Liver transplantation

The liver is a vital organ for maintaining life. Its functions are so diverse and complex that there is no artificial device that can replace it. Therefore, the only way to treat patients with end-stage liver diseases is liver transplantation. Liver transplantation is a surgical procedure that removes the afflicted liver and replaces it with a healthy one. Liver transplantation first began in the United States in 1963, followed by Korea in 1988, and by AMC in 1992. AMC had succeeded the first pediatric living donor liver transplantation in 1994, and the first adult living donor partial liver transplantation in 1997. Since then, AMC has been actively performing liver transplantations.

Why should you receive organ transplantation in AMC?

Organ transplantation is an operation that replaces the affected organ of a terminally ill patient with a healthy organ of a brain-dead or a living person. Transplantation is performed on a patient who cannot be treated with conventional therapies due to intractable diseases. Transplantation of organs including the solid organs such as the kidney, liver, pancreas, heart, and lungs as well as the tissues such as the cornea, bone marrow, bones, blood vessels, cartilage, amnions, fasciae, and heart valves are possible. After the first successful kidney transplantation in 1969, transplantation of the kidney, cornea, and bone marrow has been performed. Thereafter, the first deceased donor liver transplantation (DDLT) in 1988 was succeeded by the pancreatic and heart transplantations in 1992 and the lung transplantation in 1996.

AMC’s Liver Transplantation Center laid the foundation stone for DDLTs in Korea and paved the way for raising awareness for brain dead organ donation and transplantation. In May 1992, the center began with the first deceased donor multi-organ transplantation. The center had received global attention as it was the first to perform living donor liver transplantation using a modified right lobe graft in 1999, a dual living donor liver transplantation in 2000, and exchange liver transplantation in 2003. Furthermore, a steady stream of overseas medical professionals from prestigious transplantation centers around the world has been visiting AMC for training.

AMC’s Liver Transplantation Center, with disregard to the number of surgeries, has strengthened its outstanding position in treatment outcomes and survival rates for each type of organ transplantation; all the meanwhile, strengthening its efforts in continuous research and experiments and advanced training programs. The center will strive to concentrate on treatment, research, and training to achieve increased survival rates and better treatment outcomes.

Recipient

Adult patients with end-stage liver diseases such as liver cirrhosis, liver cancer and acute fulminant hepatic failures and pediatric patients with congenital liver cirrhosis, biliary atresia, and metabolic liver diseases are all indications for liver transplantation. Whether or not recipients are good candidates for liver transplantation is determined by examining and analyzing each patient’s medical condition and characteristics.

Donor

The liver is an organ that can be transplanted in part or in whole. Patients can receive a portion of the liver from family members or a whole liver from brain dead patients. The donor’s remaining liver regenerates, allowing for the donor to lead a normal healthy life without risks. A donor and recipient must be of similar build and should have compatible blood types, and possibility for donation is determined after thorough examinations. A donor whose liver functions are normal and healthy is qualified as a donor candidate as long as the liver is without illness, infection, and cancer. If the blood type of the donor and the recipient is incompatible, preoperative therapeutic plasma exchange may be done.

Transplant procedure

1) Living donor transplantation (partial transplantation)

Recipient examinations (General Surgery or Pediatric Department Outpatient Clinic)
Donor examinations (General Surgery Department Outpatient Clinic - check results and stay overnight in the hospital for additional testing)
Check if transplant is possible and hospitalize
Hospitalize and perform a thorough examination(transplant cancelled if there are abnormal results)
Review the results and perform liver transplantation

2) Care after transplantation

Patients will stay in the hospital for around three to five weeks after liver transplantation and will have regular outpatient visits after discharge. To prevent complications of organ transplantation, all patients must take an immunosuppressant drug every day. Also, patients who had hepatitis B before liver transplantation regular injections of hepatitis B antibodies will be given to prevent hepatitis B relapse after surgery.

AMC's treatment performance

AMC’s Liver Transplantation Center laid the foundation stone for DDLTs in Korea and paved the way for raising awareness for brain dead organ donation and transplantation. In May 1992, the center completed the first deceased donor multi-organ transplantation. In July 1992, the Center succeeded Korea’s first simultaneous pancreas-kidney transplantation. Then in August 1992, it completed the first liver transplantation and then the first heart transplantation in November. Ultimately, it took a lead in the field of deceased donor organ transplantation.

Moreover, the center performed Korea’s first living donor partial liver transplantation in 1994, the first simultaneous liver-kidney transplantation in 1999, the first adult-to-adult split-liver transplantation in 2003, the first simultaneous heart-kidney transplantation in 2005, and the first living donor simultaneous kidney-pancreas partial transplantation in 2006. It also performed the first simultaneous liver-heart transplantation in 2007, the first simultaneous seven-organ multi visceral transplantation in 2011, the first simultaneous liver-lung transplantation in 2012, and the first simultaneous liver-heart-lung transplantation in 2015. Such performance has contributed greatly to enhancing Korea’s overall medical skills and expertise in organ transplantation. Not only that but also, the center had received global attention as it was the first to perform living donor liver transplantation using a modified right lobe graft in 1999, a dual living donor liver transplantation in 2000, and exchange liver transplantation in 2003.

Thanks to recent corneal transplantation, bone marrow transplantation, and tissue transplantation, many patients have been given new hope. Every transplantation team at the center makes continuous efforts in attaining remarkable achievements. Through their efforts, achievements such as the 5,000 liver transplantations by May 2016, the 600 heart transplantations by August 2016, the 4,000 kidney transplantations by February 2015, and the 300 pancreas transplantations by July 2015 were possible.

AMC liver transplantation team performs the first dual-graft living donor liver transplantation (LDLT) in Kazakhstan

AMC’s liver transplantation team poses for a photo together with local medical staff after performing a dual-graft living donor liver transplant at the National Scientific Center of Surgery in Almaty, Kazakhstan, on March 30

AMC’s liver transplantation team performed the first dual-graft living donor liver transplant in Kazakhstan. The surgery was performed at the National Scientific Center of Surgery (named after A.N. Syzganov) in Almaty, Kazakhstan, on March 10. The patient was Shaitkulov Nurekken (male, 36) who was suffering from hepatic cirrhosis caused by hepatitis B. The liver donor was his nephew. The surgery was performed by a team of ten medical staff, including Professors Ahn Chul-Soo, Ha Tae-Yong, Jung Dong-Hwan, and Kwon Jae-hyun of the Division of Liver Transplantation and Hepatobiliary Surgery, Professor Jun In-Gu and Specialist Kim KyoungSsun of the Department of Anesthesiology and Pain Medicine, Manager Baek Seung-an, Associate Managers Kim Hee-joo and Oh Sang-gyun, and Assistant Manager Kim Jin-seon of the OR Nursing Team.

Several patients need dual-graft living donor liver transplant, but no hospital in Kazakhstan can perform this surgery. Most patients also give up this prospect, because they are too poor to afford such medical expenses. This surgery was requested by a Kazakhstan medical specialist who had completed a training program at AMC and participated in AMC’s symposium held to celebrate the 5,000th living donor liver transplantation (LDLT) on November 2018.

AMC helps medically underdeveloped countries become medically independent through the Asan in Asia Project. This venture is based on the medical skills learned from advanced countries in the 1960s and AMC’s experience in leading the medical advancement in Korea. Since 2011, AMC has continued transferring liver transplant skills to Mongolia and Vietnam to enable local medical specialists to perform liver transplantations by themselves.

American Patient with Liver Cirrhosis Gains a New Life After LDLT at AMC

Mr. Carlson, the American patient who underwent a LDLT at AMC, had a birthday celebration in Ward 102S on February 22 this year. Mr. and Mrs. Carlson in cone caps with their arms around each other’s shoulders are in the photo with AMC’s liver transplantation team members including, Chair Professor Lee Sung-Gyu (third from left) and Professor of Song Gi-Won of the Department of Liver Transplantation and Hepatobiliary Surgery

(left to the patient).

A patient with liver cirrhosis who was treated at the Stanford University Medical Center in the United States received a living-donor liver transplantation (LDLT) at AMC and fully regained health in two months. Charles Carlson (male, 47) was diagnosed with liver cirrhosis and myelodysplastic syndrome in 2011. Myelodysplastic syndrome (MDS) is a disease that causes symptoms such as immunological abnormalities, infections, and bleeding due to poorly formed cells. Despite chemotherapy for MDS, his condition only worsened. As a last resort, he was put on the liver transplant waiting list. However, his health was deteriorating over time. The only way to treat his illness was a LDLT, but it uncertain whether he would fully recover after the LDLT. Therefore, all hospitals in the United States were reluctant to perform the LDLT on him. Finally, Stanford Medical Center’s specialists recommended him to undergo surgery at AMC, for Korea has more advanced medical skills in LDLT than the United States. They personally sent an email to Professor Song Gi-Won of the Divison of Liver Transplantation and Hepatobiliary Surgery to ask for a treatment avenue.

Mr. Carlson visited AMC in November last year and underwent the LDLT on December 19. AMC’s liver transplantation team removed 62% of his wife’s liver and transplanted it to him. It was a very complicated surgery, as he had many collateral vessels, such as portal vein thrombosis, and a severe adhesion due to the repeated peritonitis caused by liver cirrhosis. The surgery took about 18 hours and required massive transfusion with 16 packs of platelets and 20 packs of blood.

After two months in the ICU, he was transferred to a general ward in the middle of February this year. He was discharged from the hospital on February 25, 2019, and he returned home. He will be followed up for a year while receiving chemotherapy for MDS at the Stanford University Medical Center and will undergo bone-marrow transplantation again later. Mr. Carlson said, “Thanks to all the staff’s efforts and care, I could regain my health without any discomfort. I would like to thank AMC for making me live a normal, happy life with my family again.”

“I could not say for sure that the liver transplantation would be successful because of the patient’s health condition, but everyone in our team shared his condition every day and worked together to make it successful,” said Professor of Song Gi-Won of the Division of Liver Transplantation and Hepatobiliary Surgery.

“It was very inspiring that Stanford University Medical Center, one of the ten leading hospitals in the United States, recognized the excellence of our medical skills and trusted us with him. We will continue working hard and researching to benefit such patients from all over the world,” said Chair Professor Lee Sung-Gyu of the Division of Liver Transplantation and Hepatobiliary Surgery.

AMC Liver transplantation team transfers LDLT skills to the University Medical Center of Ho Chi Minh City, Vietnam

Professor Song Gi-Won (second from left) of the Department of Liver Transplantation and Hepatobiliary Surgery performs LDLT at the University Medical Center of Ho Chi Minh City on March 29.

A liver transplantation team made its fourth visit to Vietnam on March 28 to transfer living donor liver transplantation (LDLT) skills to the University Medical Center of Ho Chi Minh City. The team performed LDLT on two local patients suffering from hepatic cirrhosis caused by hepatitis C and hepatocellular carcinoma. Le Van Dien (male, 56) underwent LDLT on March 29, and Dang Ti Hayat (female, 67) received a liver transplant from her daughter on March 30. The transplantations were led by Professors Song Gi-Won and Park Gil-Chun of the Division of Liver Transplantation and Hepatobiliary Surgery, who were assisted by Associate Managers So Mi-hyun and Lee Sang-kyung from the OR Nursing Team.

AMC has been transferring liver transplantation skills to the Cho Ray Hospital since October 2012 and to the University Medical Center of Ho Chi Minh City since June 2018.

AMC receives thank-you letters from the liver transplantation patient from Stanford

Mr. Carlson (first from left) who went back home after receiving LDLT at AMC sent thank-you letters to AMC’s medical staff. The photo is his family photo, which was enclosed with the letters

Four thank-you letters were received by Professors Lee Sung-gyu and Song Gi-Won of the Division of Liver Transplantation and Hepatobiliary Surgery, Ward 102S, and the International Healthcare Center. They were from American patient Charles Carlson (male, 47) who had received an LDLT at AMC and gone back home after regaining his health. He wrote letters to thank AMC’s medical staff for helping his family live a normal happy life again.

Mr. Carlson, who worked as a search engine software engineer in Silicon Valley, was diagnosed with hepatic cirrhosis and myelodysplastic syndrome. LDLT was the only treatment, but hospitals in the United States were reluctant to perform it, since they were not sure about his recovery after surgery. A medical specialist at Stanford University Hospital (where Mr. Carlson was hospitalized) emailed Professor Song Gi-Won to ask for his treatment, stating that AMC’s medical skills are far ahead of those of American hospitals. The patient received LDLT at AMC in December last year and regained his health after two months of intensive care. He finally left for home on February 25.

In a letter to Professor Lee Sung-gyu, Mr. Carlson said, “I received incredibly high-quality treatment at AMC over the last several months. I would like to express my gratitude to the liver transplantation team’s efforts for the advancement of liver transplantation and the effective treatment of patients.”

The letter to Professor Song Gi-Won says, “Thanks to your encouragement we can endure the journey without giving it up. I would like to thank you for performing the delicate operation and helping me regain my health. I will remember everything I’ve experienced in Korea.”

The letter to the medical staffs of Ward 102S says, “Thank you for helping my recovery after transplantation. I appreciate your passion and services, and I will never forget your heart-felt care.”

The letter to the medical staffs of the International Healthcare Center states, “I want to thank everyone who took care of me to receive surgery and treatment as soon as possible in a faraway country.”