Twenty-year survival post-liver transplant: challenges and lessons.

There have been numerous reports on survival outcomes after liver transplantation with short-term and mid-term follow-up. However, only a few reports are available for 20-year long-term survivors after liver transplantation. In Korea, the first successful deceased donor liver transplantation (DDLT) in a 13-year-old Wilson's disease patient was performed in 1988, and the first successful living donor liver transplantation (LDLT) in 9-month biliary atresia patient was performed in 1994. Because of the severe shortage of deceased donors and delayed launching of LDLT from December 1994, only 38 cases of liver transplantation (two pediatric LDLTs and 36 DDLTs) from 1988 to 1994 were included in this study (Strong and Fawcett, Hepatol Int 2015 [1]. doi: 10.1007/s12072-015-9617-1) to investigate more than 20-year survivors. Six adult recipients after DDLT and three pediatric recipients (one DDLT, two LDLTs) are alive now with normal liver function in Korea. Twenty-year survivors after DDLT and LDLT do not show that significant co-morbidities related to long-term immunosuppression and high-dose indefinite HBIG monotherapy has shown the reliable modality to prevent HBV-reinfection for HBV-related liver transplant candidates.