Sisters United in Dual Liver Transplants for Father

Liver Transplantation in Hong Kong

Liver transplantation (LT) is a life-saving operation for patients with acute liver failure (ALF) which is commonly caused by hepatitis B infection in Hong Kong. Without a timely LT, the prognosis of ALF is extremely poor. Unfortunately as a result of the very low organ donation rate in Hong Kong, 90% of patients with ALF die while waiting for a liver. In view of the unmet need for organ donation, the LT team at Queen Mary Hospital, The University of Hong Kong started the living donor liver transplant (LDLT) program in 1993. Since then, over 500 LDLT operations have been performed with an overall success rate greater than 90%.


Right lobe living donor liver transplantation

A major challenge for LDLT is the functional and volumetric adequacy a partial liver graft to meet the metabolic demand of the recipient. It has been shown that 40% of the recipient standard liver volume is the minimal graft size for recipient recovery. Any graft volume less than this size is regarded as small-for-size graft and would predispose the recipient to develop small-for-size syndrome, and subsequently graft failure especially in very sick patients with high urgency situations. To fulfill the graft size requirement of the recipient, we pioneered the use of a right liver graft which has now been adopted as the choice of graft in adult in most LDLT programs around the world. Despite a larger size, small-for-size phenomenon still occurs in half of the recipients with a right liver graft.


Dual graft liver transplantation

Mr Cheng is a 59-year-old Hong Kong citizen who worked in Macau as a security guard. He enjoyed good past health previously.
He was admitted to a hospital in Macau on 11/7/15 for yellowish discoloration of skin and fatigue. He was diagnosed to have hepatitis B infection and was in acute liver failure upon admission. He was transferred to Queen Mary Hospital on 15/7/15. His liver function continued to deteriorate after arrival and he soon went into grade 4 hepatic coma. Preparation for liver transplantation was started immediately after assessment. He was admitted to the adult intensive care unit and required mechanical ventilation.


Donor evaluation

Mr Cheng’s second daughter volunteered to be the living donor. Computed tomography of the liver estimated her right liver to be 507ml only, i.e. 33% of the standard liver volume of Mr Cheng. She was then declined for donation due to possible small-for-size liver graft problem. His third daughter who was studying at Portugal then returned to Hong Kong immediately for ldonor workup. However, both sisters had similar body size and her right liver was also regarded as too small for donation. In view of the insufficient liver volume for each donor, the idea of using a ‘dual’ liver graft was proposed.
On 20 July 2015, the LT team at Queen Mary Hospital performed the first dual right and left liver graft LDLT in Hong Kong and the world first simultaneous dual liver implantations. Two female donors, aged 22 and 23 donated each of their right and left livers to their father. Three simultaneous operations were undertaken in three operating theatres. The right and left lobe donor operations each lasted for about 6 hours and the recipient operation lasted for 12 hours. More than 40 medical personnels including 10 transplant surgeons, 6 anesthesiologists, 2 microvascular surgeons, 3 radiologists, 2 clinical psychologists and 22 nursing staffs in two shifts were involved. Both donors and the patient have smooth recovery and are now ready for discharge.


The world first simultaneous dual graft implantation

Dual graft LDLT is the most technically challenging operation. Each liver graft has three main vessels: portal vein, hepatic artery and hepatic vein that require reconstruction when implanted in the recipient. The usual approach for dual graft transplantation is to implant each graft in sequence that entails many separate vascular anastomoses. Such approach is cumbersome and inevitably prolongs the graft ischaemic time. In contrast, we developed a new unique approach that entailed joining up all the hepatic veins and portal veins of the two grafts into two common orifices in the backtable before implantation into the recipient’s body. Such operative strategy rendered the entire implantation process much simpler and more efficient, hence reducing the ischaemic time. To our knowledge, this was the first time in the world that a simultaneous dual liver graft implantation was conducted in this manner.
The love and courage of the two sisters has saved the life of their father, as their livers united in their father in Hong Kong’s first dual graft living donor liver transplant. The LT team at Queen Mary Hospital has discovered a new approach to transform a highly complex operation into a more simplified version.

Media Enquiry : 7306 9243 Media Relations Officer, QMH
2 August 2015





姊妹齊肝救父

香港的肝移植手術

患急性肝衰竭的病人需要換肝才可保命。在香港,突發性乙肝是最常見的急性肝衰竭原因,延遲換肝後果不堪設想。 由於屍肝捐贈率甚低,百分之九十急性肝衰竭病人等不到換肝就病逝。香港大學瑪麗醫院肝移植中心於1993年開展活體肝移植, 至今進行超過六百例活肝移植,整體成功率逾九成。


右葉活肝移植

在活體肝移植中,成功關鍵在於供肝功能與體積是否足以應付受體代謝需要。要讓急性肝衰竭患者康復, 供肝體積不可小於受體原肝的40%。 低於這分界值的供肝都是「小體積供肝」,可能引至「小肝綜合症」, 甚至移植肝功能衰竭。為足以應付受體的需要,香港大學瑪麗醫院肝移植中心開拓了「右葉活肝移植」技術。 右葉作為供肝現已成為世界各地大多數活體肝移植的主流方案。儘管右肝體積較大, 半數右半肝移植接受者仍然出現「小體積供肝」的情況。
59歲的鄭先生是一名香港市民,曾在澳門擔任保安。他過去的健康記錄良好。今年7月11日,他因為黃疸和疲勞被送到澳門一醫院,被診斷為乙肝感染及急性肝衰竭。7月15日他被轉往瑪麗醫院。他的肝功能持續惡化並進入四級肝昏迷,需接受深切治療並展開肝移植的檢測準備。


捐肝者評估

鄭先生的二女首先自願接受捐肝者評估測試,電腦掃描顯示她的右肝體積為435克, 即鄭先生標準肝體積的百份之三十三,初步評估為「小體積供肝」而不適合捐肝。 鄭先生在葡萄牙留學的三女翌日趕回香港進行捐肝者評估測試,但同樣因她的右肝體積過小而被評為不適宜單獨進行捐肝。 有見及此,瑪麗醫院肝臟移植中心醫生決定進行雙肝移植。


雙肝植入

2015年7月20日,瑪麗醫院肝移植中心進行了香港首例的「左右葉雙肝活體肝移植」, 為鄭先生同步植入他23歲女兒的肝左葉和22歲女兒的肝右葉。三項手術在三間手術室同步進行。 右及左供肝手術分別歷時六小時,雙肝移植手術則歷時十二小時。 動員逾四十名醫護,包括十位移植外科醫生、六位麻醉科醫生、兩位微血管外科醫生、三位放射科醫生、兩位臨床心理學家、兩位肝移植聯絡主任和二十二名護理人員分兩更當值襄助。三項手術均成功,鄭先生及兩個女兒的肝功能都恢復過來。


世界上首例同時雙肝植入

雙肝移植是最挑戰技術的移植手術。每個肝涉及三個主要血管:門靜脈、肝動脈、肝靜脈,需要於植入時重建。雙肝移植術通常的方法是先植入右肝然後左肝,總共分開四個肝靜脈及門靜脈吻合。這種方法累贅及延長器官缺血時間。相比之下,我們的獨特方法──首先於體外將兩個供體的肝靜脈及門靜脈吻合,然後才直接植入受肝者下腔静脈及門靜脈,從而簡化及提高植入效率,大大減少缺血時間。據我們所知,此為世界首宗同時雙供肝植入以這種方式進行的。
姊妹齊肝救父,兩姐妹的愛和勇氣挽救了父親的生命。香港大學瑪麗醫院肝移植中心再一次在移植領域上作出重大突破。

傳媒查詢:7306 9243 瑪麗醫院傳媒聯絡主任
二零一五年八月二日