Transplantation of ABO-nmatched solid organs has been associated with the development of immune hemolysis due to donor-erived 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-erived 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-nmatched liver transplantation in Korea.
Anemia, Hemolytic ; Antibodies ; Coombs Test ; Hemolysis ; Humans ; Hyperbilirubinemia ; Korea ; Liver Transplantation ; Liver* ; Lymphocytes* ; Transplants

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

Salmonella infection is an acute systemic disease that can lead to diffuse organ involvement with septicemia and cause clinically a variety of complications. But acute acalculous cholecystitis and acute hepatitis with jaundice due to Salmonella typhi occurred rarely. A 42 years old female was admitted with fever, chilling sensation and abdominal pain. On admission, the blood, stool, bile acid and bone marrow cultures were positive for Salmonella typhi. The patient had subsequently developed acute acalculous cholecystitis and acute hepatitis with jaundice. Her symptoms and signs resolved after cholecystostomy, parenteral antibiotic (ciprofloxacin) and supportive treatment. We report a case of acute acalculous cholecystitis and acute hepatitis with jaundice in a 42-ear-ld female, whose conditions were recovered completely after cholecystostomy and administration of ciprofloxacin, with reviewing the literatures.
Abdominal Pain ; Acalculous Cholecystitis* ; Adult ; Bile ; Bone Marrow ; Cholecystostomy ; Ciprofloxacin ; Female ; Fever ; Hepatitis* ; Humans ; Jaundice ; Salmonella Infections ; Salmonella typhi* ; Salmonella* ; Sensation ; Sepsis

Symptomatic hepatic cysts are infrequently seen. A 82-year-old woman was admitted because of growing abdominal mass and pain. On admission, the mass was palpated on right upper quadrant of the abdomen. Ultrasonography and computed tomography disclosed a huge cystic lesion of the liver. It measured 22.5 x 19.0 x 18.0 cm and had a thick wall that was irregular. Because of the patient's symptoms and the radiologic findings, the decision was made to aspirate the cyst percutaneously under fluoroscopic guidance. Percutaneous drainage yielded approximately 3300 cc of yellow brownish fluid. A cytologic evaluation of the fluid was negative for malignant cells, and a fluid analysis was described as predominantly inflammatory in nature. Cultures revealed a growth of Klebsiella oxytoca. After drainage of the cystic fluid, we instilled contrast medium. No communication between the cyst and bile ducts was seen. Seven days later, the patient was discharged. Four months after treatment, no reaccumulated fluid was observed by ultrasonography. Ten months after treatment, the patient is healthy without abdominal discomfort. We report a case of the infected huge hepatic cyst successfully treated with fluoroscopic-uided percutaneous drainage.
Abdomen ; Aged, 80 and over ; Bile Ducts ; Drainage* ; Female ; Humans ; Klebsiella oxytoca ; Liver ; Ultrasonography

A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.
Alkaline Phosphatase ; Bilirubin ; Biopsy ; Eosinophilia ; Graves Disease ; Humans ; Hyperthyroidism ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Methimazole* ; Middle Aged ; Prednisolone ; Propylthiouracil*

BACKGROUND/AIMS: p53 mutations have been reported to be a poor prognostic indicator in patients with HCC treated by surgical resection because of the association with frequent recurrence and shorter survival periods. Although poor differentiation of tumor has been considered to be associated with p53 mutation more frequently, the exact causes of unfavorable prognosis have not been clarified. METHODS: To evaluate the relationship of p53 mutation and details of histological features, we examined 20 HCCs and surrounding liver tissues from the patients treated with surgical resection using direct sequencing of p53 gene at exons 5, 6, 7 and 8, and analyzed histopathologic features. We also analyzed the clinical, biochemical and radiological characteristics including the recurrences of tumor and survival periods in HCC patients with p53 mutant comparing to those with wild type p53 gene. RESULTS: p53 mutants were found in 9 (45%) out of 20 resected HCC tissues, none from any surrounding tissues. p53 mutations were all point substitutions of a base; 5 in exon 8, 4 in exon 5 and 1 in exon 7. Between patients with mutants and those with wild type of p53 gene, there were no differences in age, sex, serum ALT, albumin, bilirubin and AFP levels, and HBV-ositivity. HCCs with p53 mutants tended to be larger in size (14% in < 5 cm vs 67 % in > 5 cm; p=0.03) and multinodular in type (3/9 vs 0/11; p=0.07). p53 mutants tended to be found in poorly differentiated HCCs comparing to wild types. Even though there was no evidence of vascular or biliary invasion radiologically in all, 5 of 9 p53 mutant (+) (56%) and none of 11 p53-utant (- cases showed vascular invasions microscopically (p<0.01). However, there was no correlation between p53 mutations in tumor tissues and formation of capsules, biliary invasions or association with cirrhosis. During follow-p periods (median: 22;2 -8 mos) recurrences of HCC had been found in 6 of 9 patients with mutants (67%) in contrast to only 2 of 11 with wild types (18%)(p=0.07). Extrahepatic metastases were also common in patients with p53 mutant than those without it (56% vs 9%; p=0.05). Consequently, the 1 year cancer free survival rate of HCC patients with p53 mutant was significantly lower than that with wild type (44% vs 82%; p=0.02). CONCLUSIONS: Thus, it is suggested that p53 mutations tend to be commonly associated with microvascular invasions as well as poor differentiation microscopically, which may result in micrometastasis and frequent recurrences, and consequently shorter survival periods in HCC patents undergoing surgical resection.
Bilirubin ; Capsules ; Carcinoma, Hepatocellular* ; Exons ; Fibrosis ; Genes, p53 ; Humans ; Liver ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Prognosis* ; Recurrence ; Survival Rate

BACKGROUND/AIMS: Various techniques of hepatocyte transplantation were actively studied as an alternative to liver transplantation, because of the difficulty of obtaining donor organ, technical difficulties, and high cost. Isolated hepatocytes could be appropriately banked and distributed on demand. We tried to investigate the effect of intrasplenic transplantation of allogenic cryopreserved hepatocytes, into spleen prior to 90% partial hepatectomy in rats, on the survival rate. METHODS: Cryopreserved hepatocytes, isolated by collagenase perfusion of the liver via the portal vein, were thawed and transplanted into the spleen of rats prior to induction of acute hepatic failure by resection of all lobes except caudate lobe (2.0x107 hepatocytes/rat). RESULTS: 1. The viability of freshly isolated hepatocyte was 70-5%, but cell viability after cryopreservation 30-0%. 2. Difference of survival in control and transplant group is not statistically significant. but the survival rate, 48 hours after 90% partial hepatectomy, for control (7) and transplanted group (11) were 0% and 18%, respectively. 3. Although the glucose reduction gradient was not significantly different between two groups, it was more prominent in the control group than in the transplanted group. 4. Engraftment and survival of transplanted hepatocytes were noted in the spleen 2 days after transplantation. CONCLUSIONS: We could not observe statistically significant improvement of survival with intrasplenic transplantation of cryopreserved hepatocytes in rats with 90% partial hepatectomy-nduced acute liver failure. However, 18% survival after 90% partial hepatectomy was noted in the transplanted group, compared to no survival in the control group. This suggests that intrasplenic transplantation of cryopreserved hepatocytes might be effective in the treatment of acute liver failure.
Animals ; Cell Survival ; Collagenases ; Cryopreservation ; Glucose ; Hepatectomy ; Hepatocytes* ; Humans ; Liver ; Liver Failure, Acute ; Liver Transplantation ; Perfusion ; Portal Vein ; Rats* ; Spleen ; Survival Rate ; Tissue Donors

BACKGROUND/AIMS: HBcAg is the most immunogenic HBV component and anti-Bc usually persists irrespective of ongoing liver disease or clearance of the virus in human. Therefore anti-Bc is considered as the most sensitive and occasionally the only marker of the HBV infection. Nevertheless, there are a few HBsAg carrier with persistent negative anti-Bc. The epitope which responds to HBcAg is recently defined in HLA A2 from acute viral hepatitis patient due to HBV. So we studied the clinical and laboratory features and nucleotide sequence of HBcAg corresponding to HLA A2 in the HBsAg carrier with persistent negative anti-Bc. METHODS: The subject of these study consists of eight HBsAg chronic carriers with persistent negative anti-Bc. We followed up the clinical features and serological markers of HBV infection and determined the amount of humoral immunoglobulin, HBV DNA and HBcAg when we performed the HLA class I typing and sequencing analysis of core of HBV. Control cases were selected from 3 HLA A2 heterozygote cases with chronic HBsAg carriers with anti-Bc. RESULTS: All subjects had the HBsAg persistently and good health conditions with normal ranges of aminotransferase and humoral immunoglobulin. One of them was converted to anti-Bc-ositive during follow-p period. The level of HBV DNA in serum was higher than 1.2 pg/mL in 7 of 8 chronic HBV carriers. There was a trend of differences between chronic anti-Bc negative carriers and converted one case to anti-Bc positive in the serum of HBcAg and HBV DNA(p=0.06). But strong positive correlation was observed between the amount of HBcAg and HBV DNA in sera. The core portion of HBV was amplified in 4 of 6 HLA A2 heterozygotes by single PCR. When sequenced the PCR products of the above 4 chronic anti-Bc negative HBV carriers and 3 control cases directly, there were no significant difference in the nucleotide and amino acid sequence at the HBcAg epitope which corresopond to class 1 HLA A2. CONCLUSIONS: Our results show that persistent anti-Bc negative chronic HBV carriers may be caused by large amounts of HBV DNA and HBcAg in their sera and not by variants of HBV. These suggested that active viral replication was going on, but are undetectable by the available commercial tests due to binding with excessive amount of HBcAg in the HBV carriers with persistent negative anti-Bc.
Amino Acid Sequence ; Base Sequence* ; DNA ; Hepatitis ; Hepatitis B Core Antigens* ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Heterozygote* ; Humans ; Immunoglobulins ; Liver Diseases ; Polymerase Chain Reaction ; Reference Values

BACKGROUND/AIMS: We studied to evaluate the virological and biochemical responses to lamivudine and to detect YMDD mutants in patients who received long-erm lamivudine therapy. METHODS: We conducted a one-ear trial of lamivudine in 45 Korean patients with chronic liver disease due to hepatitis B virus. The patients were treated with a single oral average dose of 100 mg of lamivudine every day for 12 months. RESULTS: The suppression of serum HBV DNA was sustained in 77.8% of the patients and the normalization of serum ALT in 80%. The proportions of patients with HBeAg seroconversion were 25%. YMDD mutants were detected in 4 of 8 patients who showed sustained HBV DNA and serum ALT response (n=31) and in 3 of 8 patients who showed HBV DNA or serum ALT breakthrough (n=9). The response to lamivudine therapy in HBeAg-egative patients was excellent. CONCLUSION: Lamivudine therapy resulted in a significant virological and biochemical improvements and were well tolerated. But, YMDD mutants were detected during lamivudine therapy.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Lamivudine* ; Liver Diseases* ; Liver*

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B. This study investigated the effect and safety of 12 week lamivudine therapy in Korean patients with chronic hepatitis B (CHB). METHODS: In an open clinical trial, 113 patients with CHB were enrolled. They received 100 mg of lamivudine orally once daily for 12 weeks, and they were followed until 2 weeks after cessation of lamivudine. HBV DNA (by bDNA assay), liver enzymes, creatine phosphokinase, creatinine and CBC were checked at 0, 2, 4, 8, 12 and 14 weeks. Compliance and side effects were evaluated at the same time. RESULTS: After receiving lamivudine 100 mg, serum HBV DNA levels fell rapidly, remaining in 94.3% below baseline values at 2 weeks and 99.8% below baseline values at 12 weeks. Serum HBV DNA was cleared in 75.2% and alanine aminotransferase level (ALT) was normalized in 64.8% at 12 weeks. Cumulative percentage of HBeAg clearance (defined by clearance of serum HBV DNA and HBeAg) was 14.4%. Clearance of HBV DNA was more frequent in patients with lower pretreatment serum HBV DNA and higher ALT. During the treatment periods, adverse effects were negligible and transient. Two weeks after cessation of lamivudine, serum HBV DNA reappeared in 70.6% of responders. CONCLUSION: It is suggested that lamivudine is effective and safe in the treatment of CHB in Korean patients, but further study for adequate duration of treatment is needed because of high recurrence after 12 weeks therapy.
Alanine Transaminase ; Compliance ; Creatine Kinase ; Creatinine ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Liver ; Recurrence