Liver transplantation is a treatment option for patients suffering from various liver diseases that cannot 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 the traditional Korean fairy tale, ‘Byeoljubujeon’, there is a story about eating a rabbit’s liver to cure the dying dragon king. Maybe the rabbit’s liver is good because it eats mostly fresh vegetables and is active running around in a clean natural environment. On the other hand, it can be assumed that the dragon king’s liver is going 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 of the dragon king being given new life by a rabbit’s healthy liver makes us wonder if our ancestors had insight into liver transplants. In addition, I guess that the results of domestic liver transplantation, which show good results all over the world, prove that.
Most liver cancer patients have liver diseases such as chronic hepatitis or cirrhosis. Therefore, it can be said that liver transplantation is the most ideal treatment to treat liver cancer at the same time as 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 prove 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 in the liver only, no metastasis to other organs, no invasion of large 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 level at which cancer markers are low. Some are amazed that since the entire liver is removed, liver cancer should not occur again if a liver transplant is performed even if the tumor is very large and numerous. However, even if the entire liver is removed, liver cancer can reoccur because liver cancer cells remain in the blood or liver cancer cells located elsewhere in the body if the liver cancer is current liver is severe.
Liver transplantation can be divided into deceased liver transplantation and living 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-death is selected as the first transplant recipient. Although it has the advantage of being able to transplant the whole liver, there are cases where the brain dead person is elderly or has a fatty liver, and in most cases, the condition of the organ is relatively poor due to problems such as time travel because the hospital where the brain death occurred and the transplant hospital do not match. A partial liver transplant accepts only a portion of the liver from a healthy person, and has the advantage of having a transplant in the best condition, even though 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 a donor liver from brain-dead patients, so most of them receive a partial liver transplant from a donor live There is little difference in the postoperative treatment results according to the two methods.
A liver transplant is one of the most essential and difficult operations, and the short-term risks caused by the operation must be considered. Immunosuppressive drugs must be taken for life, and complications can occur, so ongoing management is required. However, liver transplant outcomes are improving thanks to the development of surgical techniques and pre- and post-operative patient management, 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 a return to society and free physical activity after surgery.
[정동환 서울아산병원 간담도외과 교수]
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