Korea has become one of the leading liver transplantation countries in the world in terms of case number and outcome. A multi-institutional clinical study on liver transplantation conducted in Korea reported a 3-year survival rate of 91.4% in liver cancer patients treated.
Liver transplantation has become one of the most effective treatments for unresectable early hepatocellular carcinomas (HCCs) in patients with cirrhosis. Theoretically, it is one of the best curative treatments for HCC patients in that it replaces the patient’s whole liver with part or whole of the donor’s healthy liver, thus helping not only get rid of all the tumors in his liver but cure the underlying cirrhosis that is responsible for both hepatic functional deterioration and any other tumor developed after partial hepatectomy is done. Additionally, it allows the most accurate pathologic staging since the histologic examination of the entire liver explant is possible.
There are two types of liver transplantations according to the donor’s status: living donor liver transplantation (LDLT), deceased donor liver transplantation (DDLT). LDLT is becoming a more common procedure as an alternative to DDLT because it is very hard to find the livers from the deceased donors.
With the improvement of operative techniques, orthotopic liver transplantation (OLT) can be extended to hepatitis B virus (HBV) patients with good liver function and early HCC. OLT reduces the recurrence rate because HBV, major carcinogen, can be cured by OLT.
About two decades have passed since Korea celebrated its first successful liver transplantation in 1988. Over the past decade, the number of LDLT has risen sharply, replacing DDLT as a main liver transplantation procedure. Last year, 619 LDLTs were performed in Korea. Korea has become one of the leading liver transplantation countries in the world in terms of case number and outcome.
A multi-institutional clinical study on liver transplantation conducted in Korea reported a 3-year survival rate of 91.4% in liver cancer patients treated with LDLT who fulfilled the Milan criteria (single tumor ï‚£ 5 cm in diameter, or two to three tumors ï‚£ 3 cm in diameter) and a 3-year survival rate of 62.6% in the patients who exceeded the Milan criteria. The operation mortality currently stands at about 5% in Korea.
Created as a government-funded comprehensive organization devoted to cancer research and care in 2001, the National Cancer Center (NCC) in Korea currently performs more than 100 cases of hepatic resection for HCC patients annually. It introduced the LDLT program as one of the main treatment modalities for HCC in 2005. There were 26 cases of LDLT conducted at NCC in the first trimester, 2008, more than 70% of which were HCC patients, higher by 40% than other institutions in Korea.
There has been no liver transplantation related death in the HCC recipients and donors so far. Recently, the NCC’s liver transplantation team has developed many new techniques to improve the recipients’ survival by developing minimal anhepatic techniques that was designed to reduce harmful anhepatic time. They also have developed minimal upper midline incision techniques without laparoscopic assistance for donor hepatectomy, in an effort to reduce the length of skin incision in half, thus improving the donors‘quality of life.
Dr. Kwang-Woong Lee, MD, PhD with specialty in liver transplantation and hepatic surgery has several years of experience at the Samsung Medical Hospital as a transplant surgeon and two years of experience at the Johns Hopkins Univ., Baltimore, USA as a Living donor liver transplantation (LDLT) consultant. He also had been a consultant for LDLT program at Dar Al Fouad Hospital, Egypt. Dr. Lee is currently at the Center for Liver Cancer, National Cancer Center, Korea. He has been involved more than 400 cases of liver transplantation. He also has performed the first successful hepatocytes transplantation in Korea.