Putting Hong Kong on the World Liver-Transplant Map — HKU's Living-Donor Breakthroughs (from 1991)

The University of Hong Kong (HKU) Comprehensive Information Database · 04 Research Module Alongside its most internationally recognised strength in emerging infectious diseases and virology (see signature-virology-infection.md and hku-named-pathogens.md), HKU's other signature research area is surgery — living-donor liver transplantation in particular. This article focuses on that clinical–research breakthrough. For an overview of HKU's research achievements, see achievements.md; for its teaching hospital, Queen Mary Hospital, see ../11-medical-hospital/teaching-hospitals.md; for the State Key Laboratory of Liver Research (SKLLR), see institutes-and-labs.md; and for major research honours and named chairs, see named-centres-and-honours.md. Following this archive's house style (factual sections 00–12), historical and award-winning scientists are named factually as recorded; living clinical specialists are described strictly in terms of their professional contributions, with no reference to other identities.

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# 1. The starting point: Hong Kong's first liver transplant, 1991

• According to the HKU Department of Surgery's official page^※, the HKU team completed Hong Kong's first successful liver transplant in October 1991;
• According to the same page^※, Queen Mary Hospital's liver transplant service has since grown into one of the largest programmes of its kind in China and Southeast Asia.

Early liver transplantation relied overwhelmingly on deceased (brain-dead) donors. In Chinese societies, however, both the cultural acceptance of brain-death organ donation and its legal framework were slow to develop; registered donor rates were low, and critically ill patients with end-stage liver disease or acute liver failure on the waiting list often died before a suitable deceased-donor liver became available. This structural shortage — "patients waiting while no liver comes" — was the direct impetus for HKU's turn towards living donation. If a whole deceased-donor liver could not be found in time, could a healthy relative donate part of their own? The liver is one of the few human organs with strong regenerative capacity: in both donor and recipient, the organ grows back to near its original volume within months. That physiology was the foundation on which living-donor transplantation could be built.

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# 2. The living-donor "triple jump" (1993 → 1996)

Donor-liver shortage is a worldwide problem in transplantation; "living-donor liver transplantation" — in which a healthy relative donates part of their liver — is the key avenue around it. HKU advanced along this line in rapid succession:

According to the HKU Surgery official page^※, the 1996 adult right-lobe living-donor transplant is described as an innovative technique that offered a "life-saving option for critically ill patients".

# Why the right-lobe technique was hard: one operation, two healthy lives at stake

The real difficulty of right-lobe living-donor transplantation lies in the stringent demands it places on both donor and recipient: the surgeon must safely remove a large portion of liver from a living, healthy donor without endangering the donor's life, and then precisely connect that half-liver into a critically ill recipient with good blood flow. One technical crux that drew repeated study was the fate of the middle hepatic vein — whether to take it with the right-lobe graft directly determines whether the venous drainage of the graft's right anterior section is adequate, yet taking it can compromise venous drainage on the donor's side. The HKU team researched this detail systematically, publishing the case for and against including the middle hepatic vein in right-lobe grafts, with safety data, in Annals of Surgery and other journals^※, gradually converting a high-risk operation once driven by "feel" into a standardised, anatomically grounded and reproducible procedure.

The team also consolidated its experience at scale: Lessons Learned from One Hundred Right Lobe Living Donor Liver Transplants, a retrospective of 100 consecutive adult right-lobe living-donor transplants between May 1996 and May 2002, appeared in Annals of Surgery (2004)^※. Papers of this sort — laying out a hundred cases and showing plainly where problems arise — are exactly what moves surgical innovation from "individual success" to "systematised procedure": they let transplant centres around the world avoid repeating the mistakes HKU had already made.

Why the right-lobe technique matters especially in Asia. The value of right-lobe living donation is amplified in Asia. According to an HKUMed column^※, local deceased (brain-dead) organ donation has long been in shortage; across several Chinese societies in East Asia, acceptance of brain-death donation has spread slowly and registration rates are low, leaving deceased-donor livers far short of demand. Western transplant centres can rely much more on deceased donors, so adult recipients feel less acute pressure for living right-lobe grafts; in Hong Kong, Japan, Korea and mainland China, by contrast, living donation is often the only realistic option for critically ill adults. When HKU crossed the "adult right lobe" threshold first in 1996, it hit precisely the tightest bottleneck in East Asian transplantation — according to the Hong Kong Academy of Sciences^※, the technique is today widely adopted. This was no mere refinement: it was the key that opened the door to adult living-donor transplantation across an entire region.

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# 3. The "Father of Liver Transplantation" and his team

No surgical innovation emerges from thin air. HKU's adult right-lobe living-donor programme is inseparable from one central figure in the Department of Surgery.

• According to his profile at the Hong Kong Academy of Sciences (ASHK)^※, Professor Sheung-Tat Fan served as Chief of the Liver Transplantation and Hepatobiliary Surgery unit at Queen Mary Hospital from January 1988 to June 2008, performed Hong Kong's first successful transplant in 1991, and in 1996 pioneered adult right-lobe living-donor transplantation — an innovation that "alleviated the continuing shortage of organs for adult patients" and is now widely adopted. He joined HKU as a lecturer in 1987 and was promoted to Professor of Surgery in 1993; as the earliest and most systematic advocate of living-donor liver transplantation in a Chinese society, he has been called Hong Kong's "Father of Liver Transplantation" in the media.
• According to the Hong Kong Academy of Sciences^※, Fan's team's living-donor transplant achievements received a First-Class National Science and Technology Progress Award in 2005; in the same year he was elected an Academician of the Chinese Academy of Engineering (Division of Medicine and Health Engineering). This pins down the award — previously listed here as "unverified" — to a definite grade and year.

That HKU wrote the procedure down and taught it to others is itself evidence of research (as opposed to mere surgical prowess). The team distilled its experience into a monograph, Living Donor Liver Transplantation, edited by Sheung Tat Fan and others, published and reprinted by World Scientific^※, which became an international reference for learning the technique; the department also maintains open teaching resources such as "Liver Transplantation in a Nutshell"^※. A surgical innovation that can be written up as a textbook, replicated at other centres and repeatedly validated by patient-survival data is precisely what distinguishes a "research breakthrough" from "a single successful operation".

At the team level, the advance of adult living-donor transplantation is also tied to the clinical work of another HKU surgical specialist, Lo Chung-mau. As pieced together from public reporting^※, the HKU/Queen Mary team's clinical contributions — in adult living donation, in replacing the traditional left lobe with the right lobe, and in raising patient survival rates — formed the team backbone of this "triple jump". In keeping with this archive's factual-section conventions, this article focuses on institutional and technical milestones; the attribution of individual surgeons on each case follows official publications and paper bylines.

# Donor safety: the bottom line on which the whole technique rests

The question most often asked about living donation is: what is the real risk when you cut away half the liver of a healthy person? The HKU team's publicly reported data over the years answers this head-on.

• According to an HKUMed column of April 2024^※, the operative mortality rate for living liver donors is extremely low — about 0.1% for left-lobe donation and 0.5% for right-lobe donation, with a complication rate of around 20%; adult living donation mostly uses the right lobe, and the operation takes 6 to 8 hours, involving intricate dissection of vessels and bile ducts.
• According to the same column^※, the human liver regenerates: the donor's remaining liver grows back to roughly its original size within two to three months; living-donor liver transplantation has been performed at Queen Mary Hospital since 1994, with more than 840 cases completed to date (per this column's count). The article stresses that "donor safety is the part we value most" — the line between daring to do living transplantation and doing it responsibly.

The very existence of Hong Kong's living-donor programme is directly tied to the shortage of deceased (brain-dead) organ donations locally: critically ill patients who cannot obtain a deceased-donor liver have nowhere to turn but a relative's donation. This also explains why HKU invested so heavily in research on the donor side — because in Chinese societies living donation is not an "option" but often "the only option". Keeping donor risk to a minimum and donor recovery as fast as possible directly determines how many families are willing to take the step of donating — and therefore how many critically ill patients live to receive that life-saving half-liver.

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# 4. Institutionalisation and scale

Doing an operation once is luck. Turning a breakthrough into capacity means building a sustainable, accountable service with long-term data.

• According to the HKU Surgery official page^※, the department was designated Hong Kong's Liver Transplant Centre in November 2003; dedicated transplant wards opened in October 2011.
• Per the same page (as of early 2016)^※, cumulative transplants stood at 1,148 (134 paediatric, 1,014 adult); overall survival was 92.9% at one year, 88.2% at three years and 85.8% at five years.
• Per the Queen Mary Hospital Liver Transplant Centre (as of end of December 2022)^※, cumulative transplants had reached 1,585 (173 paediatric, 1,412 adult); for living-donor transplantation specifically, one-, three- and five-year survival were 93.5%, 89.5% and 86.9%.

The numbers speak for themselves: between 2016 and 2022, cumulative volume rose by roughly 400 cases, while five-year survival held steady rather than falling. For a high-difficulty, high-risk transplant programme, "volume up, quality holding" is far stronger evidence of a mature system than a brilliant world first.

What "designated centre" means. According to the HKU Surgery official page^※, the November 2003 designation as Hong Kong's Liver Transplant Centre meant the territory's transplant services had, institutionally, a single concentrated hub: transplant assessment, surgery and long-term follow-up for patients with severe liver disease and acute liver failure could all converge on one team with complete cumulative experience. That both guaranteed enough caseload to keep the team skilled — transplantation is the archetypal "the more you do, the safer it gets" operation — and gave Hong Kong the conditions to systematise its experience and export it to other centres in the region. Queen Mary Hospital's liver transplant service is officially described as "one of the largest of its kind in China and Southeast Asia", a standing built precisely on this "concentration plus continuity" institutional arrangement.

Background statement: A "world first" in surgical technique, combined with long-term, publicly available high survival rates, makes HKU liver transplantation an example of "clinical excellence + research output" fused in one. Together with its strength in emerging infectious diseases, it underlies the dual image of HKU medicine as both "saving patients before us" and "advancing the disciplinary frontier".

It is worth clarifying for the reader that "surgical breakthroughs" and "laboratory breakthroughs" are often treated differently in research narratives — the former can be mistaken for merely "doing surgery well" rather than "making scientific discoveries". But HKU's living-donor programme shows precisely that frontier surgery is itself a form of research: from "can adults receive living-donor grafts at all" to "left lobe or right lobe" to "should the middle hepatic vein be taken with the right-lobe graft", every step required systematic innovation in anatomy, physiology and operative technique, established in a way that was reproducible, publishable and adoptable by others. The 1996 adult right-lobe living-donor transplant is called "practice-altering" precisely because it was not an isolated successful operation but a method other transplant centres worldwide could learn and replicate — that is what "research breakthrough" truly means. Listing it in the 04 Research module, rather than recording it merely as a clinical service, is deliberate: beyond the laboratory front line of emerging infectious diseases, HKU medicine carries a second, equally world-influential research thread represented by "surgical innovation".

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# 5. Recent frontiers: from "reduce-and-remove" transplants to robotic surgery

The HKU liver transplant story did not stop in the 2000s. In recent years the team has pushed innovation in two new directions: widening who is eligible for a transplant, and transforming how the liver is harvested.

# 5.1 "Reduce and Remove": downstaging advanced liver cancer before transplant (2023)

By the time liver cancer reaches intermediate or advanced stages, it often falls outside transplant criteria: the tumour is too large or too late, and recurrence after transplant is likely. The HKU team's gambit: first shrink the tumour with stereotactic body radiotherapy (SBRT) plus immunotherapy (Reduce), bringing the patient from "inoperable" back to "operable", then remove the diseased liver entirely by living-donor transplant (Remove) for a cure.

• According to an HKU press release of 13 December 2023^※, the team reported the world's first case in which stage-4 liver cancer was downstaged to stage 1 and then completely removed by living-donor transplant. One patient, 65-year-old Mr. Wong, had an initial tumour of 18.2 cm, shrunk to 9 cm after about six months of treatment; pathology after transplant confirmed only 1.5 cm of tumour remained (stage 1), with no recurrence at four months.
• According to the same release^※, another patient, 85-year-old Mr. Ko, originally had two tumours (6.5 cm and 3.1 cm), shrunk by treatment to 2.3 cm and 1.8 cm; after liver-preserving surgery he was discharged on the fourth day — showing the "downstage-first" strategy applies not only to transplantation but can also bring some elderly, previously inoperable patients back within resectable range. The participating team included Professor Albert Chan Chi-yan (Clinical Professor of Surgery), Chih-Liang Chiang (Clinical Assistant Professor of Clinical Oncology) and Tiffany Chan Miu-yi (Honorary Clinical Assistant Professor of Surgery), all of HKUMed.

The significance of this approach is that it does not tinker with the transplant operation itself, but with the threshold question of whether a patient can be transplanted at all — bringing late-stage liver cancer patients previously judged "untransplantable" back into the curable range. Conventionally, once liver cancer reaches stage 4, most transplant centres exclude the patient, because post-transplant recurrence is highly likely. HKU's approach injects radiotherapy and immunotherapy as a "pre-transplant downstaging" phase: shrink the tumour to transplant criteria first, then cure in one stroke. It is, in effect, adding a new "screen-and-convert" stage in front of the old transplant operation.

# 5.2 World's first robotic-assisted living-donor liver transplant trial (from 2025)

If the right-lobe technique answered "how much liver to take", robotic assistance answers "how to do this demanding operation with greater precision and less trauma to the donor".

• According to SCMP reporting^※, the HKUMed surgery team has launched the world's first clinical trial of robotic-assisted living-donor liver transplantation at Queen Mary Hospital: from June 2025 up to the time of reporting, 48 robotic-assisted operations had been completed, with the report noting no long-term or post-operative complications during that period.
• Per the same report^※, robotic assistance aims to overcome inherent problems of conventional microsurgery, such as the physical strain on the surgeon of maintaining a fixed posture for long periods and the effect of fine hand tremor on delicate anastomoses; the team reportedly includes Clinical Associate Professor of Surgery Wing-Yiu Chiu and Professor Albert Chan Chi-yan, among others.

Robotic assistance matters especially for the donor. Conventional right-lobe harvesting requires a large abdominal incision, with a long recovery and visible scarring; robotic arms can complete the fine dissection of vessels and bile ducts and the liver division through far smaller openings, theoretically reducing the surgical burden and recovery time for the donor — a person, after all, who was not ill to begin with. Minimising trauma echoes the point made earlier, that donor safety is the non-negotiable bottom line. If a new technique makes donation safer and less painful for the donor, it directly enlarges the pool of people willing to donate, and so eases the liver shortage. That is why HKU places the "world's first robotic-assisted living-donor transplant trial" in the newest slot on its transplant map: it improves both surgical precision for the recipient and surgical experience for the donor.

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# 6. World-class recognition

• According to SCMP reporting^※, the HKU/Queen Mary team has performed complex transplant surgeries described as "world firsts", confirming its technical standing at the international frontier. According to reports by China News Service and others in October 2014^※, the "second transplant" performed at Queen Mary Hospital that year involved taking back a liver that had been donated to a hepatitis B carrier, and after the recipient's death, transplanting it into another patient with acute liver failure — one liver thus saving two patients in succession (or more, counting the original deceased-donor chain) — breaking the traditional taboo that "hepatitis B-carrier livers should not be transplanted", and described by the reports as a world first. This kind of exploration — squeezing every usable liver to its limit — is likewise a direct response to the donor-shortage problem.
• According to the Hong Kong Academy of Sciences fellow profile^※, HKU's pioneering work in adult right-lobe living-donor transplantation received a First-Class National Science and Technology Progress Award in 2005 (for the 2004 review cycle, awarded in 2005), and the programme's leader was elected an Academician of the Chinese Academy of Engineering the same year — the state's official recognition of the achievement, and the award this article earlier listed with "careful wording" now pinned to a definite grade and year.

Strung together, three decades of milestones trace a clear upward line. In 1991 HKU started from zero and established liver transplantation as a service in Hong Kong. From 1993 to 1996, faced with the deadlock of donor shortage, it forged its own path through the triple jump of "paediatric living-donor, adult left-lobe, adult right-lobe" — the 1996 right-lobe procedure becoming a world first and winning a National First-Class Award in 2005. From 2003 to 2011 it consolidated the breakthrough into a long-term service with "designated centre plus dedicated wards", proving systemic maturity with over 1,500 cumulative cases and five-year survival approaching 90%. From 2023 it pushed outward at both ends — "indications" (downstaging before transplant) and "technique" (robotic surgery). Each rung was not a repetition of the last but a step forward against the real constraints of donor shortage, restricted indications and donor trauma. Like the virology thread (see signature-virology-infection.md), this surgical thread shows that HKU medicine's world-class standing is not concentrated in a single laboratory, but distributed across multiple front lines, in doctors who "can identify a disease and can also cure it".

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# Unverified / to be confirmed

• Annual and latest cumulative case counts: this article records two reporting points — the official page's "as of early 2016" and the Queen Mary Transplant Centre's "as of end of 2022". The latest cumulative figure after 2023 requires checking the most recent announcements from the HKU Department of Surgery and Queen Mary Hospital.
• Full results of the robotic-assisted trial: the figure of 48 cases was the interim number at the time of reporting; complete follow-up data on long-term survival and donor recovery await subsequent peer-reviewed publications.
• Named team members: this article follows factual-section conventions in focusing on institutional and technical milestones; the named surgeons and team members for individual operations follow official publications and paper bylines.
• An academic-integrity record: According to media reports^※, two papers by Professor Sheung-Tat Fan were retracted in 2015 by the journals concerned over image-sourcing issues. This article records the matter as reported by the source, without passing judgment; nor does it affect the clinical facts established by independent multi-centre adoption of the 1996 right-lobe technique — the procedure's effectiveness rests on extensive independent data from other centres, not on any single paper.

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# Related reading

• HKU's other world-class research strength — emerging infectious diseases and virology: signature-virology-infection.md, hku-named-pathogens.md
• Overview of HKU research achievements and major honours: achievements.md, named-centres-and-honours.md
• The teaching hospital that carries all of this: ../11-medical-hospital/teaching-hospitals.md
• State key laboratories and research platform structure: institutes-and-labs.md

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