Publications by authors named "David C H Kwon"

Liver transplant (LT) for colorectal cancer liver metastases (CRLM) is increasingly popular, yet the ideal selection criteria remain unknown. Pretransplant positron emission tomography (PET) metabolic tumor volume (MTV) has been described as predicting recurrence, with a proposed cutoff of MTV ≥70 cm 3 . This approach has not been validated.

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Article Synopsis
  • The study compares liver vein deprivation (LVD) and portal vein embolization (PVE) in patients preparing for liver surgery to determine their safety and effectiveness.
  • Results showed that LVD resulted in a significantly greater increase in future liver remnant volume (FLRV) and degree of hypertrophy compared to PVE, with no adverse events reported.
  • The conclusion suggests that LVD may be a safer and more effective option than PVE for promoting liver growth before surgery.
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Liver transplantation is known to generate significant inflammation in the entire organ based on the metabolic profile and the tissue's ability to recover from the ischemia-reperfusion injury (IRI). This cascade contributes to post-transplant complications, affecting both the synthetic liver function (immediate) and the scar development in the biliary tree. The new occurrence of biliary strictures, and the recurrence of malignant and benign liver diseases, such as cholangiocarcinoma (CCA) and primary sclerosing cholangitis (PSC), are direct consequences linked to this inflammation.

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Article Synopsis
  • - Primary liver cancers, particularly hepatocellular carcinoma and cholangiocarcinoma, pose significant health challenges and often have poor outcomes due to advanced disease at diagnosis.
  • - There's an urgent need for better diagnostic tools, treatments, and monitoring methods for these liver cancers, with liquid biopsy utilizing circulating tumor DNA (ctDNA) presenting a promising avenue for advancement.
  • - This review will explore the current research on ctDNA, its applications in liver malignancies, and potential future developments in this area.
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Secondary liver malignancies are a serious and challenging global health concern. Secondary metastasis to the liver is most commonly from colorectal cancer that has metastatically spread through splanchnic circulation. Metastatic diseases can portend poor prognosis due to the progressive nature typically found on detection.

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  • * Among the 2,596 patients analyzed, those receiving NAST had better results in terms of nodal harvest and lower rates of node positivity, but they did not experience improved overall survival (OS) after surgery compared to those who had immediate surgery.
  • * The findings suggest that while NAST may enhance the quality of oncologic resection, it does not provide a survival advantage, with node positivity and positive margins being significant risk factors for reduced OS.
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Background & Aims: Metabolic syndrome (MS) is a growing epidemic and a risk factor for the development of hepatocellular carcinoma (HCC). This study investigated the long-term outcomes of liver resection (LR) for HCC in patients with MS. Rates, timing, patterns, and treatment of recurrences were investigated, and cancer-specific survivals were assessed.

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Objective: Describe the utility of circulating tumor DNA in the postoperative surveillance of hepatocellular carcinoma (HCC).

Background: Current biomarkers for HCC like alpha-fetoprotein (AFP) are lacking. Circulating tumor DNA (ctDNA) has shown promise in colorectal and lung cancers, but its utility in HCC remains relatively unknown.

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We describe a novel pre-liver transplant (LT) approach in colorectal liver metastasis, allowing for improved monitoring of tumor biology and reduction of disease burden before committing a patient to transplantation. Patients undergoing LT for colorectal liver metastasis at Cleveland Clinic were included. The described protocol involves intensive locoregional therapy with systemic chemotherapy, aiming to reach minimal disease burden revealed by positron emission tomography scan and carcinoembryonic Ag.

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Article Synopsis
  • The study aimed to evaluate the costs and complications associated with liver transplantation (LT) utilizing normothermic machine perfusion (NMP) compared to static cold storage (SCS).
  • A total of 803 liver transplant recipients were analyzed, showing that NMP reduced complications like the need for relaparotomy and renal therapy, especially in donations after circulatory death (DCD).
  • Although NMP increased organ acquisition costs, it led to lower 90-day pretransplant costs due to shorter waiting times, resulting in comparable overall costs between NMP and SCS cohorts.
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Introduction: Circulating tumor DNA (ctDNA) is emerging as a promising, non-invasive diagnostic and surveillance biomarker in solid organ malignancy. However, its utility before and after liver transplant (LT) for patients with primary and secondary liver cancers is still underexplored.

Methods: Patients undergoing LT for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), and colorectal liver metastases (CRLM) with ctDNA testing were included.

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  • Colorectal cancer liver metastasis (CRLM) is common and significantly impacts patient outcomes, with liver resection being the preferred treatment for resectable cases; the safety of intraoperative autotransfusion during this procedure is debated.
  • This study analyzed data from 316 patients who underwent liver surgery for CRLM between 1999 and 2016, focusing on demographics, surgical variables, and survival rates, using propensity score matching to mitigate potential biases.
  • Results indicated that while the overall survival rates were similar regardless of autotransfusion, patients receiving autotransfusion experienced a significant reduction in recurrence-free survival, leading to concerns about its use in surgical treatment for CRLM.
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Colorectal cancer is the second most common cause of cancer-related death worldwide, and half of patients present with colorectal liver metastasis (CRLM). Liver transplant (LT) has emerged as a treatment modality for otherwise unresectable CRLM. Since the publication of the Lebeck-Lee systematic review in 2022, additional evidence has come to light supporting LT for CRLM in highly selected patients.

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Background: Immunotherapy has emerged as an improved systemic treatment for select patients with advanced unresectable HCC. Objective response is reported in 30% of patients, yet complete response (pCR) allowing for curative-intent resection is rare. Locoregional therapies (LRTs) seem to show synergistic effects with immunotherapy, though this effect has not been scientifically reported.

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Purpose: Liver metastases occur in about 50% of colorectal cancer cases and drive patient outcomes. Circulating tumor DNA (ctDNA) is emerging as a diagnostic, surveillance, and tumor mutational information tool.

Methods: Patients with colorectal cancer liver metastasis (CCLM) seen in a multidisciplinary liver tumor clinic from January to August 2022 received ctDNA testing on each visit.

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Introduction: Cirrhotic patients with primary liver cancer may undergo curative-intent resection when selected appropriately. Patients with T1 tumors and low-MELD are generally referred for resection. We aim to evaluate whether minimally invasive hepatectomy (MIH) is associated with improved outcomes versus open hepatectomy (OH).

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Introduction: Colorectal cancer is a leading cause of cancer-related death worldwide. Metastatic liver disease develops in 50% of cases and drives patient outcomes. Although the ideal treatment for colorectal cancer liver metastases (CRLM) is resection, only a third of patients are suitable for this approach.

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Background: The innovative pure laparoscopic living donor right hepatectomy (LLDRH) procedure for liver transplantation has never been fully compared to open living donor right hepatectomy (OLDRH). We aimed to compare the donor safety and graft results of pure LLDRH to those of OLDRH.

Methods: From May 2013 to July 2017, 288 consecutive donors underwent either OLDRH (n = 197) or pure LLDRH (n = 91).

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