; DOI: https://doi.org/10.3350/cmh.2016.0064

Abstract
PDF

Background/Aims
Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT).
Methods
For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein.
Result
s: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein.
Conclusions
The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.

Citations

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Effect of contrast-enhanced ultrasound (CEUS) on liver stiffness measurements obtained by transient and shear-wave elastography
Stefano KAYALI, Andrea PASTA, Rinaldo PELLICANO, Sharmila FAGOONEE, Elisabetta GIULIANA, Chiara FACCHINI, Simona PILI, Silvia BUCCILLI, Sara LABANCA, Paolo BORRO
Panminerva Medica.2022;[Epub] CrossRef

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Liver Imaging

Liver fibrosis, cirrhosis, and portal hypertension

Portal flow steal after liver transplantation: Bohyun Kim, Kyoung Won Kim, Gi-Won Song, Sung-Gyu Lee; Clin Mol Hepatol 2015;21(3):314-317.
Published online September 30, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.3.314

Abstract
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Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.

Citations

Citations to this article as recorded by

Late Onset Hepatic Encephalopathy after Living Donor Liver Transplant: Successful Reversal by Plug Embolization of Shunt—A Report of Two Cases
Shahnawaz Bashir, Dibyalochan Praharaj, Adnan Khan, Subhash Gupta, Pragati Gakher
Journal of Clinical Interventional Radiology ISVIR.2025; 09(03): 189. CrossRef
Portal Steal During Liver Transplantation in a 31-Year-Old: When Absent Varices Signal Extensive Splenorenal Shunting
Noor Abu Zar, Chia Chey
Cureus.2025;[Epub] CrossRef
Clinical Impact of Spontaneous Portosystemic Shunts in Liver Transplantation: A Comprehensive Assessment Through Total Shunt Area Measurement
Leonardo Centonze, Giovanna Gorga, Riccardo De Carlis, Davide Bernasconi, Andrea Lauterio, Luca Carbonaro, Ivan Vella, Cristiano Sgrazzutti, Niccolò Incarbone, Francesco Rizzetto, Maria Grazia Valsecchi, Angelo Vanzulli, Luciano De Carlis
Transplantation.2023; 107(4): 913. CrossRef
Short-Term Results of Plug-Assisted Retrograde Transvenous Obliteration for Portal Steal from Complicated Portosystemic Shunts in Living-Donor Liver Transplantation
Gun Ha Kim, Dong Il Gwon, Gi-Young Ko, Hee Ho Chu, Deok-Bog Moon, Dong-Hwan Jung, Sung-Gyu Lee
Journal of Vascular and Interventional Radiology.2023; 34(4): 645. CrossRef
Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation
Vijay Kubihal, Shridhar Sasturkar, Amar Mukund
Journal of Clinical and Experimental Hepatology.2023; 13(5): 854. CrossRef
Role of portocaval shunts in development of complications after liver transplantation
D. L. Tsoy, M. I. Prudkov, O. G. Orlov, E. N. Bessonova, I. G. Leshchenko, L. V. Kardopoltsev, A. N. Ageev, S. I. Solodushkin
Transplantologiya. The Russian Journal of Transplantation.2022; 14(2): 159. CrossRef
Understanding Local Hemodynamic Changes After Liver Transplant: Different Entities or Simply Different Sides to the Same Coin?
Francisco Calderon Novoa, Juan Mattera, Martín de Santibañes, Victoria Ardiles, Adrian Gadano, Daniel E D’Agostino, Eugenia Fratantoni, Eduardo De Santibañes, Juan Pekolj
Transplantation Direct.2022; 8(9): e1369. CrossRef
Life-Threatening Portal Flow Steal Reappearing Under Increased Intrahepatic Vascular Resistance After Living Donor Liver Transplantation
Jae-Hyun Kwon, Young-In Yoon, Deok-Bog Moon, Gil-Chun Park, Gi-Won Song, Dong-Hwan Jung, Kyu-Bo Sung, Gi-Young Ko, Dong-Il Gwon, Yong-Kyu Jung, I-Ji Jeong, Jin-Uk Choi, Min-Jae Kim, Sang-Hoon Kim, Sung-Gyu Lee
Transplantation Proceedings.2021; 53(1): 166. CrossRef
Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation
Surabhi Jajodia, Anubhav H Khandelwal, Rohit Khandelwal, Abhay K Kapoor, Sanjay S Baijal
JGH Open.2021; 5(5): 599. CrossRef
Post-transplant inflow modulation for early allograft dysfunction after living donor liver transplantation
Mohamed Elshawy, Takeo Toshima, Yoshiki Asayama, Yuichiro Kubo, Shinichiro Ikeda, Toru Ikegami, Shingo Arakaki, Tomoharu Yoshizumi, Masaki Mori
Surgical Case Reports.2020;[Epub] CrossRef
N-butyl-2 cyanoacrylate (NBCA) embolus in the graft portal vein after portosystemic collateral embolization in liver transplantation recipient: what is the clinical significance?
Hye Young Jang, Kyoung Won Kim, Jae Hyun Kwon, Heon-Ju Kwon, Bohyun Kim, Nieun Seo, Jeongjin Lee, Gi-Won Song, Sung-Gyu Lee
Acta Radiologica.2017; 58(11): 1326. CrossRef

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Original Article

Viral hepatitis

Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure: Jung Min Ha, Won Sohn, Ju Yeon Cho, Jeung Hui Pyo, Kyu Choi, Dong Hyun Sinn, Geum-Youn Gwak, Moon Seok Choi, Joon Hyeok Lee, Kwang Chul Koh, Seung Woon Paik, Byung Chul Yoo, Yong-Han Paik; Clin Mol Hepatol 2015;21(3):232-241.
Published online September 30, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.3.232

Abstract
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Background/Aims

Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.

Methods

Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.

Results

A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

Conclusions

Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

Citations

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Plasma galectin-3 can be considered as a non-invasive marker to predict the prognosis of ACLF patients with new typing
Li Bai, Wang Lu, Qi Yang, Xiaoxuan Liu, Yu Chen, Zhongping Duan
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Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data
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Scientific Reports.2024;[Epub] CrossRef
PLT Counts as a Predictive Marker after Plasma Exchange in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure
Xue Li, Hao Li, Yucui Zhu, Huaqian Xu, Shanhong Tang
Journal of Clinical Medicine.2023; 12(3): 851. CrossRef
Falla hepática aguda sobre crónica: análisis de una serie de casos y revisión de la literatura
Jhon Edwar García-Rueda, Ricardo Londoño-García, Tomás Marín-Cuartas, Juan Esteban Hernández-Abaunza, Sebastián Osorio-Rico, Angélica María Bermúdez-Flórez, Juan Carlos Restrepo-Gutiérrez
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KASL clinical practice guidelines for management of chronic hepatitis B

Clinical and Molecular Hepatology.2022; 28(2): 276. CrossRef
A dynamic prediction model for prognosis of acute-on-chronic liver failure based on the trend of clinical indicators
Zhenjun Yu, Yu Zhang, Yingying Cao, Manman Xu, Shaoli You, Yu Chen, Bing Zhu, Ming Kong, Fangjiao Song, Shaojie Xin, Zhongping Duan, Tao Han
Scientific Reports.2021;[Epub] CrossRef
Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study
Man-Man Xu, Ming Kong, Peng-Fei Yu, Ying-Ying Cao, Fang Liu, Bing Zhu, Yi-Zhi Zhang, Wang Lu, Huai-Bin Zou, Bin-Wei Duan, Shao-Li You, Shao-Jie Xin, Tao Han, Zhong-Ping Duan, Yu Chen
Journal of Clinical and Translational Hepatology.2021; 000(000): 000. CrossRef
KASL clinical practice guidelines for management of chronic hepatitis B

Clinical and Molecular Hepatology.2019; 25(2): 93. CrossRef
A Dynamic Model for Predicting Outcome in Patients with HBV Related Acute-On-Chronic Liver Failure
Wei Lin, Jing Zhang, Xiaohui Liu, Hongqun Liu, Jinqiu He, Ming Li, Shuqin Zhang, Hong Chen, Changqing Zhang, Wenfang Wu, Chenggang Jin, Samuel S. Lee, Zhongping Duan, Yuexin Zhang
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Reviews

Alcohol-related liver disease

Managing alcoholic liver disease: Vijay H. Shah; Clin Mol Hepatol 2015;21(3):212-219.
Published online September 30, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.3.212

Abstract
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Alcoholic liver disease continues to be a significant cause of liver-related morbidity and mortality throughout the world. A number of diagnostic and prognostic models have been developed in the management of this condition, although specific roles for liver biopsy still remain particularly in the setting of alcoholic hepatitis. Despite a large number of recent treatment trials, the ideal pharmacotherapy approach remains undefined. Most essential is the supportive care and focus on abstinence and nutrition. Owing in part to a great deal of attention from governmental funding sources, a number of new treatment approaches are undergoing rigorous evaluation, hopefully providing future treatment options in this very severe condition.

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Ki Tae Suk, Hong Koh
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Ha Il Kim, Seo Young Park, Hyun Phil Shin
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Are Probiotics Effective in Targeting Alcoholic Liver Diseases?
Meegun Hong, Dae Hee Han, Jitaek Hong, Dong Joon Kim, Ki Tae Suk
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Development of colorectal cancer predicts increased risk of subsequent hepatocellular carcinoma in patients with alcoholic liver disease: case-control and cohort study
Won Kim, Dongjae Jeong, Jungwha Chung, Donghyeon Lee, Saekyoung Joo, Eun Sun Jang, Yoon Jin Choi, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Sook-Hyang Jeong, Nayoung Kim, Dong Ho Lee, Jin-Wook Kim
Scientific Reports.2019;[Epub] CrossRef
Growing burden of alcoholic liver disease in China: A review
Wen-Jun Wang, Peng Xiao, Hong-Qin Xu, Jun-Qi Niu, Yan-Hang Gao
World Journal of Gastroenterology.2019; 25(12): 1445. CrossRef
Effect of Taurine on Ethanol-Induced Oxidative Stress in Mouse Liver and Kidney
Zofia Goc, Edyta Kapusta, Grzegorz Formicki, Monika Martiniaková, Radoslav Omelka
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Liver Fibrosis: A Clinical Update
Lindsey C. Shipley, Page D. Axley, Ashwani K. Singal
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Ravi Daswani, Ashish Kumar, Praveen Sharma, Vikas Singla, Naresh Bansal, Anil Arora
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Epidemiology of alcoholic liver disease in Korea
Jae Young Jang, Dong Joon Kim
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Korean Patients Undergoing Deceased Donor Liver Transplantation for Alcoholic Liver Disease Have Non-Inferior Survival Outcomes than for Hepatitis B Virus: a Real-World Experience without Minimum Abstinence before Transplantation
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Liver development and regeneration

Clinical implications of advances in liver regeneration: Yong Jin Kwon, Kyeong Geun Lee, Dongho Choi; Clin Mol Hepatol 2015;21(1):7-13.
Published online March 25, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.1.7

Abstract
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Remarkable advances have been made recently in the area of liver regeneration. Even though liver regeneration after liver resection has been widely researched, new clinical applications have provided a better understanding of the process. Hepatic damage induces a process of regeneration that rarely occurs in normal undamaged liver. Many studies have concentrated on the mechanism of hepatocyte regeneration following liver damage. High mortality is usual in patients with terminal liver failure. Patients die when the regenerative process is unable to balance loss due to liver damage. During disease progression, cellular adaptations take place and the organ microenvironment changes. Portal vein embolization and the associating liver partition and portal vein ligation for staged hepatectomy are relatively recent techniques exploiting the remarkable progress in understanding liver regeneration. Living donor liver transplantation is one of the most significant clinical outcomes of research on liver regeneration. Another major clinical field involving liver regeneration is cell therapy using adult stem cells. The aim of this article is to provide an outline of the clinical approaches being undertaken to examine regeneration in liver diseases.

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Viral hepatitis

Management of viral hepatitis in liver transplant recipients: Soung Won Jeong, YoungRok Choi, Jin-Wook Kim; Clin Mol Hepatol 2014;20(4):338-344.
Published online December 24, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.4.338

Abstract
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Recurrence of viral hepatitis after liver transplantation (LT) can progress to graft failure and lead to a decrease in long-term survival. Recently, there have been remarkable improvement in the treatment of chronic hepatitis B (CHB) using potent antiviral agents. Combination of hepatitis B immunoglobulin and potent antiviral therapy has brought marked advances in the management of CHB for liver transplant recipients. Post-transplant antiviral therapy for hepatitis C virus infection is generally reserved for patients showing progressive disease. Acheiving a sustained virological response in patients with LT greatly ameliorates graft and overall survival, however this only occurs in 30% of transplant recipient using pegylated interferon and ribavirin (RBV). Direct acting antivirals such as protease inhibitors, polymerase or other non-structural proteins inhibitors are anticipated to establish the new standard of care for transplant recipients. In liver transplant recipients, hepatitis E virus infection is an uncommon disease. However, it can lead to chronic hepatitis and cirrhosis and may require retransplantation. Recently, 3-month course of RBV monotherapy has been reported as an effective treatment. This review focuses on the recent management and therapeutic approaches of viral hepatitis in liver transplant recipient.

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Hepatitis E in post‐liver transplantation: is it time to routinely consider it?
Brian B. Borg, Zongdi Feng, Truman M. Earl, Christopher D. Anderson
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Antigenic composition and immunoreactivity differences between HEV recombinant capsid proteins generated from different genotypes
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Case Reports

Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia: Tae Jun Park, Keun Soo Ahn, Yong Hoon Kim, Hyungseop Kim, Ui Jun Park, Hyoung Tae Kim, Won Hyun Cho, Woo-Hyun Park, Koo Jeong Kang; Clin Mol Hepatol 2014;20(1):76-80.
Published online March 26, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.1.76

Abstract
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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.

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Digestive Diseases and Sciences.2018; 63(1): 248. CrossRef

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Liver Transplantation

Liver transplantation for acute-on-chronic liver failure from erythropoietic protoporphyria: Pyoung-Jae Park, Shin Hwang, Young-Il Choi, Young-Dong Yu, Gil-Chun Park, Sung-Won Jung, Sam-Youl Yoon, Gi-Won Song, Tae-Yong Ha, Sung-Gyu Lee; Korean J Hepatol 2012;18(4):411-415.
Published online December 21, 2012; DOI: https://doi.org/10.3350/cmh.2012.18.4.411

Abstract
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Erythropoietic protoporphyria (EPP) is an inherited disorder of the heme metabolic pathway that is characterized by accumulation of protoporphyrin in the blood, erythrocytes, and tissues, and cutaneous manifestations of photosensitivity, all resulting from abnormalities in ferrochelatase (FECH) activity due to mutations in the FECH gene. Protoporphyrin is excreted by the liver, and excess protoporphyrin leads to cholelithiasis with obstructive episodes and chronic liver disease, finally progressing to liver cirrhosis. Patients with end-stage EPP-associated liver disease require liver transplantation. We describe here a 31-year-old male patient with EPP who experienced acute-on-chronic liver failure and underwent deceased-donor liver transplantation. Surgical and postoperative care included specific shielding from exposure to ultraviolet radiation to prevent photosensitivity-associated adverse effects. The patient recovered uneventfully and was doing well 24 months after transplantation. Future prevention and treatment of liver disease are discussed in detail.

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Xiaoxin Wu, Xiumei Zhou, Shuai Zhao, Keting He, Wenxin Zhoudi, Shangci Chen, Xiaowei Xu
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Yutaka Endo, Taizo Hibi, Masahiro Shinoda, Hideaki Obara, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa, Kentaro Matsubara, Shutaro Hori, Masayuki Tanaka, Satomi Makiuchi, Yutaka Nakano, Osamu Itano, Tatsuo Kuroda, Yuko Kitagawa
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Akiko Shimazaki, Takuma Hashimoto, Masaya Kai, Tetsuzo Nakayama, Mai Yamada, Karen Zaguirre, Kentaro Tokuda, Makoto Kubo, Ken Yamaura, Masafumi Nakamura
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K. Peoc’h, C. Martin-Schmitt, N. Talbi, J.-C. Deybach, L. Gouya, H. Puy
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Zoubida Karim, Said Lyoumi, Gael Nicolas, Jean-Charles Deybach, Laurent Gouya, Hervé Puy
Clinics and Research in Hepatology and Gastroenterology.2015; 39(4): 412. CrossRef

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Review

Acute Liver failure in Korea: etiology, prognosis and treatment: Young Suk Lim; Korean J Hepatol 2010;16(1):5-18.
Published online March 26, 2010; DOI: https://doi.org/10.3350/kjhep.2010.16.1.5

Abstract
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Acute liver failure (ALF) is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in individuals without previously recognized liver disease. The outcomes of patients with ALF vary greatly according to etiology, and the etiology of ALF varies markedly by geographical region. In Korea, about 90% of ALF are associated with etiologies that usually result in poor outcomes, including hepatitis B virus (HBV) infection and herbal remedies. The main causes of death in patients with ALF are increased intracranial pressure, systemic infection, and multi-organ failure. Recent advances in the intensive care of patients with ALF have contributed to a marked improvement in their overall survival. Emergency adult to adult living-donor liver transplantation (LDLT) can be performed expeditiously and safely for patients with ALF, and greatly improves survival rate as well as deceased-donor transplantation. As the window during which transplantation is possible is limited, emergency adult LDLT should be considered to be one of the first-line treatment options in patients with ALF, especially in regions in which ALFs are caused by etiologies associated with poor outcome and the supply of organs is very limited. (Korean J Hepatol 2010;16:5-18)

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An Aggressive Natural Killer Cell Lymphoma Presenting as Acute Liver Failure with Ascites
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Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
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The Ewha Medical Journal.2016; 39(3): 76. CrossRef
Understanding Acute Liver Failure– A Basic Overview of Definition and Treatment
Yeonjung Ha, Young-Suk Lim
The Korean Journal of Medicine.2015; 89(6): 672. CrossRef
The Analysis of Prognostic Factors Affecting Survival in Liver Transplantation: A Single Institution Experience
Sung Won Park, Gil Jae Lee, Sang Tae Choi, Yeon Ho Park, Jung Nam Lee, Keon Kuk Kim
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Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure
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Original Article

Clinical features of patients with fulminant hepatitis A requiring emergency Liver transplantation: comparison with acute Liver failure due to other causes: Jin Dong Kim, M.D., Jong Young Choi, M.D., Chung-Hwa Park, M.D., Myeong Jun Song, M.D., Jeong Won Jang, M.D., Si Hyun Bae, M.D., Seung Kew Yoon, M.D., Young Sok Lee, M.D., Young Kyoung You, M.D.1, Dong Goo Kim, M.D.1; Korean J Hepatol 2010;16(1):19-28.
Published online March 26, 2010; DOI: https://doi.org/10.3350/kjhep.2010.16.1.19

Abstract
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Background/Aims
According to recent prevalence of hepatitis A virus (HAV) infection, acute liver failure ALF) due to HAV infection is observed frequently in parallel. The aim of this study was to elucidate the clinical, laboratory, and pathologic features of patients who have undergone emergency liver transplantation (LT) due to fulminant HAV infection. Methods: Clinical, laboratory, and pathologic data of 11 transplant recipients with anti-HAV IgM-positive ALF between December 2007 and May 2009 were analyzed, and compared with data of 10 recipients who underwent LT for the management of ALF due to other causes. Results: The median age of the patients with HAV-related ALF was 34 years (range: 15-43 years). The levels of hemoglobin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine were higher and the level of bilirubin was lower in the HAV-related ALF group than in the other group (P=0.005, 0.001, 0.001, 0.010, and 0.003, respectively). The time from the onset of initial symptoms to the development of encephalopathy was shorter in the HAV-related ALF group than in the other group (median 5 days, range: 4-13 days; P<0.001). In patients with HAV-related ALF, laboratory findings and clinical prognostic parameters including the Acute Liver Failure Study Group prognostic index, King`s College criteria, and model for endstage liver disease (MELD) and Child-Pugh scores were not associated with the grade of hepatic encephalopathy or time of progression to encephalopathy. Conclusions: The results of this study indicate that the clinical condition of patients with HAV-related ALF requiring emergency LT aggravates rapidly. Prognostic parameters are not sufficient for discriminating transplant candidates in patients with fulminant hepatitis A. (Korean J Hepatol 2010;16:19-28)

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International Journal of Infectious Diseases.2022; 118: 34. CrossRef
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Derya Kalyoncu, Nafiye Urganci, Seda Geylani Gulec
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Usefulness of B-mode and doppler sonography for the diagnosis of severe acute viral hepatitis A
Sang Wook Shin, Tae Yeob Kim, Woo Kyoung Jeong, Yongsoo Kim, Jinoo Kim, Young Hwan Kim, Hwan Cheol Park, Joo Hyun Sohn
Journal of Clinical Ultrasound.2015; 43(6): 384. CrossRef
Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis
Hye Sun Shin, Sae Pyul Kim, Sang Hoon Han, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon, Jun Yong Park
Yonsei Medical Journal.2014; 55(4): 953. CrossRef
Genotypic shift of the hepatitis A virus and its clinical impact on acute hepatitis A in Korea: a nationwide multicenter study
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Journal of Medical Virology.2011; 83(8): 1308. CrossRef

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Current status of hepatic surgery in Korea: Kyung Sik Kim; Korean J Hepatol 2009;15(60):60-64.
Published online December 31, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.S6.S60

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Current status of Liver diseases in Korea: Toxic and alcoholic Liver diseases: Kyung Ah Kim; Korean J Hepatol 2009;15(60):29-33.
Published online December 31, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.S6.S29

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Case Reports

Four patients with hepatitis A presenting with fulminant hepatitis and acute renal failure and who underwent Liver transplantation: Se Hoon Oh , Joon Hyoek Lee , Ji Won Hwang , Hye Young Kim , Chang Hoon Lee , Geum Youn Gwak , Moon Seok Choi , Kwang Chul Koh , Seung Woon Paik , Byung Chul Yoo; Korean J Hepatol 2009;15(3):362-369.
Published online September 30, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.3.362

Abstract
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Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (≥39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of sub-massive hepatic necrosis. (Korean J Hepatol 2009;15:362-369)

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Sul-Ki Kim, Cheon-Hoo Jeon, Nam-Heon Lee, Jung-Hyo Cho, Chang-Gue Son
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Treatment with pegylated interferon and ribavirin in a patient with fibrosing cholestatic hepatitis due to recurrent hepatitis C after liver transplantation: Byung Kook Kim, M.D., So Young Kwon, M.D., Soon-Young Ko, M.D., Won Hyeok Choe, M.D., Chang Hong Lee, M.D., He-Seong Han, M.D.1, Seong-Hwan Chang, M.D.2; Korean J Hepatol 2008;14(4):519-524.
Published online December 31, 2008; DOI: https://doi.org/10.3350/kjhep.2008.14.4.519

Abstract
PDF

Fibrosing cholestatic hepatitis (FCH) is the most devastating manifestation of recurrent hepatitis C in transplant recipients with hepatitis C virus (HCV), possibly leading to death or retransplantation. Although FCH was first described as a complication of hepatitis B, this manifestation has been well documented in association with HCV in the setting of liver transplantation, bone marrow transplantation, heart transplantation, and end-stage human immunodeficiency virus infection. We report the clinical course and antiviral response in a patient with FCH due to recurrent hepatitis C after cadaveric liver transplantation who was treated with pegylated interferon α-2a and ribavirin. (Korean J Hepatol 2008;14:519-524)

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Fei Liu, Dawei Deng, Xinyang Chen, Zhiyu Qian, Samuel Achilefu, Yueqing Gu
Molecular Imaging and Biology.2010; 12(6): 595. CrossRef

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Original Article

Clinical Outcome after Living Donor Liver Transplantation in Patients with Hepatitis C Virus-associated Cirrhosis: Jeong-Ik Park, M.D.1, Kun-Moo Choi, M.D.2, Sung-Gyu Lee, M.D.1, Shin Hwang, M.D.1, Ki-Hun Kim, M.D.1, Chul-Soo Ahn, M.D.1, Deok-Bog Moon, M.D.1, Young-Hwa Chung, M.D.3, Yung-Sang Lee, M.D.3, Dong-Jin Suh, M.D.3; Korean J Hepatol 2007;13(4):543-555.
Published online December 20, 2007; DOI: https://doi.org/10.3350/kjhep.2007.13.4.543

Abstract
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Background/Aims
Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT). Methods: We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed. Results: HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient`s age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period. Conclusions: Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT. (Korean J Hepatol 2007;13:543-555)

Citations

Citations to this article as recorded by

Current Status and Perspectives of Living Donor Liver Transplantation
Shin Hwang, Deok-Bog Moon, Sung-Gyu Lee
Journal of the Korean Medical Association.2008; 51(8): 700. CrossRef
Review: Clinical Outcome after Living Donor Liver Transplantation in Patients with Hepatitis C Virus-associated Cirrhosis
Hyung Joon Kim
The Korean Journal of Hepatology.2007; 13(4): 489. CrossRef

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Editorial

Review: Clinical Outcome after Living Donor Liver Transplantation in Patients with Hepatitis C Virus-associated Cirrhosis: Hyung Joon Kim; Korean J Hepatol 2007;13(4):489-494.
Published online December 20, 2007; DOI: https://doi.org/10.3350/kjhep.2007.13.4.489

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Case Report

A Case of Passenger Lymphocyte Syndrome in a ABO-unmatched Liver Transplant Patient: Dong Kyun Park, M.D., Sun Suk Kim, M.D., Hyun Chul Park, M.D., Duck Joo Choi, M.D., Dong Hoon Kang, M.D., You Kyoung Kim, M.D., Jong Jae Park, M.D., Joung Nam Lee, M.D.*, Ill Hae Seo, M.D.†and Ju Hyun Kim, M.D.; Korean J Hepatol 1999;5(2):162-167.

Abstract
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Transplantation of ABO-unmatched solid organs has been associated with the development of immune hemolysis due to donor-derived antibodies produced by passenger lymphocytes in the graft, called "Passenger Lymphocyte Syndrome". In a liver transplantation, about 40% of patients at risk has detectable donor-derived antibodies and hemolytic anemia occurs in 29% of patients. It is characterized by hemoglobinemia, a rapid fall in hemoglobin, hyperbilirubinemia, and an excessive red cell transfusion requirement occurring 1 to 3 weeks after the transplantation. These clinical findings are accompanied by the laboratory findings of a positive direct antiglobulin test and the detection of unexpected antibodies in the patients' red cell eluate and serum. Both the hemolytic anemia and serology resolve over the course of weeks to months. To the best of our knowledge, this is the first case of hemolytic anemia due to passenger lymphocyte syndrome after ABO-unmatched liver transplantation in Korea. (Korean J Hepatol 1999;5:162－167)

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Original Articles

The Effect of Lipo-PGE1 on Ischemia - Reperfusion Injury and Endothelin-1 Concentrations After Canine Partial Liver Transplantation: Ki Youl Seo, M.D., Il-Hwan Moon, M.D., Kwon Yoo, M.D., Hye Kyung Jung, M.D., Ku Yong Chung, M.D.*, and Kum Ja Choi, M.D.*; Korean J Hepatol 2001;7(4):475-484.

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Background
/ Aim : The lipo-PGE₁, known for being more stable during pulmonary circulation and having more targeting effect, has been reported to inhabit ET-1 induced stellate cell contraction. We assessed the effect of lipo-PGE₁ on the change of ET-1 concentration and the relationship between ET-1 concentration and the liver damage. Methods : Mongrel dogs weighting about 25kg were divided into a control(n=6) and a lipo-PGE₁ (n=6)group. Partial liver allotransplantation was performed. In the lipo-PGE₁ group, lipo-PGE₁ was slowly infused (60 ㎍/day) for 48 hours after reperfusion. The AST,ALP,LDH and ET-1 concentrations were monitored Results : The AST and ALP levels of the lipo-PGE₁ group were significantly lower than those of the control group both at 1 hour and 48 hours after reperfusion. The LDH level in the lipo-PGE₁ group was lower at 1 hour and 48 hours after reperfusion. But there was no statistical difference between the two groups. The baseline ET-1 concentration was elevated gradually in the control group. There was no significant difference between the two groups at 48 hours. There was no correlation between ET-1 concentrations and AST , ALP,LDH levels. Conclusion : This study demonstrated the hepatoprotective effect of the lipo-PGE₁ against ischemia-reperfusion injury in canine partial liver allotransplantation. However, the baseline ET-1 level was eight tomes higher in the lipo-PGE₁ group than that of the comntrol group in spite of the hepatoprotective effects of the lipo-PGE₁. (Korean J Hepatol 2001;7 :475- 484)

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Prevalence and Risk Factors of Significant Intrapulmonary Shunt in Cirrhotic patients awaiting liver transplantation: Ji Min Lee,Moon Seok Choi,Sang Chol Lee,Seung Woo Park,Mun Hee Bae,Joon Hyeok Lee,Kwang Cheol Koh,Seung Woon Paik,Poong Lyul Rhee,Jae Jun Kim,Jong Chul Rhee; Korean J Hepatol 2002;8(3):271-276.

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Backgrounds/Aims
Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. Methods: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrastenhanced echocardiography. Significant shunt was defined as a shunt of grade ≥2. Results: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p<0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. Conclusion: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt. (Korean J Hepatol 2002;8:271-276)

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