Between February 1997 and December 2001, 311 adult-to-adult living donor liver transplants (A-A LDLTs) were performed at the Asan Medical Center for patients above 20 years of age. Indications for A-A LDLT were: chronic hepatitis B (203), chronic hepatitis C (5), hepatocellular carcinoma (64), alcoholic cirrhosis (9), cryptogenic cirrhosis (4), secondary biliary cirrhosis (5), primary biliary cirrhosis (1), Wilson' s disease (2), autoimmune hepatitis (1), hepatic tuberculosis (1), cholangiocarcinoma (1), fulminant hepatic failure (14) and primary non-function of cadaveric liver graft (1). Of 311 A-A LDLTs, 36 were of medical high urgency, 20 were for acute and subacute hepatic failure, 15 were for hepato-renal syndrome and 1 was for primary non-function. Recipient age ranged from 27 to 64 years. Donor age ranged from 16 to 62 years. There was no donor mortality. Implanted liver grafts were categorized into seven types: 175 modified right lobe (MRL), 70 left lobe, 32 right lobe, 20 dual grafts, 10 left lobe plus caudate lobe, three extended right lobe and one posterior segment. In MRL, the tributaries of the middle hepatic vein were reconstructed by interpositioning a vein graft. Indication for dual graft implantation was the same as single graft A-A LDLT, and four of 20 were emergency cases. Of 20 dual grafts, 14 received two left lobes, four received a left lobe and a lateral segment, one received a right lobe and a left lobe and one received a lateral segment and a posterior segment. Graft volume ranged from 28% to 83% of the standard liver volume of the recipients. There were 33 (10.6%) in-hospital mortalities (< 4 months) among the 310 patients after 311 A-A LDLTs. Of the 36 patients receiving emergency transplants, 31 survived. These encouraging results justify the expansion of A-A LDLT in coping with increasing demands, even in urgent situations. We have aimed to introduce the establishment of the efficacy of A-A LDLT in various end-stage chronic and acute liver diseases, as well as new technical advances to overcome small graft-size syndrome by using dual-graft implantation and MRL, both of which were first developed in our department.
Background and aims: This study aimed to assess the safety and efficacy of endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) in the management of benign pancreatic tumors. Methods: In a single-center, prospective study, 10 patients with benign solid pancreatic tumors underwent EUS-RFA. After inserting the RFA electrode into pancreatic mass, the radiofrequency generator was activated to deliver 50 W of ablation power for 10 s. Complete ablation was defined by the disappearance of enhancing tissue at the tumor site on imaging. Results: In 10 patients, 16 sessions of EUS-RFA were successfully performed. There were 7 cases of nonfunctioning neuroendocrine tumor, 1 case of insulinoma, and 2 cases of solid pseudopapillary neoplasm; the median largest diameter of the tumors was 20 mm (range, 8e28 mm). The anatomical locations of the pancreatic tumors were as follows: head (n = 4), body (n = 5), and tail (n = 1). During follow-up (median 13 months, range 8e30 months), the postprocedure imaging showed complete ablation in 7 patients. The median EUS diameter of the tumors changed from 20 mm (IQR 15e24 mm) at the baseline to 6.5 mm (IQR 3.7e11.3) at the end of the follow-up (p < .001). In the 16 total ablation procedures, the procedure-related adverse events included one patient with abdominal pain (6.2%) and one with pancreatitis (6.2%). Conclusions: EUS-RFA may be a safe and potentially effective treatment option in selected patients. Multiple sessions may be required if there is a remnant or recurrent mass, and procedure-related adverse events must be cautiously monitored.
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