Costa Rica's first adult living donor liver transplant successfully performed by Asan Medical Center-trained liver transplantation team

The team of 24 trainees established a local living donor liver transplantation system after completing their training at Asan Medical Center four years ago

"With the help of Asan Medical Center, the lives of patients in Costa Rica have changed."

 

▲ The liver transplantation team at Hospital Doctor Rafael Ángel Calderón Guardia in Costa Rica, who received transplantation training at Asan Medical Center, successfully performed their country's first adult living donor liver transplantation. The photo is from 2019 during their training at Asan Medical Center.

 

On April 11th (Tuesday) at 6 a.m., bright lights turned on in two operating rooms at Hospital Doctor Rafael Ángel Calderón Guardia in Costa Rica. As a mother and daughter entered their respective room side by side, a team of 20 medical professionals from the liver transplantation team began to move busily. In a tense and focused atmosphere, surgery to remove the daughter's healthy right lobe of the liver took place in one room, while preparations were made in the adjacent room to transplant a healthy liver to the mother. Finally, after 18 hours of intense struggle, the daughter's liver was successfully transplanted to her mother, and cheers erupted among the medical team. “We have succeeded!” It was the moment when the first adult living donor liver transplantation took place in Costa Rica. This success was the outcome of a 20-hour flight to Korea four years ago and shadowing the liver transplantation team at Asan Medical Center for over a month, learning surgical techniques from morning till night. The surgery ended without a hitch, and the patient showed a stable recovery, being discharged on the 8th day in a healthy condition.

 

Liver transplantation, first developed by a Korean surgeon about 30 years ago to save patients with critical end-stage liver disease, has borne its first fruit on the other side of the world in Costa Rica, a nation located in Central America.

 

Asan Medical Center recently announced that the transplantation team at Hospital Doctor Rafael Ángel Calderón Guardia under the Costa Rican Social Security Fund(Spanish: Caja Costarricense de Seguro Social), successfully performed Costa Rica’s first adult living donor liver transplantation on April 11th, based on the liver transplantation skill and experience transferred from Asan Medical Center.

 

In 1991, Professor Sung-Gyu Lee of the Division of Liver Transplantation and Hepatobiliary Surgery at Asan Medical Center devised the ‘modified right-lobe graft’ to improve the success rate of living donor liver transplantation. This technique involves creating a new middle hepatic vein in the transplanted right lobe of the liver to ensure proper blood drainage in the entire right lobe.

 

▲ Ms. Jeannette Lorio(left), who underwent Costa Rica’s first adult living donor liver transplantation, and her daughter Ms. Bianca Oviedo, the donor, are captured smiling in a photo taken on the 25th day after the surgery.

 

The modified right-lobe liver transplantation, which has now become the standard surgical procedure worldwide, enabled Ms. Jeannette Lorio(60 years old), suffering from liver cirrhosis in Costa Rica, to receive a healthy liver from her daughter Ms. Bianca Oviedo(32 years old), allowing her to recover her health miraculously.

 

Living donor liver transplantation is more complex and carries a higher risk of complications compared to deceased donor liver transplantation, making it difficult to ensure a high survival rate. However, in Costa Rica, the low organ donation rate (7 per million population) and high waitlist mortality rate (30%) made living donor liver transplantation an urgent necessity.

 

Hospital Doctor Rafael Ángel Calderón Guardia, one of the renowned hospitals in Costa Rica, has over 550 beds and has been at the forefront of performing liver, pancreas, small intestine, and lung transplantations in Costa Rica and Central America.

 

Based on their transplantation experience, the liver transplantation team of Hospital Doctor Rafael Ángel Calderón Guardia reached out to Asan Medical Center, the world’s first hospital to develop modified right-lobe liver transplantation and 2-to-1 living donor liver transplantation, and performed 5,000 cases of living donor liver transplantation until 2018, to embark on the challenge of living donor liver transplantation.

 

Finally, in May 2019, Asan Medical Center decided to transfer the expertise of living donor liver transplantation, and the 24 members of Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team underwent five separate sessions of training at Asan Medical Center until December of that year.

 

The training team consisted of specialists in surgery, anesthesiology and pain medicine, and radiology, as well as nurses from the operating room and intensive care unit. They received six weeks of training on surgery, post-operative care, and complications treatment. The training team enthusiastically participated in every medical aspect of Asan Medical Center’s liver transplantation team, including attending the daily 7 a.m. meetings, participating in the process of obtaining organs from deceased donors, and even involving in late-night emergency surgeries.

 

▲ The liver transplantation team at Hospital Doctor Rafael Ángel Calderón Guardia in Costa Rica sent a group photo with the message "Gamsa-hamnida(meaning ‘Thank you’ in Korean’) Asan Medical Center” along with a letter.

 

After returning to their home country following the training, Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team established various systems in their local setting. These included the living donor liver transplantation program, improvements in vascular reconstruction for liver transplantation, a laparoscopic surgery program, standardization of liver transplantation nursing techniques, intensive care unit nursing management, and infection control for liver transplantation recipients. With these systems in place, they finally achieved a successful adult living donor liver transplantation in April of this year.

 

Professor Vanessa Lopez, a liver pancreatic bile duct and transplant surgery specialist at Hospital Doctor Rafael Ángel Calderón Guardia, who led the surgery said, "With the help of the liver transplantation team at Asan Medical Center, we were able to change the lives of patients and their families in Costa Rica. We would like to express our sincere gratitude to Asan Medical Center’s liver transplantation team for wholeheartedly passing on their expertise and contributing to our success in achieving self-sufficiency in living donor liver transplantation."

 

Professor Sung-Gyu Lee of the Division of Liver Transplantation and Hepatobiliary Surgery at Asan Medical Center stated, "I vividly remember the image of the medical professionals from Costa Rica who displayed a great eagerness to continuously expand their knowledge during their training with us. I want to extend my heartfelt congratulations and gratitude to Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team who skillfully performed the challenging surgery. We will continue to pass on our medical expertise to places that need our assistance, thereby providing patients around the world with second chances at life."

 

▲(From the left) Professor Vanessa Lopez(Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team), Mr. Jinhae Kim(Ambassador of the Republic of Korea in the Republic of Costa Rica), Dr. Mary Munive(Vice President of Costa Rica and Minister of Health), Ms. Marta Esquivel(President and CEO of the Costa Rican Social Security Fund), Ms. Jeannette Lorio(Costa Rica’s first adult living donor liver transplantation recipient), and Ms. Bianca Oviedo(the liver donor) during a press conference held on April 19th, commemorating Costa Rica’s first adult living donor liver transplantation 

 

The knowledge transfer of liver transplantation has been ongoing at Asan Medical Center for a long time. Since 2011, Asan Medical Center's transplantation team has been visiting Mongolia and Vietnam, countries with a high incidence of liver cancer, 2 to 4 times a year to train local medical professionals. Also, more than 250 local medical professionals have been invited to Asan Medical Hospital for specialized training. As a result, the First Central Hospital of Mongolia and Cho Ray Hospital and University Medical Center (UMC) of Ho Chi Minh City (HCMC) of Vietnam are now able to independently perform liver transplantation.

 

Furthermore, Asan Medical Center's liver transplantation team has expanded the scope of their knowledge transfer to other countries. They achieved several significant milestones, including △ Turkey’s first adult living donor liver transplantation in 2001 △ France’s first (the first in Europe) 2-to-1 living donor liver transplantation in 2004 △Turkey’s first 2-to-1 living donor liver transplantation in 2006 △Qatar’s first adult living donor liver transplantation in 2016 △Kazakhstan’s first 2-to-1 living donor liver transplantation in 2019.

 

Asan Medical Center is leading the world in the field of liver transplantation, achieving a remarkable record of 8,000 liver transplantations (6,658 living donor cases, 1,342 deceased donor cases) with a success rate of 98% as of September 2022.