• Vol. 38 No. 4, 322–331
  • 15 April 2009

Liver Transplantation in Asia: Past, Present and Future

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ABSTRACT

With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.


Liver transplantation is the best treatment modality for patients with end-stage liver diseases. It has been landmarked as one of the most important advances in the medical field. Its applicability is expanding tremendously worldwide, particularly in many Asian countries. The history of liver transplantation dates back to 1963 when Starzl in Colorado first attempted cadaveric liver transplantation (CLT) in human in the world.1 Following this failed trial, the first successful cadaveric liver transplantation was performed by Starzl again in 1967 and long-term survival result was then reported.2 In Asia, this innovative operation was started early in 1964 by Nakayama in Japan, using a graft from a non-heart beating donor.3 It was not until 1978 that the second CLT in Asia was performed by researchers in China for a patient with advanced HCC. Over 50 CLTs were then carried out in the early 1980s in China but there was no long-term survivor from these operations.4 In Taiwan, Chen performed the first successful CLT with long-term survival in 1984.5 Following the implementation of legislation on brain death in Asian countries (Taiwan, Japan, Hong Kong and Korea) from 1987 to 1999, the practice of CLT propagated in Asia.6 In fact, the early success of CLT relied on the two major contributing factors, including the clinical use of calcineurin inhibitor (cyclosporine A)7 and the improved graft preservation by hypothermic perfusion of University of Wisconsin solution.

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