Liver transplantation is a treatment option for patients suffering from various liver diseases that cannot be cured by conventional medical or surgical methods and the disease continues to progress. It is an amazing medical technique that can miraculously give 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 an infection or a bleeding and it seems impossible to recover. .
In the Korean 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 in a clean natural environment. On the other hand, it can be assumed that the dragon king’s liver deteriorated because he ate a lot of alcohol and fatty foods in the palace, got help from various servants and maids, and didn’t exercise at all. The legend that the dragon king gets a new life thanks to the healthy liver of a rabbit makes us wonder if our ancestors had any idea about liver transplantation. Also, I suppose the results of home liver transplantation, which are showing good results all over the world, are proving that.
Most liver cancer patients have liver disease such as chronic hepatitis or cirrhosis. Therefore, liver transplantation can be said to be the most ideal treatment to cure liver cancer at the same time as existing liver diseases. Among the 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 it. Furthermore, liver transplantation is the only method that can be applied even if liver cancer cannot be cured due to severe cirrhosis of the liver. 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 in which a good prognosis cannot be expected from liver transplantation show good results if the response to the performed liver cancer treatment before surgery is good or the level of cancer markers is low. . Some wonder, since the entire liver is removed, should liver cancer 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 come back 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 death is selected as the first transplant recipient. Although it has the advantage of being able to transplant the whole liver, there are cases that the brain dead person is elderly or has fatty liver, and in most cases, the condition of the organ is relatively poor due to problems such as travel time because the brain death hospital and the transplant hospital do not match. Partial liver transplantation of a living person receives only part 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. Because 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 livers from brain-dead patients’ donors, so most of them receive partial liver transplantation. living donor liver. There is little difference in the treatment results after surgery according to the two methods.
Liver transplantation is one of the most critical and difficult surgeries and the short-term risks posed by the operation must be considered. Immunosuppressant drugs must be taken for life, and complications can occur, so ongoing management is required. However, liver transplant outcomes are improving due to the development of surgical techniques and patient management before and after surgery, as well as the development of immunosuppressants and various treatments against the hepatitis virus. Recently, the 10-year disease-free survival rate after liver transplantation in patients with liver cancer is more than 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]
If you liked this article, Please hit like.
like it 0
