Age of Extinction?

Dr Kenneth Siu Ho Chok

Consultant

Department of Surgery

The University of Hong Kong

In Hong Kong, about 8% of all liver transplants are done for diseases related to hepatitis C, which include decompensated liver cirrhosis and hepatocellular carcinoma. Treatment for hepatitis C before liver transplantation is notoriously difficult because the patients usually have poor liver function and thrombocytopenia. Moreover, the peg-interferon-based regimen, which is usually used in such treatment, has intolerable side effects. Reinfection of hepatitis C virus (HCV) is almost universal if the virus is not eradicated before reperfusion of the liver grafts.

 

Dr Alvin Young,
Council member, HKST.
(Chief of Service & NTEC Cluster Coordinator (O&VS), Department of Ophthalmology & Visual Sciences,
The Chinese University of Hong Kong).

Corneal transplantation has come a long way since the first successful human surgery performed more than 100 years ago in 1905. Over the past decade, advancements in microsurgical equipment and refinements in grafting techniques have led to the development of novel forms of anterior and posterior (endothelial) lamellar keratoplasty, replacing only the diseased tissue instead of the entire thickness of the cornea ( Hong Kong Med J. 2012 Dec;18(6):509-16 ). The number of lamellar (LK) procedures performed in HK has been steadily growing from 25 cases in 2008 to 77 cases in 2012. Unfortunately, the number of cornea harvested and subsequently distributed for transplant in 2002 was 281, and in 2012 was only 255, reflecting the local problem of poor organ donation rates.

The common indications of anterior transplant would include non full thickness corneal scars, dystrophy and or keratoconus. On the other hand, for posterior or endothelial keratoplasty, the main indications would be primary endothelial failure related to dystrophy, or secondary to prior trauma (including surgery and or laser) and or inflammation.

The big surge in LK is mainly related to the growth in numbers of endothelial keratoplasty (EK) performed. The current hot issue on EK is whether one should transplant only an extremely thin donor tissue (DMEK), with the potential to offer better visual acuity and even less chance of rejection ( Ophthalmology. 2012 Mar;119(3):536-40. doi: 10.1016/j.ophtha.2011.09.019 ). However, there is a relative high tissue wastage rate that must be considered, especially in the local context of graft scarcity. ( Clin Experiment Ophthalmol. 2008 Nov;36(8):707-8. doi: 10.1111/j.1442-9071.2008.01883.x. )

The eye donor selection criteria of the HA Eyebank has been updated and aligned with international standards since Feb 2013. The main difference is the inclusion of deceased cancer patients as eligible CORNEAL donors, provided that they did not have lymphoma, leukaemia, myeloma and malignant tumours of ocular or peri-ocular area. This may help to alleviate the shortage of cornea for HK.

(I wish to thank Ms Catherine Wong and eye bank staff in their kind assistance of local data)

Dr Cheng Lik Cheung

Heart transplantation beyond 2011- continuous evolution and new challenges in Hong Kong

The first heart transplantation was performed by Professor CK MOK in December, 1992. Up to May 2011, a total of 113 patients underwent heart transplantation in Hong Kong. There were 89 men with a mean age of 43.8±12.5 years. The cumulative 1 year survival rate is 92%. In Hong Kong the two leading causes for end-stage heart failure required heart transplantation are dilated cardiomyopathy and valvular heart disease. In contrast to developed countries, ischaemic heart disease is third on the list. Due to limited organ availability, donor and recipient selections are being continuously reviewed and updated so as to encourage better utilization of donor heart that may go unused. Criteria for heart donors were revised in 1997 to include those up to the age of 60 years and marginal donors who have had previous cardiopulmonary resuscitations or high-dose inotropic therapy, provided that transthoracic echocardiograms performed by cardiologists are satisfactory. No significant coronary artery disease must be demonstrated on coronary angiogram for those donors over 45 years old and with known risk factors for ischemic heart disease. Since 2008, the recipient’s criteria were extended to include patients up to 65 years old and those who were chronic Hepatitis B carrier (low infectivity and without evidence of liver injury).

 

Dr. CF Wong

 

Introduction

Since the first successful clinical lung transplant in the early 80’s, this procedure has evolved greatly over the past 2 decades and now it has been a well-accepted therapeutic intervention for patients with advanced pulmonary or pulmonary vascular diseases. Over the past years, there has been an increase in the number of transplants performed worldwide and the improvement in outcome was evident. From the registry of International Society of Heart and Lung Transplantation ( ISHLT ), there have been over 20,000 lung transplants performed worldwide and about 2,000 cases done annually.