The liver is the largest organ in our body, often referred to as the 'chemical factory of the human body.' It processes nutrients, sending them throughout the body or storing them, and also handles waste. However, even if 70% to 80% is damaged by attacks from viruses, alcohol, fat, or drugs, it does not send out warning signals. This is why it is called 'the silent organ.'
If liver cell damage continues, cirrhosis occurs, which can lead to liver cancer. Liver cancer is the seventh most common cancer in Korea. If a tumor is found within the liver or just around it, it can be treated with a resection alone. However, it is often missed in the early stages, and even after surgery, there is a limit as cancer can recur. The solution is liver transplantation.
Professor Lee Seung-hwan (47) of the Gastrointestinal Surgery Department at the Gangdong Kyunghee University Hospital Organ Transplantation Center said on the 11th, "During my residency, I saw a patient who fell into a coma due to acute hepatitis regain consciousness within 2 to 3 days after liver transplantation and walk around the ward within a week, and I thought, 'I want to do this.'" He noted, "From a doctor's standpoint, surgery, especially transplant surgery, yields the most dramatic results," adding, "It was immensely rewarding to see patients improve so quickly, despite the challenges."
Liver transplantation involves removing the damaged liver and replacing it with a new one, fundamentally treating cirrhosis and liver cancer. In the surgical field, liver transplantation is considered a highly complex operation, taking about 9 hours due to the need to connect numerous blood vessels. Nonetheless, the success rate of liver transplantation in Korea is nearly 100%. The global medical community ranks the liver transplantation techniques of Korean medical staff as the best in the world.
If liver cancer is detected early, it can be treated with resection, radiofrequency ablation, and non-surgical therapies such as medication. Professor Lee explained, "The resection procedure, which involves removing the tumor, has evolved into laparoscopic liver resection, where 5 holes of 5 to 12 mm are made and then light, cameras, and surgical tools are inserted to remove the liver along with the tumor during open surgery."
However, even early-stage liver cancer may require a liver transplant if liver function is compromised due to cirrhosis. Professor Lee stated, "The primary causes of cirrhosis and liver cancer are hepatitis B and alcohol," adding, "While the number of patients with cirrhosis due to hepatitis B has decreased with the development of antiviral treatments, I feel that the number of patients with alcoholic cirrhosis has increased."
Liver transplantation occurs when patients with cirrhosis and liver cancer do not improve with treatment or when complications such as ascites, jaundice, or bleeding arise. If liver damage progresses rapidly, death can occur within days to weeks without receiving a transplant. The issue is that while there are many patients waiting for transplantation, there are few organ donors. According to the National Organ and Tissue Donation Management Center, as of 2023, there are over 51,800 people on the organ transplantation waiting list in Korea.
Korean medical professionals have addressed this issue with living liver donor liver transplantation methods. Liver transplantation is broadly classified into 'whole brain-dead donor liver transplantation,' which involves moving the entire liver from a deceased donor, and 'living liver transplantation,' which involves partial resection of a healthy person's liver for transplantation. Since the liver can function even if only a portion remains, both donor and recipient can maintain adequate function.
Professor Lee stated, "In Korea, due to a shortage of brain-dead organ donors, about 70% of total liver transplants are performed using living liver donation," and noted, "In the United States and Europe, unlike us, the number of brain-dead liver transplant surgeries exceeds that of living liver transplants due to the differing organ donation cultures."
Living liver transplantation is also possible even if blood types differ. Professor Lee successfully performed a living liver transplantation last year for a patient with a different blood type. A male patient in his 50s with end-stage cirrhosis was discharged in good health less than a month after the surgery. Professor Lee explained, "Other treatments could no longer restore liver function, so transplantation was necessary," and added, "We decided to proceed with a family living liver donation, but the patient and the donor had different blood types."
When the blood from a different blood type enters the body, the body's antibodies can cause a rejection reaction. Blood clots may form in the blood vessels, leading to death. Therefore, managing immune rejection is crucial when attempting to transplant a liver from someone with a different blood type.
Professor Lee emphasized that treatment to eliminate antibodies against the donor's blood type must precede the surgery, and that therapy to suppress the activity of key immune cells known as B lymphocytes is also applied to reduce the patient's immune rejection reaction. He stated, "After the surgery, it's important to consistently take immunosuppressants and to be cautious about infections."
Professor Lee stressed the importance of managing liver health in daily life. He indicated that not only post-operative patients but also healthy individuals must maintain healthy eating habits and regular exercise. He stated, "If you're concerned about liver health, you should avoid drinking alcohol altogether," and advised to "avoid high-fat and high-carbohydrate meals and to exercise regularly."
He particularly warned that traditional medicines or folk remedies may actually harm liver health. Professor Lee noted, "If a patient who has undergone surgery eats a lot of nutritious food due to decreased physical strength, it may lead to fatty liver instead," and expressed his regret that "many patients damage their liver function with unverified folk remedies."
In the medical field, the golden period of activity for surgeons is evaluated to be in their late 40s. This is the time when their proficiency in clinical practice, research, and surgical techniques reaches its peak, and professor Lee perfectly embodies this.
However, in Korea, where liver transplantation surgery is world-class, it may become increasingly difficult to find surgical specialists like Professor Lee in the future. This is due to the challenging work environment, low compensation for medical services, and the potential for medical disputes, which has significantly decreased the number of medical students pursuing surgery. According to the Korean Association of Hepato-Biliary-Pancreatic Surgery, there are only 86 specialists nationwide who hold a hepatobiliary and pancreatic surgery certification.
Professor Lee remarked, "The surgical skills of Korean surgeons are recognized as being at the highest level in the world," and expressed his hope that an environment would be established where junior doctors can receive fair treatment, save more patients, and continue the legacy of Korea's outstanding surgical skills.