Expertise: Minimally invasive hepatobiliary and pancreatic tumor resection, minimally invasive gastrointestinal surgery, integrated minimally invasive biliary stone surgery, endoscopic inguinal hernia repair, endoscopic incisional hernia repair, liver transplantation, kidney transplantation, minimally invasive liver donation surgery, minimally invasive kidney donation surgery

          The evolution of liver transplantation began in 1963 when Dr. Thomas Starzl performed the world’s first human liver transplant in Denver, United States. In 1967, he achieved the first case of long-term survival, laying the foundation for clinical application of liver transplantation. Although early outcomes were poor, the introduction of effective immunosuppressants—such as cyclosporine and tacrolimus—along with advances in surgical techniques, significantly improved success rates. By the 1980s, liver transplantation became a standard treatment for end-stage liver disease. In the 21st century, the adoption of living donor transplantation and minimally invasive techniques has not only expanded donor availability but also accelerated postoperative recovery, positioning several Asian countries as leaders in this evolving field.

               Liver transplantation is the most decisive and effective treatment for patients with end-stage liver diseases such as advanced liver cancer, severe cirrhosis, and acute liver failure. When liver function can no longer sustain basic life and conventional treatments fail, transplantation often becomes the only life-saving option. However, not everyone is eligible for liver transplantation; indications, surgical requirements, and postoperative care must all undergo rigorous evaluation and supporting protocols.

               Our hospital has long been committed to developing precise and safe minimally invasive hepatobiliary and pancreatic surgeries, having performed over 2,300 minimally invasive liver procedures—making us one of the most experienced surgical teams in Taiwan. Notably, in March 2012, we successfully completed the nation’s first laparoscopic living donor liver transplant, becoming only the second team in the world to perform this high-difficulty technique. This achievement underscores our leadership in organ transplantation and minimally invasive surgery, both in technical skill and clinical outcomes.

               The major indications for liver transplantation can be classified into three categories. First, hepatocellular carcinoma (HCC): patients who meet the Milan or UCSF criteria and show no vascular invasion or distant metastasis may achieve long-term survival post-transplant. The Milan criteria include a single tumor ?5 cm or up to three tumors each ?3 cm with no vascular or distant spread. The UCSF criteria slightly expand the limits to a single tumor ?6.5 cm or up to three tumors with a total diameter ?8 cm.

            Second, decompensated cirrhosis, often seen in chronic hepatitis B or C patients: when the MELD (Model for End-stage Liver Disease) score exceeds 15 and complications such as variceal bleeding or ascites occur, these patients are considered high-risk candidates.

                Third, acute liver failure, such as that caused by drug toxicity (e.g., acetaminophen overdose), necessitates rapid assessment for urgent transplantation within a critical time window. Notably, Taiwan has made significant progress in antiviral treatments for hepatitis B and C in recent years. The development and accessibility of effective antiviral agents have led to a marked decline in the number of patients requiring emergency transplantation due to fulminant viral hepatitis.

                 According to the 2023 report from the Taiwan Organ Registry and Sharing Center (TORD), the 1-year, 5-year, and 10-year survival rates for liver transplant recipients in Taiwan are approximately 86%, 73%, and 60%, respectively—comparable to major international transplant centers. In recent years, Taiwan has performed approximately 350 to 400 liver transplants annually, including both deceased and living donor procedures. This stable trend reflects both increasing patient acceptance and continuous improvements in transplant expertise.

               Currently, liver transplants are performed using two major donor sources: deceased donor and living donor. In Taiwan, the Milan criteria are typically applied to deceased donor liver transplantation (DDLT) to ensure consistent outcomes and equitable organ allocation. For living donor liver transplantation (LDLT), the UCSF criteria are more commonly used, allowing greater flexibility when the donor is a family member or spouse.

              With rising rates of fatty liver disease and metabolic-associated liver fibrosis or cirrhosis, these conditions have become increasingly important indications for liver transplantation—especially in patients without viral hepatitis. Deceased donor liver transplantation (DDLT) involves organs from brain-dead donors and is allocated through the national registry system. Living donor liver transplantation (LDLT), often conducted among close relatives or spouses, requires thorough evaluation of the donor’s liver volume, health status, and safety risks. A key advantage of LDLT is that the timing of surgery can be planned in advance, reducing waiting risks and allowing for optimized preoperative preparation. Compared with deceased donor transplantation, the graft size in LDLT is usually smaller, demanding highly precise surgical planning and execution to ensure safety for both donor and recipient. The procedure involves intricate reconstruction of hepatic veins, portal vein, hepatic artery, and bile ducts, making it one of the most complex surgical operations in the field.

               Postoperative care focuses on three key areas: (1) Prevention of graft rejection—patients require long-term immunosuppressive therapy such as tacrolimus and mycophenolate mofetil; (2) Infection prevention—as immunosuppression increases susceptibility to bacterial, viral, and fungal infections, routine vaccinations and prophylactic medications are essential; and (3) Liver function monitoring and nutritional support—close monitoring through laboratory tests and imaging is required in the early postoperative phase, with gradual resumption of a high-protein, low-salt, moderate-fat diet.

              Common postoperative complications include acute or chronic rejection, biliary stricture or leak, hepatic artery thrombosis, portal vein stenosis, bleeding, and infections. Rejection episodes are usually managed by adjusting immunosuppressive drug regimens. Biliary and vascular complications may require interventional procedures or revision surgery. Infectious complications must be addressed with targeted antimicrobial therapy, along with careful modulation of immunosuppression to balance infection control and graft protection.

              Looking ahead, liver transplantation techniques are evolving rapidly. Advances include organ preservation using normothermic or hypothermic perfusion and artificial organ perfusion systems, which improve preservation duration and post-transplant function. Robotic liver transplantation is also being explored in select centers, offering the potential for enhanced precision and reduced invasiveness. Xenotransplantation is gradually progressing from animal models to clinical trials, and may offer a promising solution to the ongoing shortage of donor organs in the future.

               Our liver transplant team continues to refine minimally invasive techniques and integrate multidisciplinary care pathways. We offer one-stop, high-quality care from preoperative evaluation and donor matching to surgery and long-term follow-up. Through technological innovation and collaborative care, we aim to bring renewed life and improved quality of life to more patients with end-stage liver disease.