Background: Chromosomal alterations serve as diagnostic and prognostic markers in acute leukemia. Given the evolving landscape of chromosomal abnormalities in acute leukemia, we previously studied these over two periods. In this study, we investigated the frequency of these abnormalities and clinical trends in acute leukemia in Korea across three time periods. Methods: We retrospectively analyzed data from 1,787 patients with acute leukemia (319 children and 1,468 adults) diagnosed between 2006 and 2020. Conventional cytogenetics, FISH, and multiplex quantitative PCR were used for analysis. The patient groups were divided according to the following three study periods: 2006–2009 (I), 2010–2015 (II), and 2016–2020 (III). Results: Chromosomal aberrations were detected in 92% of patients. The PML::RARA translocation was the most frequent. Over the 15-yr period, chromosomal aberrations showed minimal changes, with specific fusion transcripts being common among patients.ALL was more prevalent in children than in adults and correlated significantly with the ETV6::RUNX1 and RUNX1::RUNX1T1 aberrations. The incidence of ALL increased during the three periods, with PML::RARA remaining common. Conclusions The frequency of chromosomal abnormalities in acute leukemia has changed subtly over time. Notably, the age of onset of adult AML has continuously increased. Our results may help in establishing diagnoses and clinical treatment strategies and developing various molecular diagnostic platforms.

Background: Alcoholic liver disease (ALD) includes a wide clinical spectrum from acute alcoholic hepatitis to severe cirrhosis and/or hepatocellular carcinoma. Until now, there has been no report revealing the bleeding tendency of ALD compared to other diseases in liver transplantation (LT). Thus, we analyzed blood loss and transfusion amounts during operation according to the etiologies of liver disease and model for end-stage liver disease (MELD) score. Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipients’ baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and nonALD according to MELD score. Results: The number of patients in the ALD group was 130 (17.9%), and 598 (82.1%) in the non-ALD group. The ALD group showed younger age, higher MELD score, and a higher proportion of deceased donor LT than the non-ALD group. Intraoperative blood loss and transfusions of red blood cells (RBCs), fresh frozen plasma, and platelets were significantly higher in the ALD group. When stratified by MELD score (cut-off: 20), ALD patients in both high and low MELD subgroups demonstrated greater blood loss and RBC transfusion requirements, even when international normalized ratio and platelet counts were similar. In multivariate logistic regression analysis, ALD was a significant risk factor for massive transfusion (odds ratio 1.813, 95% confidence interval 1.158–2.840, p=0.009). Conclusion The ALD group showed increased bleeding tendency than the non-ALD group during LT, irrespective of MELD score. This suggests that transplant surgeons should anticipate greater blood loss and ensure adequate transfusion resources during LT for ALD patients.

Purpose: This study aimed to describe adult living donor liver transplantation (LDLT) for acute liver failure and evaluate its clinical significance by comparing its surgical and survival outcomes with those of deceased donor liver transplantation (DDLT). Methods: We retrospectively reviewed the medical records of 267 consecutive patients (161 LDLT recipients and 106 DDLT recipients) aged 18 years or older who underwent liver transplantation between January 2006 and December 2020. Results: The mean periods from hepatic encephalopathy to liver transplantation were 5.85 days and 8.35 days for LDLT and DDLT, respectively (P = 0.091). Among these patients, 121 (45.3%) had grade III or IV hepatic encephalopathy (living, 34.8% vs. deceased, 61.3%; P < 0.001), and 38 (14.2%) had brain edema (living, 16.1% vs. deceased, 11.3%; P = 0.269) before liver transplantation. There were no significant differences in in-hospital mortality (living, 11.8% vs. deceased, 15.1%; P = 0.435), 10-year overall survival (living, 90.8% vs. deceased, 84.0%; P = 0.096), and graft survival (living, 83.5% vs. deceased, 71.3%;P = 0.051). However, postoperatively, the mean intensive care unit stay was shorter in the LDLT group (5.0 days vs. 9.5 days, P < 0.001). In-hospital mortality was associated with vasopressor use (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.45–7.96; P = 0.005) and brain edema (OR, 2.75; 95% CI, 1.16–6.52; P = 0.022) of recipient at the time of transplantation. However, LDLT (OR, 1.26; 95% CI, 0.59–2.66; P = 0.553) was not independently associated with in-hospital mortality. Conclusion LDLT is feasible for acute liver failure when organs from deceased donors are not available.

Purpose: Breast cancer is one of the most common causes of cancer-related death in females. Numerous drug-targetable biomarkers and predictive biomarkers have been developed. Some researchers have expressed doubts about the need for next-generation sequencing (NGS) studies in daily practice. This study analyzed the results of NGS studies on breast cancer at a single institute and evaluated the real-world applications of NGS data to precision medicine for breast cancer. Materials and Methods: We retrospectively collected the results of NGS studies and analyzed the histopathologic features and genetic profiles of patients treated for breast cancer from 2010 to 2021. Seventy cases had data from CancerSCAN, a customized panel of 375 cancer-associated genes, and 110 cases had data from TruSight Oncology 500. Results: The most frequently detected single nucleotide variant was the TP53 mutation (123/180, 68.3%), followed by PIK3CA muta-tions (51/180, 28.3%). Estrogen receptor 1 (ESR1) mutation was detected in 11 patients (6.1%), of whom 10 had hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer, and two had no history of prior endocrine therapy. Based on their NGS study results, 13 patients (7.2%) received target therapy. Among them, four patients had a BRCA1 or BRCA2 germline mutation, and nine patients had a PIK3CA mutation. Conclusion NGS can provide information about predictive biomarkers and drug-targetable biomarkers that can enable treatment and participation in clinical trials based on precision medicine. Further studies should be conducted to excavate novel drug-targetable biomarkers and develop additional target therapies.

Background: The study aims to elucidate the relationship between cytomegalovirus (CMV) infection and graft survival, as well as to identify risk factors for CMV infection in deceased donor liver transplantation (DDLT) recipients without prophylaxis. Methods: A retrospective study was conducted on 465 DDLT recipients at Severance Hospital, South Korea, employing a nested case-control design to explore CMV infection risk factors. Results: All study population showed CMV antibody seropositivity and did not received CMV prophylaxis. CMV infection was observed in 38.6% of DDLT recipients within the first year. Patients with CMV infection showed reduced graft survival rates within 5 years after matched time points compared to those without infection (57.9% vs. 67.5%, p=0.039), which confirmed in multivariable analysis (hazard ratio 1.44, p=0.047). Risk factor analysis revealed that Child-Pugh class C, donor liver macrovesicular steatosis ≥20%, and elevated pretransplant neutrophil levels were independently associated with an increased risk of CMV infection. Conclusion This study confirms that CMV infection post-DDLT is a significant predictor of reduced graft survival. Addressing risk factors of CMV infection through targeted interventions could potentially improve patient management and post-transplant outcomes after DDLT.

Background: This study aims to analyze the outcomes of living donor liver transplantation (LDLT) using grafts with multiple hepatic arteries (HAs), compared to those with a single HA. Methods: A retrospective analysis was conducted on 1,059 LDLT patients from July 2005 to December 2022 at Severance Hospital, South Korea. Patients were categorized into multiple-HA and single-HA groups. Propensity score matching was employed to balance baseline characteristics, with primary outcomes being graft survival and secondary outcomes including HA, biliary, and total vascular complications. Results: The study included 27 patients in the multiple-HA group and 925 in the single-HA group before matching. After propensity score matching, no significant difference in 5-year graft survival rates was observed between the groups (60.4% for multiple-HA vs. 72.8% for single-HA, p=0.172). However, the multiple-HA group exhibited a higher incidence of bile duct complications (80.0% vs. 48.3%, p=0.038).Multivariable Cox regression analysis did not find multiple HAs to be a significant predictor of graft loss but confirmed their association with increased bile duct complications. Conclusion LDLT using grafts with multiple HAs does not adversely affect overall graft survival compared to single-HA grafts. Nevertheless, the increased risk of bile duct complications associated with multiple HAs necessitates careful surgical planning and postoperative management to mitigate this risk.

Background: Carbapenem-resistant gram-negative rod bacteremia (CRGNR-B) is emerging as a formidable challenge, complicating patient management and outcomes in liver transplantation (LT). This study aimed to investigate the incidence, mortality, and risk factors associated with CRGNR-B within 90 days following LT. Methods: A retrospective nested case-control study was conducted using single centric LT data (n=1,379). CRGNR-B cases were matched 1:5 with control patients for analyzing survival and risk factors for CRGNR-B. Results: The incidence of CRGNR-B within 90 days post-LT was 6.5% (n=87). The CRGNR-B group showed significantly lower 1-year post-LT survival compared to the control group (37.9% vs. 90.0%, p<0.001). CRGNR-B was significantly correlated with increased mortality after adjustment of covariates (adjusted hazard ratio, 5.66;95% confidence interval [CI], 3.89–8.24; p<0.001). Key risk factors identified include higher pretransplant model for end-stage liver disease scores (odds ratio [OR], 1.05;95% CI, 1.01–1.09; p=0.006), encephalopathy prior to transplant (OR, 2.79; 95% CI, 1.48–5.30; p=0.002), retransplantation (OR, 10.4; 95% CI, 2.79–42.1; p<0.001), each 60-minute increase in cold ischemic time (OR, 1.20; 95% CI, 1.01–1.42; p=0.037), and bile duct complications (OR, 6.16; 95% CI, 2.66–14.2; p<0.001). Conclusion The occurrence of CRGNR-B within 90 days post-LT poses a significant risk to patient survival, with identifiable pre- and peri-transplant risk factors. These findings underscore the importance of targeted preventive measures, early detection, and effective management strategies to enhance outcomes for LT recipients.

Background: This investigation delves into the intricacies of graft-versus-host disease (GVHD) in the context of liver transplantation (LT), focusing on the experiences from a Korean single center. Despite GVHD’s relatively low incidence, its severe implications on patient mortality underscore the urgent need for advanced management and comprehension strategies. Methods: In a retrospective analysis at Severance Hospital, Korea, we reviewed 1,107 adult LT recipients from January 2009 to March 2023, excluding those who succumbed within 14 days post-transplantation, to scrutinize the manifestation, treatment, and outcomes of GVHD. Diagnostic approaches ranged from skin to colonoscopic biopsies, with interventions including high-dose corticosteroids and tailored immunosuppressive adjustments. Results: GVHD was diagnosed in 1.3% of the study cohort, predominantly identified through skin biopsies. Critical findings include the significant role of donor liver characteristics and recipient pre-transplant conditions in GVHD development. Notably, GVHD affected patients exhibited markedly lower survival rates at one year compared to their non-GVHD controls (21.4% vs. 90.2%, p<0.001), with deceased donor liver transplants and human leukocyte antigen one-way mismatches between donor and recipient identified as significant GVHD risk factors. Conclusion This study reaffirms the severe impact of GVHD on post-LT patient survival and highlights specific risk factors associated with its development. Enhanced understanding and targeted management of these risk factors are crucial for improving outcomes for LT recipients facing this complex complication.

Background: The use of small grafts, defined by a graft-to-recipient weight ratio (GRWR) less than 0.8, is possibly associated with an increased risk of graft loss in living donor liver transplantation (LDLT). This study aims to validate risk factors for graft loss in LDLT with GRWR<0.8 using single-center data. Methods: LDLT recipients, who received GRWR<0.8 graft at Severance Hospital, between July 2007 and December 2022, were categorized based on the number of risk factors identified in previous Korean multicentric study: recipient age ≥60 years, model for end-stage liver disease (MELD) score ≥15, and male donor. Baseline characteristics and graft survival were compared among these groups. Results: The median GRWR was 0.74 (interquartile range 0.69–0.78) and minimum was 0.49. Recipients with more risk factors exhibited lower graft survival rates: 100% at 5 years in the Risk 0 group (n=18), 72.7% in the Risk 1 group (n=20), and 54.5% in the Risk≥2 group (n=18, p=0.015). This trend was similar in subgroups of right lobe graft and the others (left lobe plus right posterior lobe), although not statistically significant. Donor age did not significantly affect graft survival in GRWR<0.8 transplants (78.9% for donor age≥45 vs. 69.2% for donor age<45, p=0.25). Conclusion This study confirms that the number of risk factors, including recipient age, MELD score, and donor sex, significantly impacts graft survival in LDLT with GRWR<0.8. These findings highlight the need for careful recipient and donor selection to improve outcomes in LDLT.

Background/Aims: We evaluated the role of next-generation sequencing (NGS)-based disease monitoring for elderly patients diagnosed with acute myeloid leukemia (AML) who received decitabine therapy. Methods: A total of 123 patients aged > 65 years with AML who received decitabine were eligible. We analyzed the dynamics of variant allele frequency (VAF) in 49 available follow-up samples after the fourth cycle of decitabine. The 58.6% VAF clearance (Δ, [VAF at diagnosis − VAF at follow-up] × 100 / VAF at diagnosis) was the optimal cut-off for predicting overall survival (OS). Results: The overall response rate was 34.1% (eight patients with complete remission [CR], six of CR with incomplete hematologic recovery, 22 with partial responses, and six with morphologic leukemia-free status). Responders (n = 42) had significantly better OS compared with non-responders (n = 42) (median, 15.3 months vs. 6.5 months; p < 0.001). Of the 49 patients available for follow-up targeted NGS analysis, 44 had trackable gene mutations. The median OS of patients with ΔVAF ≥ 58.6% (n=24) was significantly better than that of patients with ΔVAF < 58.6% (n = 19) (20.5 months vs. 9.8 months, p = 0.010). Moreover, responders with ΔVAF ≥ 58.6% (n = 20) had a significantly longer median OS compared with responders with VAF < 58.6% (n = 11) (22.5 months vs. 9.8 months, p = 0.004). Conclusions This study suggested that combining ΔVAF ≥ 58.6%, a molecular response, with morphologic and hematologic responses can more accurately predict OS in elderly AML patients after decitabine therapy.