As the largest legacy hospital in Singapore with numerous global awards under its belt, Singapore General Hospital’s journey is one of medical excellence.  Currently, liver transplant is one of SGH’s key services, where SGH’s Transplant programmes perform the highest number of transplants in the country.

Established in 2005, the Liver Transplant programme brings together various specialists from the cluster including hepato-pancreato-biliary/ transplant (HPB) surgeons, hepatologists, and infectious disease specialists and allied health specialists into a multi-disciplinary centre to provide holistic care for patients with liver disease and require liver transplant.

Care is organised around the patients and their needs, where patients have the convenience of seeing their doctors in the same place.

Liver Transplant Services

We offer a full range of comprehensive services related to liver transplantation including:

• Adult living liver donor liver transplant
  • Blood group compatible and incompatible
  • Small for size graft
  • Retransplant
  • Patients requiring inflow modulation
  • Patients with complete portal vein thrombosis
  • Pure laparoscopic donor hepatectomy
• Adult Deceased donor liver transplant
• Combined solid organ transplant
• Pre transplant recipient assessment
• Liver donor assessment Pre and peri liver transplant management
• Lifetime post transplant follow up care
• Post living liver donation care

On top of that, patients will receive full access to supportive care from multi-disciplinary team.

Programme Milestones

SGH's liver transplant programme has consistently broken new ground since its establishment, achieving numerous regional and national firsts that have advanced transplant medicine across Southeast Asia.

• 15 Feb 2006 – 1st Deceased Donor Liver Transplant
• 22 May 2006 – 1st Living Donor Liver Transplant
• 8 Apr 2009 – 1st combined heart and liver transplant in the region
• 18 Jul 2017 – 1st ABO-incompatible transplant in South-East Asia
• 19 Mar 2019 – 1st Laparoscopic Living Liver Donor hepatectomy in SGH
• 26 Mar 2022 – 1st Living Donor Intestinal Transplant in Singapore

Multi-disciplinary Team

Our team (Surgeons, Hepatologists, Infectious Disease Physician, Endocrinologist and Allied Health Professional, etc) is devoted to improving patient care and transplant outcomes, ensuring clinical excellence at its best.

Surgical Techniques & Outcomes

What is Pure Laparoscopic Adult Donor Hepatectomy?

Pure laparoscopic adult donor hepatectomy is a minimally invasive surgical technique where the entire liver donation procedure is performed through small keyhole incisions using a camera and specialised instruments, eliminating the need for large open incisions and resulting in faster recovery, reduced pain, and better cosmetic outcomes for living donors.

One of the major milestones was the introduction of pure laparoscopic adult living donor hepatectomy in 2019.

At the moment, SGH is one of the leading centres in the region for pure laparoscopic adult living donor hepatectomy where 90% of our living donors underwent laparoscopic hepatectomy since implementation.

Several advantages of laparoscopic living donor hepatectomy are:

• Faster recovery
• Improved cosmetics
• Lower postoperative pain
• Lower rate of hernia incidence
• Less adhesions
• Reduce length of stay

SGH deploys its highly experienced surgeons to master the challenges and tackle the complex techniques of laparoscopic liver surgery. SGH HPB surgeons have vast experience with over 1,200 laparoscopic liver resections and annual volume of 140 -150 laparoscopic liver resections per annum.

Since introducing pure laparoscopic adult living donor hepatectomy in 2019, SGH has established itself as a regional pioneer in this advanced surgical technique. The chart below demonstrates our commitment to best practices in minimally invasive approaches, with the overwhelming majority of our living donors benefiting from laparoscopic procedures that offer faster recovery, improved cosmetics, and reduced post-operative complications.

This achievement reflects our surgical team's expertise and dedication to providing donors with the safest, most comfortable experience possible whilst maintaining the highest standards of recipient outcomes.

Our approach is supported by comprehensive research, including a systematic review and network meta-analysis that evaluates outcomes across different surgical techniques for living donor hepatectomy; read more: A systematic review and network meta-analysis of outcomes after open, mini-laparotomy, hybrid, totally laparoscopic, and robotic living donor right hepate

ctomy.

Types of Living Donor Hepatectomy

What is the difference between Deceased Donor Liver Transplant (DDLT) and Living Donor Liver Transplant (LDLT)?

The primary difference lies in the source of the donor liver and timing of the procedure. Deceased donor liver transplant utilises a liver from a deceased donor under Singapore's Human Organ Transplant Act (HOTA), which allows for the removal of kidneys, liver, heart, and corneas from deceased persons for transplantation purposes without requiring consent unless they have opted out. This typically requires patients to wait on a transplant list until a suitable organ becomes available. In contrast, living donor liver transplant involves a healthy living person donating a portion of their liver to the recipient, allowing for planned surgery timing and often shorter waiting periods. Both procedures are highly effective, but living donor transplants offer the advantage of better timing control and often superior outcomes, as demonstrated by SGH's 100% one-year survival rate for living donor cases compared to 97% for deceased donor transplants. The choice between the two depends on factors such as donor availability, medical urgency, and individual patient circumstances.

What are the liver transplant success rates at Singapore General Hospital?

SGH's liver transplant programme achieves exceptional success rates that exceed international standards. Our one-year patient survival rates reach 97% for deceased donor transplants and 100% for living donor transplants, compared to international benchmarks of 91.6% and 90.9% respectively. These outstanding outcomes reflect our multidisciplinary team's expertise in patient selection, advanced surgical techniques, and comprehensive post-transplant care that delivers transplant medicine at its best.

*Analysis for one year only includes SGH benchmarked cases.
For DDLT:, benchmarked cases = 54.1%
For LDLT: benchmarked cases = 40.0%
#Analysis for five year includes all cases.

Legend

DDLT: Deceased Donor Liver Transplant
LDLT: Living Donor Liver Transplant
¹ Organ Procurement and Transplantation Network (OPTN)/Scientific Registry of Transplant Recipients (SRTR) 2021 Annual Data Report: Liver, American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2023; 23(2S1): pp. S178–S263
² Living donor liver transplantation in Europe HepatoBiliary, Surg Nutr 2016; 5(2): pp. 159-175
³ Defining Benchmarks in Liver Transplantation A Multicenter Outcome Analysis Determining Best Achievable Results, Annals of Surgery 2018; 267(3): pp. 419-425
⁴ Novel Benchmark for Adult-to-Adult Living-donor Liver Transplantation Integrating Eastern and Western Experiences,  Annals of Surgery 2023; 278(5): pp. 798-806

Patient Selection Criteria for Success Rate Analysis

Based on patients who received transplants between 2015-2023

Deceased Donor Liver Transplant (DDLT)

Patients included in our success rate calculations:

• MELD (Model for End-Stage Liver Disease) score below 30 (lower scores indicate less severe liver disease)
• BAR (Balance of Risk) score of 9 or below (a measure of transplant complexity and risk)
• No previous liver or bile duct surgery
• No blood clots in the portal vein
• Not in acute liver failure requiring breathing support

Living Donor Liver Transplant (LDLT)

Patients included in our success rate calculations:

• MELD (Model for End-Stage Liver Disease) score below 20
• No blood clots in the portal vein
• No previous major abdominal surgery
• Not in acute liver failure
• Not requiring intensive care, dialysis, or breathing support at time of transplant
• Standard-sized liver graft without special blood flow modifications

Patients excluded from our success rate calculations:

• Cases involving biliary atresia (a childhood liver condition)
• Previous major surgeries (colon, stomach, bile duct, or liver surgery)
• Small liver grafts (less than 0.8 times the recipient's body weight requirement)

Why These Criteria Matter

These selection criteria help ensure we are comparing similar cases when reporting success rates, giving patients a clearer picture of outcomes for patients with comparable medical situations.

Media Engagement

The Liver Transplant Centre actively engages with various media platforms to educate the public about liver health, transplantation procedures, and organ donation, aiming to raise awareness and promote understanding of this critical medical field:

• Daily Cuts - S1E48: A New Lease Of Life | Channel News Asia
• Man lives to see birth of daughter after liver donation from his brother | The Straits Times
• SGH is first in South-east Asia to perform living donor liver transplant involving incompatible blood groups | The Straits Times

Liver Transplant Resources for Patients

Our webpage serves as a vital knowledge hub for those navigating the complexities of liver transplantation. This extensive collection of materials offers insights into every aspect of the transplant process, from initial evaluation to long-term post-transplant care. We strongly emphasize the importance of patients and caregivers educating themselves through these resources, as informed individuals are better equipped to work in partnership with the clinic to manage their condition effectively.

• Liver Transplant Booklet (English)
• Liver Transplant Booklet (Chinese)
• Liver Transplant Booklet (Malay)
• Living Donor Booklet
  
• Post Transplant Information Sheet
  
• Post Transplant Recovery