Vol 25 • No 4 • October 2002270

MAK AND TAN

AsianJournal of

Surgery©Excerpta Medica Asia Ltd

Editorial Comments

Liver transplantation has undergone rapid evolutionover the last two decades and has been established as themost effective treatment for various end-stage liverdiseases. Yet, liver transplantation is a difficultundertaking. It requires not only sophisticated equipment,expensive drugs, and a team of dedicated and skilledclinicians, but it also entails the availability of a humanliver graft. The development of liver transplantation inAsia has been very much slower than that in the westernworld, largely because of financial constraints and thescarcity of donor organs. Amongst 9,354 liver transplantsreported to the Worldwide Transplant Directory in theyear 2000, only 417, or less than 5%, were from Asiancountries.

This symposium entitled “Liver Transplantation inAsia” focused on issues that are of special interest tosurgeons in Asia. Professor Chao-Long Chen from ChangGung Memorial Hospital, Kaohsiung, Taiwan addressedthe attractive concept of doubling the number of cadavergrafts by splitting one liver graft into two. The operationis not only more technically demanding, it requires morecomplicated manpower and is more logisticallydemanding for the resource-restricted transplant centresin Asia. The paper discusses the various issues in theapplication of the technique and summarizes the earlyexperience in Asia.

With the critical shortage of organ donors, livingdonor liver transplantation has the strongest appeal inAsia, and transplant centres in Asia have repeatedlyadvanced the frontier of living donor liver transplantation,particularly in its application in adult recipients. Thepaper by Professor Sung Gyu Lee and his colleaguesdescribes the world’s largest single-centre experience ofadult-to-adult living donor liver transplantation (LDLT)programme at the Asan Medical Centre in Seoul, Korea.The Asan group is recognized internationally for its

development of surgical innovations such asreconstruction of the branches of middle hepatic veinwith jump grafts as in modified right lobe livertransplantation and the use of dual liver grafts from twodonors for one recipient. Such surgical innovations haveextended the benefits of LDLT in adult recipients andhave provided a new donor pool for the furtherdevelopment of liver transplantation in Asia. For years tocome, many countries in Asia as well as other parts of theworld will continue to depend on the expanded use ofLDLT and the largest practice for this innovative procedurewill remain centred in Asia.

Apart from surgical innovations to overcome theproblem of organ shortage, surgeons in Asia areparticularly interested in the role of liver transplantationfor the treatment of hepatocellular carcinoma (HCC).HCC is one of the most common cancers world-wide andthe largest concentration of cases is in Asia. Dr. Kai-ChahTan and his colleagues from Singapore discussed thecurrent selection criteria for patients with HCC to undergoliver transplantation. As a result of the limitations createdby the extraordinary mismatch between the supply (loworgan donor rate) and demand (high incidence of HCC),the potential role of liver transplantation in the treatmentof HCC is severely restricted. The authors present atreatment strategy under such circumstances.

Liver transplantation is the last court of appeal forvirtually all patients dying of end-stage liver disease.Nevertheless, liver transplantation is among the mostdemanding clinical disciplines in medicine and theoutcomes are usually reflected with either great successor total failure, rarely a middle ground. There is muchroom for advancement in the development of livertransplantation in Asia and surgeons should take the leadin refining their knowledge and skills in order to achievea fruitful outcome for their desperate patients.

Liver Transplantation in Asia — Challenges andOpportunities

C.M. Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong.