10th Japan-Korea transplantation forumLiver transplantationLiver Transplantation in Korea: Past, Present, and Future

•Over the last decade, the number of LTs in Asia has increased rapidly, by 10-fold, largely as a result of development of LDLT.•The proportion of HCC patients in adult LDLT in Korea has increased remarkably from 18.7% to 50.3% during the last 10 years.•The clinical outcomes of ABO-i adult LDLTs at a single center with a large number of patients were reported by Song et al; currently their institute's proportion of ABO-i adult LDLT is increased up to 25% of their adult LDLT numbers.•However, the future LT number in Korea is anticipated to decrease by lowering the HBV carrier rate and new potent anti-HBV agents.

PurposeThis study reviewed the past and present status of liver transplantation (LT) and outlooks for the future of LT in Korea.MethodThe first LT in Korea was successfully performed using a deceased donor graft in 1988. Pediatric and adult living donor liver transplantations (LDLTs) were initiated in 1994 and 1997, respectively. From 1988 to 2013, 10,581 LTs were performed at 40 centers, whereas LDLT accounted for 76.5% of all LTs.ResultsIn the early 1990s, the deceased organ donation rate was less than 1.5 per million population (PMP) per year, but it increased to 5 PMP beginning in 2008. Despite the increasing number of deceased donor liver transplantations (DDLTs), high prevalence of hepatitis B virus (HBV)-induced cirrhosis and hepatocellular carcinoma (HCC) has provoked persistent performance of adult LDLT with technical advancement including middle hepatic vein (MHV) reconstruction of right lobe graft and dual graft LDLT with 1 nationwide donor mortality.ConclusionThe number of LTs in Korea in 2010 was 23.2 PMP (1042 LTs/45 million population), lower than 23.5 PMP of Spain, but higher than 20 PMP of the United States. However, future LT numbers may decrease because of lowering the HBV carrier rate (neonatal HBV universal vaccination began in 1992), new potent anti-HBV agents, and lowest birth rate (1.22 children per family) with a decrease of potential live donors.