Publications by authors named "Kwangpyo Hong"

9 Publications

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Minimally Invasive Living Donor Liver Transplantation: Pure Laparoscopic Explant Hepatectomy and Graft Implantation Using Upper Midline Incision.

Liver Transpl 2021 Apr 10. Epub 2021 Apr 10.

Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.

Minimally invasive approaches, including laparoscopic procedures, have increasingly been applied in surgery due to their advantages such as reduced surgical trauma, a better quality of life, shorter hospital stay, and less postoperative morbidity compared with open surgeries. Minimally invasive approaches in liver transplantation (LT) may have similar advantages for the recipients, including less pain and a shorter hospital stay, which could facilitate rehabilitation.
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http://dx.doi.org/10.1002/lt.26066DOI Listing
April 2021

Clinical usefulness of T1-weighted MR cholangiography with Gd-EOB-DTPA for the evaluation of biliary complication after liver transplantation.

Ann Hepatobiliary Pancreat Surg 2021 Feb;25(1):39-45

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Backgrounds/aims: Biliary complications continue to be the major morbidity and mortality causes following living donor liver transplantation (LT). Endoscopic retrograde cholangiopancreatography (ERCP) has been performed to identify the biliary leakage source. However, this can lead to retrograde cholangitis and pancreatitis, and is not sufficient to diagnose bile leakage from cuts' surface. This study aimed to describe the use of T1-Weighted Magnetic Resonance (MR) Cholangiography with Gd-EOB-DTPA (Primovist) examination for evaluating the bile duct complication following LT.

Methods: From March 2012 to December 2018, 869 adult LT were performed at the Seoul National University Hospital. Forty-three recipients had undergone MR Cholangiography with Gd-EOB-DTPA. We reviewed these cases with their clinical outcomes and described the utility of the MR cholangiography with Gd-EOB-DTPA.

Results: In radiologic examinations performed in the patients suspected of bile duct complication, 95% had bile leakage and stricture. Cut surface leakage was diagnosed in two cases, and biliary leakage from the anastomosis site was diagnosed in the others. Most patients with leakage had undergone percutaneous drainage and ERCP, which was performed to evaluate the bile secretion function of the hepatocytes. There was no contrast-enhanced bile duct image in one case with severe rejection, and it might have been related to hepatocyte secretary dysfunction.

Conclusions: T1-Weighted MR Cholangiography with Gd-EOB-DTPA 40-minute delay examination is a feasible and safe non-invasive procedure for identifying biliary leakage sites.
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http://dx.doi.org/10.14701/ahbps.2021.25.1.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952671PMC
February 2021

Short-term therapy with anti-ICAM-1 monoclonal antibody induced long-term liver allograft survival in nonhuman primates.

Am J Transplant 2021 Jan 10. Epub 2021 Jan 10.

Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.

Tolerance induction remains challenging following liver transplantation and the long-term use of immunosuppressants, especially calcineurin inhibitors, leads to serious complications. We aimed to test an alternative immunosuppressant, a chimeric anti-ICAM-1 monoclonal antibody, MD-3, for improving the outcomes of liver transplantation. We used a rhesus macaque liver transplantation model and monkeys were divided into three groups: no immunosuppression (n = 2), conventional immunosuppression (n = 4), and MD-3 (n = 5). Without immunosuppression, liver allografts failed within a week by acute rejection. Sixteen-week-long conventional immunosuppression that consisted of prednisolone, tacrolimus, and an mTOR inhibitor prolonged liver allograft survival; however, recipients died of acute T cell-mediated rejection (day 52), chronic rejection (days 62 and 66), or adverse effects of mTOR inhibitor (day 32). In contrast, 12-week-long MD-3 therapy with transient conventional immunosuppression in the MD-3 group significantly prolonged the survival of liver allograft recipients (5, 96, 216, 412, 730 days; p = .0483). MD-3 effectively suppressed intragraft inflammatory cell infiltration, anti-donor T cell responses, and donor-specific antibody with intact anti-cytomegalovirus antibody responses. However, this regimen ended in chronic rejection. In conclusion, short-term therapy with MD-3 markedly improved liver allograft survival to 2 years without maintenance of immunosuppressant. MD-3 is therefore a promising immune-modulating agent for liver transplantation.
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http://dx.doi.org/10.1111/ajt.16486DOI Listing
January 2021

Outcomes of Pediatric Liver Transplantation in Korea Using Two National Registries.

J Clin Med 2020 Oct 26;9(11). Epub 2020 Oct 26.

Department of Surgery, Seoul National University College of Medicine, Seoul 08826, Korea.

Background: This retrospective study aimed to evaluate overall survival and the risk factors for mortality among Korean pediatric liver transplantation (LT) patients using data from two national registries: the Korean Network Organ Sharing (KONOS) of the Korea Centers for Disease Control and Prevention and the Korean Organ Transplantation Registry (KOTRY).

Methods: Prospectively collected data of 755 pediatric patients who underwent primary LT (KONOS, February 2000 to December 2015; KOTRY, May 2014 to December 2017) were retrospectively reviewed.

Results: The 1-, 5-, 10-, and 15-year survival rates were 90.6%, 86.7%, 85.8%, and 85.5%, respectively, in KONOS, and the 1-month, 3-month, 1-year, and 2-year survival rates were 92.1%, 89.4%, 89.4%, and 87.2%, respectively, in KOTRY. There was no significant difference in survival between the two registries. Multivariate analysis identified that body weight ≥6 kg ( <0.001), biliary atresia as underlying liver disease ( = 0.001), and high-volume center ( < 0.001) were associated with better survival according to the KONOS database, while hepatic artery complication ( < 0.001) was associated with poorer overall survival rates according to the KOTRY database.

Conclusion: Long-term pediatric patient survival after LT was satisfactory in this Korean national registry analysis. However, children with risk factors for poor outcomes should be carefully managed after LT.
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http://dx.doi.org/10.3390/jcm9113435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694033PMC
October 2020

Influence of Large Grafts Weighing ≥ 1000 g on Outcome of Pure Laparoscopic Donor Right Hepatectomy.

J Gastrointest Surg 2020 Oct 26. Epub 2020 Oct 26.

Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea.

Background: Depending on a transplant center's level of experience, utilization of pure laparoscopic donor right hepatectomy (PLDRH) may be limited due to graft size or anatomical variations. Here, we aimed to evaluate the influence of large hepatic grafts (≥ 1000 g) when performing PLDRH in both donors and recipients of such grafts.

Methods: Medical records of living donors who underwent either PLDRH from November 2015 to August 2019 or open conventional donor right hepatectomy (CDRH) from January 2010 to August 2019 and those of the graft recipients were retrospectively reviewed. Donors were separated into three groups: PLDRH graft ≥ 1000 g (n = 10; study group), PLDRH graft < 1000 g (n = 280; control-I group), and CDRH graft ≥ 1000 g (n = 24; control-II group).

Results: Total operative duration (P = 0.017) and warm ischemia time (P < 0.001) were significantly longer in the study than in the control-I and control-II groups, respectively. ΔAlanine aminotransferase% was significantly lower in the study than in the control-I group (P = 0.001). There was no significant difference in minor complication incidence between the study and control-I (P = 0.068) and control-II (P = 0.618) donors. There were no major complications in the study and control-II donors, whereas six control-I donors (2.1%) experienced a major complication (P = 1.000). Length of hospitalization was significantly shorter in the study than in the control-II group (P < 0.001). There was no significant difference in early and late major complication incidence for recipients between the study and control-I and control-II groups.

Conclusions: PLDRH for grafts weighing ≥ 1000 g appears to be safe and feasible when performed by experienced surgeons in a well-equipped center.
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http://dx.doi.org/10.1007/s11605-020-04837-7DOI Listing
October 2020

Parietal Peritoneum as a Novel Substitute for Middle Hepatic Vein Reconstruction During Living Donor Liver Transplantation.

Transplantation 2020 Jun 15. Epub 2020 Jun 15.

Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.

Background: Although autologous, cryopreserved, or artificial vascular grafts can be used as interpositional vascular substitutes for MHV reconstruction during LDLT, they are not always available, are limited in size and length, and are associated with risks of infection. This study aimed to evaluate the parietal peritoneum as a novel substitute for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT).

Methods: Prospectively collected data of 15 patients who underwent LDLT using the right liver with reconstruction of MHV using the recipients' own parietal peritoneum graft were retrospectively reviewed.

Results: The 1-, 2-, 3-, and 5-month patency rates were 57.1%, 57.1%, 57.1%, and 28.6%, respectively. Among the 15 cases assessed, the most recent 6 cases showed patent graft flow until discharge with 1-, 2-, 3-, and 5-month patency rates of 80.0%, 80.0%, 80.0%, and 20.0%, respectively. All patients survived with tolerable liver function tests. There were no significant congestion-related problems, except for 1 patient who experienced MHV thrombosis requiring aspiration thrombectomy and stent insertion. There were no infection-related complications. All patients survived to the final follow-up, with a minimum follow-up duration of 8 months. When comparing the latter 6 cases of peritoneal grafts and the recent 28 cases of conventional polytetrafluorethylene (PTFE) graft, the overall patency rate of the PTFE group was higher (P = 0.002). There were no major differences other than long-term patency rate.

Conclusions: Parietal peritoneum may be a novel autologous substitute for MHV reconstruction during LDLT.
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http://dx.doi.org/10.1097/TP.0000000000003349DOI Listing
June 2020

Acute appendicitis after liver transplantation: A single center experience and review of the literature.

Ann Hepatobiliary Pancreat Surg 2020 Feb 27;24(1):44-51. Epub 2020 Feb 27.

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Backgrounds/aims: Acute appendicitis is one of the most common emergent disease in the general population requiring surgical treatment. However, only a few cases of appendicitis after liver transplantation (LT) were reported. We described experiences of acute appendicitis after LT in single center.

Methods: From March 1988 to July 2019, we reviewed retrospectively all the patients who diagnosed with acute appendicitis after LT at the Seoul National University Hospital. We described and analyzed clinical outcomes of appendectomy after LT.

Results: A total of 12 patients out of 2,237 LT patients underwent appendectomy due to acute appendicitis. The mean age was 48±12 years. Nine patients (75%) underwent deceased donor liver transplantation (DDLT) and three patients (25%) underwent living donor liver transplantation (LDLT). The mean days from transplantation to the onset of acute appendicitis was 739 (range 57-4,496) days. Every patients underwent appropriate appendectomy within 1 days after visiting hospital. Leukocytosis was seen in three patients (25%). Seven patients (58%) underwent laparoscopic appendectomy and five patients (42%) underwent open appendectomy. The total operative time was 47.5 (range 25-135) minutes. The median postoperative hospitalization was 4 (range 2-11) days. There was no postoperative complications documented. There was no significant difference of clinical outcomes between laparoscopic appendectomy group and open appendectomy group.

Conclusions: Early surgical management achieved satisfactory postoperative results without graft dysfunction after LT. Laparoscopic appendectomy also could be applicable with safe and feasible outcomes even in post-LT recipients.
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http://dx.doi.org/10.14701/ahbps.2020.24.1.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061048PMC
February 2020

Fatigue and related factors after liver transplantation.

Korean J Hepatobiliary Pancreat Surg 2015 Nov 30;19(4):149-53. Epub 2015 Nov 30.

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Backgrounds/aims: Fatigue is common in chronic hepatitis and end-stage liver disease. However, little is known about fatigue after liver transplantation (LT). We therefore evaluated the prevalence, severity, and related factors of fatigue after LT.

Methods: We retrospectively reviewed adult recipients who responded to our survey at outpatient clinics between April and May 2013. Fatigue and its severity were assessed using a questionnaire with the Fatigue Severity Scale (FSS). We defined fatigue as FSS of 4.0 or more and severe fatigue as FSS of 5.1 or more. The related factors including hepatocellular carcinoma and complications were analyzed.

Results: A total of 93 patients were included in this study. The mean age was 54.9 (19-76) years and two-thirds were men (67.7%). Living donor LT was 77.4%. Hepatitis B related liver disease was the main underlying disease (77.4%), with hepatocellular carcinoma accompanied in 33.3%. The mean follow-up period was 66.8±43.2 (2-171) months. The mean FFS was 2.83±1.48 (1.0-6.7) overall and 5.10±0.82 (4.0-6.7) in the fatigue group. Of the 93 adult patients, fatigue was presented in 20 patients (21.5%). Among these, 9 patients (45.0%) showed severe fatigue. Even though post-LT complications tended to be greater in the fatigue group (50.0% vs. 30.1% in the non-fatigue group, p=0.098), there were no significant related factors of fatigue after LT, including hepatocellular carcinoma and major complication.

Conclusions: Fatigue is present in a considerable portion of recipients after LT, and almost half of them have severe fatigue. Further efforts are needed to decrease fatigue in LT recipients.
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http://dx.doi.org/10.14701/kjhbps.2015.19.4.149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683918PMC
November 2015

Secondary ion mass spectrometry study of thermal diffusion of Au nanoparticles in porous SiO2 matrices.

J Nanosci Nanotechnol 2011 May;11(5):4400-5

Department of Chemistry and Interdisciplinary Program of Integrated Biotechnology, Institute of Biological Interfaces, Sogang University, Seoul 121-742, Korea.

Migration of Au nanoparticles by thermal diffusion into porous SiO2 matrix substrates has been studied using secondary ion mass spectroscopy (SIMS). When the samples having four different porosities were annealed at T = 410 K for 1.5 h, no noticeable variations in the thermal diffusion of Au nanoparticles were observed. All the measured diffusion coefficients of Au particles, were an order of 10(-15) cm2/s at 300-410 K in a very limited interfacial region. Regardless of their porosities, the pores must be discontinuous, which acts as a diffusion barrier to block the continuous diffusion of Au particles.
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http://dx.doi.org/10.1166/jnn.2011.3635DOI Listing
May 2011