Liver transplantation is a treatment option for patients suffering from various liver diseases who are unable to be treated by conventional medical or surgical methods and the disease continues to progress. It is an amazing medical technique that can miraculously give a new life if a good liver is transplanted at the right time even if a healthy person’s liver deteriorates rapidly or a patient with liver disease deteriorates due to infection or bleeding and seems impossible to recover. .
In Korea’s traditional fairy tale, ‘Byeoljubujeon’, there is a story about eating a rabbit’s liver to cure the dying dragon king. Perhaps the rabbit’s liver is good because it mainly eats fresh vegetables and is active while running around in a clean natural environment. On the other hand, it can be assumed that the dragon king’s liver got bad because he ate a lot of alcohol and greasy food in the palace, received help from various servants and maids, and did not exercise at all. The legend that the dragon king gets a new life through a rabbit’s healthy liver makes us wonder if our ancestors had an insight into liver transplantation. In addition, I speculate that domestic liver transplant results, which are showing good results worldwide, are proving it.
Most liver cancer patients have liver diseases such as chronic hepatitis or cirrhosis. Therefore, liver transplantation can be said to be the most ideal treatment to treat liver cancer simultaneously with existing liver diseases. Among various treatments for liver cancer, liver transplantation has the highest survival rate, and the statistics that the recurrence rate after liver cancer treatment is low proves this. In addition, liver transplantation is the only method that can be applied even if liver cancer cannot be cured due to severe liver cirrhosis. However, liver transplantation is possible for all patients with liver cancer, and the results are not good. In the disease evaluation stage, there must be cancer only in the liver, no metastases to other organs, no invasion of major blood vessels, and small tumors with a small number of tumors to achieve good results after liver transplantation.
Fortunately, through the recent development of various prognostic factors for liver transplantation, it has been reported that even cases where a good prognosis cannot be expected from liver transplantation show good results if the response to liver cancer treatment performed before surgery is good or the level of cancer markers is low. . Some wonder, since the entire liver is removed, liver cancer should not recur if liver transplantation is performed even if the tumor is very large and numerous. However, even if the entire liver is removed, liver cancer can recur due to liver cancer cells remaining in the blood or liver cancer cells located somewhere in the body if the existing liver cancer is severe.
Liver transplantation can be divided into deceased liver transplantation and live partial liver transplantation depending on the method of obtaining a new organ. Brain-dead liver transplantation involves transplanting the liver of a brain-dead donor, and the patient with the worst liver at the time of brain-dead death is selected as the first transplant recipient. Although it has the advantage of being able to transplant the entire liver, there are cases in which the brain dead person is elderly or has fatty liver, and in most cases, the organ condition is relatively poor due to problems such as travel time because the hospital where the brain death occurred and the transplant hospital do not match. Partial liver transplantation of a living person receives only a portion of the liver from a healthy person, and has the advantage of receiving a transplant in the best condition, although the size of the liver to be transplanted is small. Since the number of brain-dead patients in Korea is low, it is very difficult for liver cancer patients with relatively good liver function to receive donor livers from brain-dead patients, so most of them receive partial living-donor liver transplantation. There is little difference in the treatment outcomes after surgery according to the two methods.
Liver transplantation is one of the most critical and difficult surgical operations, and the short-term risks posed by the operation must be considered. Immunosuppressive drugs must be taken for life, and complications may occur, so continuous management is required. However, the results of liver transplantation are improving thanks to the development of surgical techniques and patient management before and after surgery, as well as the development of immunosuppressants and various hepatitis virus treatments. Recently, the 10-year disease-free survival rate after liver transplantation in liver cancer patients is over 70%. Liver transplantation is difficult, relatively risky, and requires lifelong management, but it is a treatment that brings good results as well as return to society and free physical activity after surgery.
[정동환 서울아산병원 간담도외과 교수]
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