LIVER TRANSPLANTATION IN HONG KONG

LIVER TRANSPLANTATION IN HONG KONG

Professor Sheung-Tat Fan, Professor and Chair,

Department of Surgery

Oriental

Introduction

Liver transplantation is the best treatment for end-stage liver diseases because:
- success rate is high (85%)
- quality of life is excellent
This service was not available in Hong Kong before 1991 because of:
- lack of expertise
- lack of funding
- lack of organ donors
- prevalence of hepatitis B which recurs after transplantation

Objectives

To establish a liver transplant service in Hong Kong

To overcome the problem of organ shortage by developing innovative surgical techniques of liver transplantation from living donors

To analyze the risks and benefits of these techniques and to formulate the selection criteria

To develop measures to prevent recurrent hepatitis B after liver transplantation

Major equipment involved

Red cell saver-	for collection of blood loss for auto-transfusion during operation
Rapid infusion system-	for rapid transfusion during operation
Ultrasonic dissector-	for cutting the liver with minimal blood loss
Veno-venous bypass pump-	for temporary circulation of blood outside the body
Doppler ultrasound-	for demonstration of patency of blood vessels

Procedure

	Phase 1- 1990 Technical refinement in a pig-model in the animal laboratory.
	Phase 2- 1991 Initiation of clinical liver transplant service
	Phase 3- 1993 Development of living donor liver transplantation in children
	Phase 4- 1994 Extension of living donor liver transplantation to adults with innovative techniques using extended left lobe (1994) and extended right lobe grafts (1996).

extended right lobe graft

from living donor

Phase 5- 1995
Use of lamivudine as prophylaxis in liver transplantation for hepatitis B

Results and Achievements

Local- Provision of liver transplant service for the whole territory of Hong Kong
-the first successful liver transplant in Hong Kong in October 1991
-102 liver transplants performed up to June 1999
-1-year patient survival rate of 87% is amongst the best in the world
-recurrence rate of hepatitis B was reduced to 3.8% only

Regional- The largest liver transplant service in China and South-east Asia
-receiving patients referred from South-east Asian countries for transplantation
-collaboration with Chang Gung Memorial Hospital Kaohsiung Medical Center in the first
successful split-liver transplantation in Asia
-provision of advice for hospitals in China and South-east Asia in developing liver transplant service

International- Pioneer in living donor liver transplantation
irst successful adult-to-adult living donor liver transplant between spouses for acute liver failure
-first successful adult-to-adult living donor liver transplant using extended right lobe graft
-one of the three largest centers in adult-to-adult living donor liver transplants in the world
-pioneer in emergency living donor liver transplantation under urgent situations

Academic output

-Doctorate thesis	1
-Publications in international peer-reviewed journals	18
-Publications in regional/local peer-reviewed journals	10
-Five most important publications:

1.	Minimum graft volume for successful adult-to-adult living donor liver transplantation for fulminant hepatic failure. (Lo, C.M., Fan, S.T., Chan, J.K.F., Wei, W., Lo, R.J.W. and Lai, C.L.) Transplantation, 1996, 62(5): 696-698.
2.	Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. (Lo, C.M., Fan, S.T., Liu, C.L., Lo, R.J.W., Lau, G.K.K., Wei, W.I., Li, J.H.C., Ng, I.O.L. and Wong, J.) Transplantation, 1997, 63(10): 1524-1528.
3.	Adult-to-adult living donor liver transplantation using extended right lobe grafts. (Lo, C.M., Fan, S.T., Liu, C.L., Wei, W.I., Lo, R.J.W., Lai, C.L., Chan, J.K.F., Ng, I.O.L., Fung, A. and Wong,J.) Annals of Surgery, 1997, 226(3): 261-270.
4.	Applicability of living donor liver transplantation to high-urgency patients. (Lo, C.M., Fan, S.T., Liu, C.L., Wei, W.I., Chan, J.K., Lai, C.L., Lau, G.K. and Wong, J.) Transplantation, 1999, 67: 73-77.
5.	Minimum graft size for successful living donor liver transplantation. (Lo, C.M., Fan, S.T., Liu, C.L., Chan, J.K., Lam, B.K., Lau, G.K.K., Wei, W.I. and Wong, J.) Transplantation (In press)

Conclusion

A liver transplant service with excellent results has been established in Hong Kong. The applicability and results of the operation have been improved through this research project. More patients with end-stage liver disease will benefit from this life-saving procedure.

Acknowledgements

Funding from Oriental Press Charitable Fund Association HK$ 3,814,175

Co-investigator:	Dr. Chung-Mau Lo, Associate Professor, Department of Surgery
	Dr. Irene O.L. Ng, Associate Professor, Department of Pathology
	Professor Ching-Lung Lai, Professor, Department of Medicine