Thirty-year survival following living donor liver transplantation: a case report.

- About - Issues - Editorial Policies - For Contributors - For Readers Article View Clin Transplant Res 2025; 39(2): 181-182 Published online June 30, 2025 https://doi.org/10.4285/ctr.25.0006 © The Korean Society for Transplantation Kyung Mo Kim1, Sung-Gyu Lee2 1Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Correspondence to: Sung-Gyu Lee Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil 88, Songpagu, Seoul 05505, Korea E-mail: [email protected] Received: January 17, 2025; Accepted: April 2, 2025 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. To the Editor: In 1995, we published the first successful case of living donor liver transplantation (LDLT) in Korea in this journal [1]. The recipient was a 9-month-old infant diagnosed with biliary atresia who had not undergone Kasai portoenterostomy. The transplant was performed on December 8, 1994, using a lateral segment donated by her 35-year-old father. The surgeon who performed the procedure, along with the pediatricians involved in her posttransplant care, actively managed her follow-up for 30 years. After transplantation, the patient received immunosuppressive therapy with cyclosporin and corticosteroids. After a single episode of acute rejection during the early postoperative period, she was discharged without infectious, vascular, or biliary complications. The donor also recovered without surgical complications. Immunosuppressive therapy was later adjusted to tacrolimus monotherapy 5 years posttransplant. The patient maintained stable liver function for 14 years until she developed posttransplant diabetes mellitus (PTDM) [2]. The PTDM was managed with insulin therapy for approximately 15 years; then, insulin dependence resolved 28 years posttransplant, and her diabetes is now controlled with oral hypoglycemic agents. In the 25th year after transplantation, she was diagnosed with endometriosis, underwent a left oophorectomy, and continues to maintain normal reproductive function. During the adjustment of immunosuppressive therapy to optimize glycemic control, two episodes of rejection were confirmed via biopsy. Because the biopsy performed at 28 years posttransplant showed no evidence of rejection only with minimal fibrosis (Metavir stage 0) [3], Immunosuppressive therapy was consequently modified to a regimen of tacrolimus and everolimus, and the patient has maintained normal liver function since then. The patient showed significant catch-up growth after transplantation, with her height and weight increasing from the 5th percentile to the 50th percentile, eventually stabilizing at the 25th percentile. She is currently in good health, free from hypertension, hyperlipidemia, renal dysfunction, or neurological complications, and her liver function remains normal. She is employed and leads a life comparable to that of her peers. Her father, the donor, is now 65 years old, remains healthy, and is actively engaged in his professional life. LDLT, introduced as a solution to organ shortages [4], has flourished, particularly in Asia [5]. At our center, LDLT began with pediatric cases and later expanded to include adults, with the first adult LDLT in Korea performed in 1997 [6]. By the end of 2024, LDLT accounted for 84% of 8,400 adult liver transplants and 73% of 487 pediatric liver transplants performed at our center (unpublished data). The exceptional outcomes of liver transplantation at our center can be attributed to surgical advancements [7] and the multidisciplinary management of pediatric patients [8], which have resulted in excellent short- and mid-term results. These achievements underscore the necessity of establishing a robust system for managing long-term survivors. This case represents the first report of a 30-year survival following LDLT in Korea, marking a significant milestone in long-term survival management. It emphasizes the potential of LDLT to achieve extended survival and improved quality of life, thereby providing an important reference point for the future care of long-term survivors. - Lee SG, Lee YJ, Kwon TW, Kim KM, Choi KM, Park KM, et al. Liver transplantation from a living donor to his daughter. J Korean Soc Transplant 1995;9:187-92. - Cho JM, Oh SH, Kim KM, Namgoong JM, Kim DY, Song GW, et al. Prevalence and treatment of new-onset diabetes mellitus after liver transplantation in Korean children: a single-center study. Transplant Proc 2014;46:873-5. - Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24:289-93. - Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet 1989;2:497. - Lee SG. Asian contribution to living donor liver transplantation. J Gastroenterol Hepatol 2006;21:572-4. - Lee SG, Moon DB, Hwang S, Ahn CS, Kim KH, Song GW, et al. Liver transplantation in Korea: past, present, and future. Transplant Proc 2015;47:705-8. - Yoon YI, Kim KH, Hwang S, Ahn CS, Moon DB, Ha TY, et al. Outcomes of 6000 living donor liver transplantation procedures: a pioneering experience at ASAN Medical Center. Updates Surg 2024 Apr 10 [Epub]. https://doi.org/10.1007/s13304-024-01807-5 - Oh SH, Jeong IS, Kim DY, Namgoong JM, Jhang WK, Park SJ, et al. Recent improvement in survival outcomes and reappraisal of prognostic factors in pediatric living donor liver transplantation. Liver Transpl 2022;28:1011-23.