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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.

Latar Belakang: Endoleak tipe 1a banyak ditemukan pada AAA dengan anatomi sulit. Sebelum tindakan EVAR, anatomi AAA perlu dinilai dan pitfall dikenali agar dapat mempersiapkan tindakan tambahan ataupun mempertimbangkan pembedahan terbuka. Belum banyak penelitian yang menggambarkan anatomi aneurisma pasien Asia dan kaitannya dengan kesuksesan dan kesulitan saat EVAR. Metode: Desain penelitian adalah cross–sectional pada pasien AAA yang menjalani EVAR oleh tim vaskular dan endovaskular FKUI-RSCM tahun 2013-2017. Pasien AAA yang disertai aneurisma torakal dieksklusikan. Untuk mengetahui adanya hubungan antara anatomi dengan kejadian endoleak tipe 1a dilakukan uji unpaired t-test atau Mann – Whitney test tergantung dengan distribusi data. Hasil: Didapatkan 55 subjek, 52 (94,5%) pria dan tiga (5,5%) wanita. Semua berusia di atas 60 tahun; rata-rata usia 70,2 (SD±5,8) tahun. Ditemukan enam kasus Endoleak tipe 1a (10,9%), dua tipe 1b dua (3,6%) dan tipe 4 satu kasus (1,8%). Rata-rata diameter leher proksimal 21,8 (SD±3,8) mm, median panjang 20 (10,1-61,9) mm dan rata-rata angulasi 138,8 (SD±26,7) derajat. Rata-rata panjang aneurisma 128,1 (25,4) mm dengan median diameter 58,8 (27,5-143,2) mm. Derajat keparahan anatomi diameter leher proksimal terdapat 29 (52,7%) pada kelompok absen, 12 (23,6%) ringan, 8 (14,5%) sedang dan 5 (9,1%) berat; Panjang leher proksimal, 21 (38,2%) dalam kelompok absen, 27 (49,1%) ringan  dan 7 (12,7%) sedang. Derajat keparahan angulasi leher proksimal didapatkan 17 (30,9%) absen, 9 (16,4%) ringan, 16 (29,1%) sedang dan 13 (23,6%) berat. Derajat keparahan aneurisma paling banyak didapatkan dalam kelompok berat 34 (61,8%) diikuti dengan kelompok sedang 13 (23,6%), ringan 5 (9,1%) dan absen 3 (5,5%). Tidak terdapat hubungan yang signifikan antara terjadinya endoleak tipe 1a dengan panjang aneurisma (p = 0,740), diameter aneurisma (p = 0,466), panjang leher proksimal (p = 0,253), diameter leher proksimal (p = 0,766) maupun angulasi leher proksimal (p = 0,090). Simpulan: Endoleak didapatkan pada sembilan subjek dengan tipe endoleak terbanyak adalah endoleak tipe 1a, tidak berbeda dengan yang didapatkan pada penelitian lain di dunia. Berdasarkan data yang didapatkan, dapat disimpulkan bahwa EVAR, dengan stent-graft yang digunakan,  masih dapat dipertimbangkan bahkan pada anatomi aneurisma yang sulit dengan persiapan yang baik.

This study aimed to create a tailored prediction model of hepatocellular carcinoma (HCC)-specific survival after transplantation based on pre-transplant parameters. Data collected from June 2006 to July 2018 were used as a derivation dataset and analyzed to create an HCC-specific survival prediction model by combining significant risk factors. Separate data were collected from January 2014 to June 2018 for validation. The prediction model was validated internally and externally. The data were divided into three groups based on risk scores derived from the hazard ratio. A combination of patient demographic, laboratory, radiological data, and tumor-specific characteristics that showed a good prediction of HCC-specific death at a specific time (t) were chosen. Internal and external validations with Uno’s C-index were 0.79 and 0.75 (95% confidence interval (CI) 0.65–0.86), respectively. The predicted survival after liver transplantation for HCC (SALT) at a time “t” was calculated using the formula: [1 − (HCC-specific death(t’))] × 100. The 5-year HCC-specific death and recurrence rates in the low-risk group were 2% and 5%; the intermediate-risk group was 12% and 14%, and in the high-risk group were 71% and 82%. Our HCC-specific survival predictor named “SALT calculator” could provide accurate information about expected survival tailored for patients undergoing transplantation for HCC.

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Introduction: Resection of renal cell carcinoma liver metastases (RCCLM) is known to provide a good survival outcome. Simultaneous RCCLM resection with the primary tumor is commonly done in cases with direct extension of locally advanced RCC to liver parenchyma. Cases of safe simultaneous resection of liver and kidney in malignancy have not been reported before in Indonesia. Case Presentation: We aim to describe two cases of left-sided RCC with right-sided RCCLM who underwent simultaneous kidney and liver resection. Both patients had good short-term survival with no intra-operative and post-operative complications.Conclusion: Although simultaneous kidney and liver resection poses challenges of substantial morbidity, a safe surgical and multidisciplinary approach could be implemented in selected cases with a good surgical outcome.

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