[Click! Health] The Last Hope for a Damaged Liver: 'Liver Transplant'... When and How

Liver transplantation has been gradually increasing since 1994, when living-donor liver transplantation, involving the transplantation of a portion of another person's liver, became possible. Liver transplantation is also called the last recovery method for a damaged liver. We spoke with Professor Shin Hyunpil of the Department of Gastroenterology and Professor Lee Seunghwan of the Department of Gastrointestinal Surgery at Kangdong Kyung Hee University Hospital to learn about when and how liver transplantation is performed.

From the left, Hyunpil Shin, Professor of Gastroenterology at Kangdong Kyung Hee University Hospital, and Seunghwan Lee, Professor of Gastrointestinal Surgery.

Liver transplantation is performed when liver damage progresses rapidly and death can occur within days to weeks without transplantation. Representative cases include acute liver failure causing hepatic encephalopathy with decreased consciousness, hepatorenal syndrome where kidney function cannot be maintained, bleeding from the esophagus or stomach, and complications such as ascites. Another case is when chronic liver disease does not improve despite treatment, or when complications from liver failure make management impossible.

Professor Shin Hyunpil stated, “Among chronic liver disease patients, those with significantly decreased liver function who are diagnosed with relatively early-stage liver cancer receive liver transplantation. In the case of liver cancer, if there is no extrahepatic metastasis and it is early-stage, surgery should be performed to lower the recurrence rate of liver cancer, so if transplantation surgery is possible, it is better to proceed promptly.”

Recent advances in surgery have reported a 3-year survival rate of over 80%. Professor Lee Seunghwan explained, “If the surgery is successful, it is not just about living a few more years but being able to live a healthy life for a lifetime,” adding, “As experience has increased, the range of patients eligible for liver transplantation has gradually expanded, and surgeries for patients over 60 years old, which were previously avoided, now have higher success rates, increasing interest in liver transplantation.”

The liver can be received by two methods. One method is to remove the entire liver from a brain-dead donor and transplant it, with priority determined according to urgency. The other method is to transplant a portion of the liver from a healthy donor.

Because it is a difficult surgery involving connecting many blood vessels, complications can occur after liver transplantation. The new liver may not function well, or may fail to produce adequate blood coagulation factors, leading to intra-abdominal bleeding. Complications may resolve naturally over time, require additional treatment, or necessitate re-transplantation with a new liver.

Since donors in liver transplantation are originally healthy individuals, the safety of the donor is of utmost importance. In Korea, living-donor liver transplantation, where family members or relatives donate part of their liver, is active. Liver donors are patients under 60 years old without accompanying chronic liver disease, with a remaining liver volume of at least 30% after donation, and with less than 30% fatty liver. Although overseas mortality rates are about 2 to 5 per 1,000 donors, donor deaths during transplantation surgery in Korea occur less frequently than this.