Fan, ST

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Title Liver transplantation in Hong KongAuthor(s) Fan, STCitation Hong Kong Practitioner, 1997, v. 19 n. 2, p. 49-50Issued Date 1997URL http://hdl.handle.net/10722/45390Rights Creative Commons: Attribution 3.0 Hong Kong LicenseThe Hong Kong College ofGeneral PractitionersTel •. 2528 6618 (2 Lines)Fax: 286606168th Floor,Duke of Windsor Building,15 Hennessy Road, Hong Kong.EDITORDr. Lam Tai PongDEPUTY EDITORSDr. David VK. ChaoDr. Wong Hung WaiBOARD MEMBERSDr. Cynthia S.Y. ChanDr. Chan Wai SunDr. Stephen ChenDr. Nelson K.H. CheungDr. Rudolph WM. ChowDr. Julie CohenDr. Kwok Kon HungDr. Augustine T. LamDr. Cindy L.K. LamDr. Lam Tai KwanDr. Lam YuenDr. Bernard WK. LauDr. Frederick C.T. LeeDr. Glenn K.L. LeeDr. Peter C.Y. LeeDr. Lawrence K.C. LeungDr. Ronson C.T. LiDr. John MackayDr. Charles C.Y. NgDr. Ng Chun BorDr. David OwensBUSINESS MANAGERDr. Betty K.M. KwanADMINISTRATIVE MANAGERMs. Teresa LeeEDITORIAL ADVISERSProf. Cindy S.T. AunProf. Augustine F. ChengProf. Tony DixonProf. Wes FabbProf. S.T. FanProf. A. HedleyProf. Walter WK. KingProf. C.R. KumanaProf. C.P. LauProf. S.H. LeeProf. P.C. LeungDr. Mak Ki YanProf. C.W OgleDr. Wilfred C.G. PehProf. Grace TangProf. Mark TsoProf. C.A. Van HasseltProf. C.K. WongProf. Jean WooProf. C.Y. YeungProf. R.T.T. YoungSTATISTICAL CONSULTANTSDr. Joseph LauDr. Ian LauderThe Hong Kong Practitioneris indexed in Excerpta Medica(EMBASE).Printed & Designed ByPrinthouse Production CenterHong KongEDITORIALLiver Transplantation InHong KongLiver transplantation is an established treatment for patients withterminal liver disease. The 5-year survival rate in Western countriesapproaches 80%. The majority of patients can lead a normal life, and returnto gainful employment, and some female patients can deliver normal babies.Although liver transplantation was not available in Hong Kong before 1991the results are equally as favourable as in Western countries.1 Up toDecember 1996, 53 liver transplantations were performed at Queen MaryHospital, with a survival rate of 84%. Of these 53 operations, 14 wereperformed on paediatric patients whose survival rate is 100%. Our resultsand number of liver transplantations are now ranked the third in Asia, beingnext to Kyoto University and Shinshui University of Japan. The success isdue to the contributions of the anaesthetists, hepatologists, microbiologists,paediatricians, pathologists, radiologists and surgeons; all of whom devotednumerous hours on the care of the patients, in addition to their daily work inthe hospital.The medical profession in Hong Kong is slow to accept livertransplantation. Not infrequently patients with terminal liver disease are notreferred to the hospital, or if referred at all then only at the stage when thepatient is already moribund. Transplanting a patient who is critically ill isrisky, expensive, labour-intensive and is associated with a high mortalityrate. On the other hand, transplanting a patient at an earlier stage is muchsafer, less expensive and not very different from a major hepatectomy.Physicians may not be convinced that a patient who is still up and aboutshould require a liver transplantation. A good guideline, however, can beobtained from the synthetic function of the liver. When the prothrombintime is longer than 20 seconds, or the serum albumin is less than 23 g/1, theliver function is unlikely to support the patient for another 6-12 months. Aliver transplantation should then be considered before the lethalcomplication of cirrhosis appears.The real problem is the lack of cadaveric organ donation. This is due toinsufficient awareness by doctors of potential donors as well as thereluctance of the relatives of brainstem dead patient to donate. However,there should be a sufficient donor pool in both private and public hospitalsin Hong Kong. To increase the chance of organ donation it is essential topromote the concept of brainstem death and the willingness of the medicalpractitioners to report to the transplant coordinator of a potential donor. Ingeneral, a brainstem dead patient is suitable for organ donation if he isbelow 60 years of age and has a near-normal liver biochemistry. Afterexplaining to the patient's relatives about brainstem death, the primary49EditorialEDITORIALphysician does not need to be involved in thecounselling for organ donation. This is entirely the dutyof the transplant coordinator.In the absence of cadaveric organ donation, livingdonation may be an alternative. Although we are nowable to perform living-related liver transplantation evenin adult recipients2 who may be bigger in size than thedonor, this operation should not be encouraged as itinvolves extra costs and, more importantly, a risk of thedonor dying from the operation. A case of mortality of aliver donor has already been reported from an Europeancentre.3 The goal in the future in Hong Kong should beto further enhance promotion of cadaveric organdonation so as to meet the demands of about 90 livertransplantations per year.Liver transplantation is an expensive operation. Ithas always been argued whether the actual benefits areworth the additional costs. A solid answer based on aprospective randomized trial cannot be given becauseliver transplantation produces such a good result that atrial comparing it with a group of patients not receivingliver transplantation seems unethical. Nevertheless, ithas been estimated that the number of quality-adjustedlife-years that might be gained by liver transplantation isabout 5.6 years.4 Such an estimate is based on thereports from experienced centres in the West. If wewant to produce even better results (in order to benefitour patients and to justify the cost of livertransplantation) the correct approach should be theredistribution of resources to establish a genuine livertransplant centre in Hong Kong. |S T Fan, MS, FRCS(Glas and Edin), FACSProfessor, Chair of SurgeryDepartment of SurgeryThe University of Hong KongReferences1. Fan ST, Lo CM, Chan KL el at. Liver transplantation - perspectivefrom Hong Kong. Hepatogastroenterology 1996; 43: 893-897.2. Lo CM. Gertsch P, Fan ST. Living unrelated liver transplantationbetween spouses for fulminant hepatic failure. Br J Surg 1995. 82:1037.3. Malago M, Rogiers X, Burdelski M, Broelsch CE. L i v i n g relatedliver transplantation: 36 cases at the Un ive r s i ty of Hamburg.Transplantation Proceedings 1994. 26: 3620-3621.4. Michel BC, Van Hout BA, Bensel GJ. Assessing the benefits oftransplant services. Bailliere's Clinical Gasiroenteralogy 1994, 3:411-423.50

Liver transplantation in Hong Kong

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Liver transplantation in Hong Kong

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