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Chung-Mau Lo

Publications and source records attributed to Chung-Mau Lo.

At least 19 recordsLinked to original sources
PubMed2005

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation.

AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) <5 cm in diameter eligible for radiofrequency ablation (RFA). METHODS: The treatment-related mortality, morbidity, long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated. RESULTS: Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high alpha-fetoprotein level (AFP) and the size of the largest tumor >3 cm in diameter were adverse prognostic factors in multivariate analysis. CONCLUSION: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.

Aged↗
PubMed2005

Macrophage migration inhibitory factor expression correlates with inflammatory changes in human chronic hepatitis B infection.

BACKGROUND: Macrophage migration inhibitory factor (MIF) has emerged to be a pivotal cytokine in immune-mediated diseases. PATIENTS AND METHODS: To investigate the role of MIF in chronic hepatitis B infection, we studied two groups of hepatitis B surface antigen positive patients: group 1 (immune tolerant, n = 16) and group 2 (immune clearance, n = 16). Serum level of MIF was measured by enzyme-linked immunosorbent assay and intrahepatic expression of MIF, macrophage and T-cell localisation were detected by double immunohistochemistry. RESULTS: An increased serum MIF correlated significantly with increased serum alanine aminotransferase activity (r = 0.73, P < 0.001) and the severity of necroinflammatory injury (r = 0.642, P < 0.001). In group 2, there was marked MIF mRNA expression in all KP-1+ macrophages and CD45RO+ activated T cells and, to a lesser extent, in hepatocytes within inflammatory areas. In contrast to its mRNA expression, the cytoplasmic MIF protein level in hepatocytes, infiltrating macrophages and T cells within the inflammatory area was reduced, which probably contributed to the increased serum MIF level. CONCLUSIONS: Our data suggested that MIF played a role in sustaining cell-mediated hepatic injury during the immune-clearance phase of chronic hepatitis B infection.

Adult↗
PubMed2005

Versatility and viability of hepatic venoplasty in live donor liver transplantation using the right lobe with the middle hepatic vein.

Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile, and able to cope with variation of the configurations of the hepatic vein.

Adult↗
PubMed2004

Safety of duct-to-duct biliary reconstruction in right-lobe live-donor liver transplantation without biliary drainage.

BACKGROUND: Duct-to-duct biliary reconstruction is frequently used in right-lobe live-donor liver transplantation (RLDLT), and routine biliary drainage has been recommended. The aim of the present study was to evaluate the safety and operative outcomes of duct-to-duct biliary reconstruction after RLDLT without biliary drainage. METHODS: The study comprised 41 RLDLT recipients who had duct-to-duct biliary reconstruction. During donor and recipient operations, precautions were taken to preserve blood supply to the bile duct. Biliary anastomosis was performed with fine Prolene sutures without stents or drainage tubes. The operative outcomes were prospectively evaluated. RESULTS: The median postoperative intensive care unit and hospital stay were 3 days (range, 1-47 days) and 19 days (range, 8-114 days), respectively. There was no hospital mortality. At a median follow-up of 13.3 months (range, 4.0-26.8 months), the graft and patient survival rates were 95% and 98%, respectively. Three (7%) patients had biliary leakage. These three patients and the other seven patients developed late biliary stricture. The overall biliary complication rate was 24%. On multivariate analysis, preoperative Model for End-Stage Liver Disease (MELD) score of greater than or equal to 35 was the risk factor associated with biliary complication (P =0.032; risk ratio, 4.58). CONCLUSIONS: Duct-to-duct anastomosis without biliary drainage is safe in RLDLT. Patients with a high preoperative MELD score were associated with an increased incidence of biliary complications. Further studies are required to investigate the hemodynamic changes and modulation of blood flow of liver grafts in patients with chronic liver disease, which may significantly affect the incidence of biliary complications.

Adolescent↗
PubMed2004

Impact of preoperative fine-needle aspiration cytologic examination on clinical outcome in patients with hepatocellular carcinoma in a tertiary referral center.

HYPOTHESIS: Preoperative fine-needle aspiration cytologic examination (FNAC) exerts a statistically significant adverse effect on long-term clinical outcome in patients with hepatocellular carcinoma (HCC). DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: A total of 828 patients with clinical suggestion of HCC received surgical treatment. Ninety-one patients underwent preoperative FNAC, suggesting HCC, and 737 patients did not. MAIN OUTCOME MEASURES: The resectability and histologic diagnoses of liver masses were evaluated in patients with and without preoperative FNAC. Clinicopathologic data and operative and survival outcomes of patients who underwent curative hepatic resection for HCC were compared between the FNAC and non-FNAC groups. RESULTS: The resectability rates of the FNAC (81.3%) and non-FNAC (81.8%) groups did not differ (P =.91). Histologic examination of tumor confirmed HCC in 766 patients. The positive predictive value of preoperative FNAC was 96%, whereas that of preoperative imaging studies was 92% (P =.23). Among patients with nondiagnostic serum alpha-fetoprotein concentrations (< or =400 ng/mL), 3% in the FNAC group (n = 66) had benign liver diseases vs 9.5% in the non-FNAC group (n = 432) (P =.09). Among patients with curative hepatic resection (70 in the FNAC group and 545 in the non-FNAC group), hospital mortality was 4% and 6% in the FNAC and non-FNAC groups, respectively. In the FNAC group, needle tract tumor seeding was not encountered. Excluding patients with preexisting and iatrogenic tumor rupture, intraperitoneal extrahepatic metastasis occurred in 1 patient (2%) in the FNAC group and in 30 (6%) in the non-FNAC group (P =.34). The cumulative 1-, 3-, and 5-year overall survival rates were 79%, 61%, and 48%, respectively, for the FNAC group and 75%, 55%, and 43% for the non-FNAC group (P =.77). The disease-free survival results of the groups were similar (P =.51). CONCLUSIONS: Preoperative FNAC has no statistically significant adverse effect on the operability, the possibility of extrahepatic tumor spread, or the long-term survival of patients with HCC. Preoperative FNAC may play a diagnostic role in selected patients with liver nodules on imaging studies when the serum alpha-fetoprotein concentration is not diagnostic.

Adult↗
PubMed2004

Microvascular reconstruction of the hepatic artery in live donor liver transplantation: experience across a decade.

HYPOTHESIS: Hepatic arterial anastomosis by means of a microvascular technique can be performed with a high success rate in live donor liver transplantation in adult recipients. DESIGN: Retrospective analysis of data collected prospectively. SETTING: Tertiary referral center. PATIENTS: From September 28, 1993, through December 23, 2002, 28 children received left lateral segment grafts (n = 23) or left lobe grafts (n = 5), and 124 adults received left lobe (n = 6) or right lobe (n = 118) grafts. Microvascular technique was used for hepatic arterial anastomosis. Attention was paid to exposure, orientation of the axis of arterial ends, and matching of size. Long microinstruments were used for arterial ends deeply located inside an adult's abdominal cavity. An average of 16 stitches was used for a vessel anastomosis 3 mm in diameter. INTERVENTIONS: Intraoperative and postoperative Doppler ultrasonography were performed. MAIN OUTCOME MEASURES: Hepatic artery thrombosis rate. RESULTS: All hepatic arterial anastomoses were patent after reconstruction. Complications occurred in 3 patients. They had hepatic arterial thrombosis at 19 days, 25 days, and 3 months after liver transplantation. The overall complication rate was 2%. CONCLUSION: With attention to exposure, appropriate instruments, and experience, a low complication rate of 2% can be achieved in hepatic arterial anastomosis by using a microvascular technique, even in adult patients with the liver graft situated deeply in the abdominal cavity.

Adolescent↗
PubMed2004

De novo sarcoma of donor origin in a liver allograft determined by microsatellite analysis: a short report.

This case report describes a patient who underwent liver transplantation for HBV cirrhosis for hepatocellular carcinoma [corrected]. At 3.5 years post transplant, 6 cm tumor was found with CT scanning. With microsatellite analysis it was determined that the tumor was of donor origin. The patient underwent successful right hepatectomy of the tumor that proved to be sarcoma. The patient is doing well without recurrence 1.5 years after resection and 5 years post transplant.

Humans↗
PubMed2004

The role and limitation of living donor liver transplantation for hepatocellular carcinoma.

Liver transplantation for hepatocellular carcinoma (HCC) is restricted by the scarcity of cadaver grafts. Living donor liver transplantation (LDLT) may potentially increase the applicability but its role and limitation are not clear. We studied the outcome of a cohort of 51 patients with unresectable HCC who were accepted on list for both options of deceased donor liver transplantation (DDLT) and LDLT. Twenty-five of 51 (49%) patients had voluntary living donors (group 1) and 26 did not (group 2). Patients in group 1 were younger, and more often had a MELD score more than 20 or blood group other than O. Twenty-one patients of group 1 underwent LDLT after a median waiting time of 24 days (range, 2-126 days), but 4 did not because the donors were not suitable (HBsAg-positive, 2; ABO-incompatible, 1; liver dysfunction, 1). Of the 30 patients who remained on list, only 6 underwent DDLT after a median waiting time of 344 days (range, 22-1359 days, P <.005). Nineteen died before transplantation and 2 were alive but taken off the list because of disease progression (drop-out rate, 70%). One patient was alive on list and 2 had undergone transplantation outside Hong Kong. The 1-, 2-, 3-, and 4-year intention-to-treat survival rates were 88%, 76%, 66%, and 66%, respectively, for group 1 and 72%, 46%, 38%, and 31%, respectively, for group 2 (relative risk of death for group 1, 0.35; 95% CI, 0.14 to 0.90; P =.029). In conclusion, although complicated factors such as donor voluntarism and selection criteria limit the role of LDLT for HCC, LDLT allows more patients to undergo early transplantation and results in a better outcome.

Adolescent↗
PubMed2004

Fibrosing cholestatic hepatitis secondary to precore/core promoter hepatitis B variant with lamivudine resistance: successful retransplantation with combination adefovir dipivoxil and hepatitis B immunoglobulin.

Fibrosing cholestatic hepatitis (FCH) is a peculiar variant of hepatitis B virus (HBV) infection in immunocompromised patients characterized by rapid viral replication. Posttransplant patients receiving lamivudine for prophylaxis or treatment of HBV infection may develop drug resistance due to viral mutants, but FCH is rare because escape mutants are usually replication deficient. We report the development of FCH due to lamivudine-resistant HBV mutants in 2 patients at 12 and 13 months after liver transplantation. Rapidly progressive graft failure, accompanied by an escalating HBV DNA level, developed within weeks of onset. Analysis of gene sequence variation by polymerase chain reaction (PCR) and direct sequencing showed that both had a core promoter variant A1762T/G1764A and 1 had a concomitant precore stop codon G1896A variant in prelamivudine and postrecurrence serum samples. Comparison of the HBV polymerase gene in the 2 serum samples revealed a single mutation with methionine-to-isoleucine substitution at codon 552 (M552I) in both patients. "Add-in" treatment with adefovir dipivoxil resulted in a more than 2 to 3log10 reduction in HBV DNA level within 2 weeks and retransplantation was performed with adefovir dipivoxil and hepatitis B immunoglobulin (HBIG) prophylaxis. Both patients were alive at 15 months and 48 months after retransplantation, with normal graft function and serum negative for HBsAg and HBV DNA by quantitative PCR (< 200 copies/mL). The current report demonstrates that recurrent graft infection by precore/core promoter variant with lamivudine-resistant escape mutation may result in FCH. With combination of adefovir and high-dose HBIG, however, long-term survival can be achieved after retransplantation.

Adenine↗
PubMed2004

Randomized comparison of piperacillin/tazobactam versus imipenem/cilastatin in the treatment of patients with intra-abdominal infection.

OBJECTIVES: Treatment of intra-abdominal infections remains a challenge because of their polymicrobial nature and associated mortality risk. Broad-spectrum empiric coverage is usually required. This randomized study compared the efficacy and safety of intravenous piperacillin/tazobactam with those of intravenous imipenem/cilastatin in the treatment of 293 hospitalized patients with intra-abdominal infection. METHODS: A total of 149 patients received piperacillin/tazobactam 4 g/500 mg every 8 hours, and 144 patients received imipenem/cilastatin 500 mg/500 mg every 6 hours. Efficacy was evaluated by clinical and bacteriological response. Safety was evaluated by analysis of adverse events and physical and laboratory examinations. RESULTS: Clinical and bacteriological responses in both evaluable treatment groups were equivalent. The clinical success was 97% (108/111) for piperacillin/tazobactam and 97% (100/103) for imipenem/cilastatin. Bacteriological success was 97% (67/69) for piperacillin/tazobactam and 95% (61/64) for imipenem/cilastatin. The most common pathogens were Escherichia coli, Klebsiella pneumoniae, Enterobacter species and Pseudomonas aeruginosa. The frequencies of treatment-related adverse events were similar (16 with piperacillin/tazobactam and 19 with imipenem/cilastatin). CONCLUSIONS: These results suggest that the safety and efficacy of piperacillin/tazobactam administered every 8 hours are equivalent to those of imipenem/cilastatin administered every 6 hours for the treatment of intra-abdominal infections.

Abdominal Abscess↗
PubMed2004

Internal hernia of the small bowel after right-lobe live donor liver transplantation.

Internal hernia of small bowel is an uncommon but potentially fatal complication of liver transplantation. We report on four patients in whom internal hernia of small bowel occurred after right-lobe live donor liver transplantation (LDLT). Three patients had small bowel herniation with volvulus around the Roux-en-Y loop whereas the other patient had herniation through the mesenteric window of transverse mesocolon after hepaticojejunostomy for biliary reconstruction. Based on clinical and radiologic findings, early diagnosis was made in all cases. All patients survived following surgical reduction of the hernia and closure of the mesenteric defect without bowel resection. Transplant surgeons should be aware of this serious complication so that early diagnosis and appropriate operative intervention can be made. The complication can be avoided with duct-to-duct biliary reconstruction or meticulous closure of all mesenteric defects with non-absorbable suture materials after hepaticojejunostomy in patients undergoing right-lobe LDLT.

Adult↗
PubMed2004

Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.

OBJECTIVE: The aim of this study was to determine whether abdominal drainage is beneficial after elective hepatic resection in patients with underlying chronic liver diseases. SUMMARY BACKGROUND DATA: Traditionally, in patients with chronic liver diseases, an abdominal drainage catheter is routinely inserted after hepatic resection to drain ascitic fluid and to detect postoperative hemorrhage and bile leakage. However, the benefits of this surgical practice have not been evaluated prospectively. PATIENTS AND METHODS: Between January 1999 and March 2002, 104 patients who had underlying chronic liver diseases were prospectively randomized to have either closed suction abdominal drainage (drainage group, n = 52) or no drainage (nondrainage group, n = 52) after elective hepatic resection. The operative outcomes of the 2 groups of patients were compared. RESULTS: Fifty-seven (55%) patients had major hepatic resection with resection of 3 Coiunaud's segments or more. Sixty-nine (66%) patients had liver cirrhosis and 35 (34%) had chronic hepatitis. Demographic, surgical, and pathologic details were similar between both groups. The primary indication for hepatic resection was hepatocellular carcinoma (n = 100, 96%). There was no difference in hospital mortality between the 2 groups of patients (drainage group, 6% vs. nondrainage group, 2%; P = 0.618). However, there was a significantly higher overall operative morbidity in the drainage group (73% vs. 38%, P < 0.001). This was related to a significantly higher incidence of wound complications in the drainage group compared with the nondrainage group (62% vs. 21%, P < 0.001). In addition, a trend toward a higher incidence of septic complications in the drainage group was observed (33% vs. 17%, P = 0.07). The mean (+/- standard error of mean) postoperative hospital stay of the drainage group was 19.0 +/- 2.2 days, which was significantly longer than that of the nondrainage group (12.5 +/- 1.1 days, P = 0.005). With a median follow-up of 15 months, none of the 51 patients with hepatocellular carcinoma in the drainage group developed metastasis at the drain sites. On multivariate analysis, abdominal drainage, underlying liver cirrhosis, major hepatic resection, and intraoperative blood loss of >1.5L were independent and significant factors associated with postoperative morbidity. CONCLUSION: Routine abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.

Abdomen↗
PubMed2004

Lessons learned from one hundred right lobe living donor liver transplants.

OBJECTIVE: To evaluate the first 100 adult right lobe living donor liver transplants (LDLT) in a single center to determine whether the results have improved with technical modifications and better experience. SUMMARY BACKGROUND DATA: Right lobe LDLT has been increasingly performed for adults with end-stage liver disease. Numerous modifications in technique have been introduced, and a learning curve is likely in view of its complexity. METHODS: One hundred consecutive adult right lobe LDLTs performed between May 1996 and May 2002 were retrospectively studied by comparing the first 50 (group 1) with the last 50 cases (group 2). The median follow-up was 37 (27 to 79) months for group 1 and 15 (7 to 27) months for group 2. RESULTS: The characteristics of donors and liver grafts were similar. In group 2, fewer recipients were intensive care unit (ICU)-bound or had hepatorenal syndrome before transplantation, and there was a lower disease severity as shown by a lower Child-Pugh score and Model for End-Stage Liver Disease (MELD) score. Significant improvements were found in the operation time, blood loss, ICU stay, and postoperative complication rate of the donors and in the operation time, transfusion requirements, number of reoperations, ICU stay, and hospital stay of the recipients in group 2. The hospital mortality rate of recipients was reduced from 16% to 0% (P = 0.006). Graft survival rates at 12 months and 24 months were improved from 80% and 74%, respectively, in group 1 to 100% and 96%, respectively, in group 2 (P = 0.002). After adjusting for differences in recipient risk factors (ICU-bound, hepatorenal syndrome, Child-Pugh score, and MELD score) in a multivariate Cox model, recipients in group 2 had significantly lower risk of graft loss (relative risk compared with group 1, 0.13; 95% CI, 0.03 to 0.66; P = 0.014). CONCLUSIONS: There is a learning curve in adult right lobe LDLT. The results have significantly improved with technical refinement and better experience.

Adult↗
PubMed2004

Disruption of p53-p21/WAF1 cell cycle pathway contributes to progression and worse clinical outcome of hepatocellular carcinoma.

p53-p21/WAF1 cell cycle pathway plays an important role in growth control, and the inappropriate deregulation of this pathway has been implicated in carcinogenesis. Although the role of p53 in hepatocellular carcinoma (HCC) has been suggested, its exact molecular mechanism in relation to its down-stream gene p21/WAF1 remains unclear. To investigate the relationship between the expression of p53 and p21/WAF1 and the possible roles of the 2 proteins in HCC, we examined the intracellular expression of p53, p21/WAF1 and PCNA immunohistochemically, together with apoptosis by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling assay in 35 clinical tissue specimens. The correlation between the clinicopathologic parameters and the intracellular gene expression were analyzed. The results showed that p53 over-expression is a reliable marker for mutational modulation of p53 function. p53 was negatively correlated with p21/WAF1 in hepatitis B virus-related HCC (p=0.024, r=-0.432). Patients with a high p53 expression had a significantly higher Edmondson grading (12/21 vs 13/14, p=0.024) and larger tumor size (10 vs 6 cm, p=0.029). Patients with higher p53 expression had shorter disease-free survival (4 vs 19 months, p=0.0131) and overall survival (11 vs 42 months, p=0.0031). Intracellular expression of p21/WAF1 was positively correlated to proliferating cell nuclear antigen (p=0.001, r=0.776) and apoptosis (p=0.003, r=0.639). Our findings suggest that disruption of p53-p21/WAF1 cell cycle pathways contributes to tumor progression and worse clinical outcome of HCC.

Carcinoma, Hepatocellular↗
PubMed2004

Rapid onset Chilaiditi's sign on top of fulminant hepatic failure.

Fulminant hepatic failure is a medical emergency. When this condition declared itself irreversible, a timely liver transplantation is the only effective treatment. A 34-year-old Chinese with fulminant hepatic failure was evaluated as a potential liver transplantation candidate. On the erect chest radiograph, Chilaiditi's sign has developed over a very short period of a week due to rapid shrinkage of the liver. Awareness of Chilaiditi's sign facilitated distinguishing the condition of free gas under the diaphragm due to bowel perforation and subphrenic abscess by gas forming micro-organisms. Rapidity of onset of this sign parallels the deterioration of liver function and reflects the urgency of condition.

Adult↗
PubMed2003

Live-donor liver transplantation for acute-on-chronic hepatitis B liver failure.

BACKGROUND: The survival results of patients demonstrating acute-on-chronic liver failure and undergoing live-donor liver transplantation (LDLT) have been reported to be poor. This study evaluates the survival outcomes of patients who underwent LDLT using right-lobe liver grafts for acute-on-chronic hepatitis B liver failure. METHODS: The study comprised 32 patients who demonstrated acute-on-chronic hepatitis B liver failure with mean (+/- standard error of mean) Model for End-Stage Liver Disease scores of 36+/-1.8. The mean preoperative intensive care unit stay was 2.4 days. LDLT using a right-lobe liver graft including the middle hepatic vein was performed in all patients. Oral lamivudine 100 mg daily was used for hepatitis B prophylaxis. RESULTS: The patients received liver grafts that were 52%+/-2% of the estimated standard liver weight. Hospital mortality occurred in two patients, and two other patients died on follow-up. At a median follow-up of 23 months, both patient and graft survival rates were 88%. The survival results were not different from those of 49 patients who underwent right-lobe LDLT for elective conditions during the same study period (graft survival=82%, P=0.55; patient survival=84%, P=0.75). Two (6.3%) patients developed hepatitis B virus DNA breakthrough 47 and 53 months, respectively, after transplantation, but they remained well after treatment with adefovir. CONCLUSION: Right-lobe LDLT is an effective therapeutic option for patients with acute-on-chronic hepatitis B liver failure. It results in satisfactory survival outcomes comparable to those in patients undergoing LDLT for elective conditions.

Acute Disease↗