Living donation opens new doors for colorectal cancer patients in need
of liver transplants
Date:
March 30, 2022
Source:
University Health Network
Summary:
A study is the first in North America to demonstrate that
living-donor liver transplant is a viable option for patients who
have systemically controlled colorectal cancer and liver tumors
that cannot be surgically removed.
FULL STORY ==========================================================================
A study published in the Journal of the American Medical Association
Surgery is the first in North America to demonstrate that living-donor
liver transplant is a viable option for patients who have systemically controlled colorectal cancer and liver tumors that cannot be surgically removed.
========================================================================== "This study proves that transplant is an effective treatment to improve
quality of life and survival for patients with colorectal cancer
that metastasized to the liver," said senior study author Dr. Gonzalo Sapisochin, a transplant surgeon at the Ajmera Transplant Centre and
the Sprott Department of Surgery at University Health Network (UHN).
"As the first successful North American experience, it represents an
important step towards moving this protocol from the research arena
to standard of care," adds Dr. Sapisochin, who is also a clinician
investigator at the Toronto General Hospital Research Institute and an Associate Professor in the Department of Surgery at University of Toronto.
The study, which was conducted at UHN, the University of Rochester Medical Center (URMC), and the Cleveland Clinic, focused on colorectal cancer
in part because of its tendency to spread to the liver. Nearly half of
all patients with colorectal cancer develop liver metastases within a
few years of diagnosis and 70 percent of liver tumors in these patients
cannot be removed without removing the entire liver.
Unfortunately, deceased-donor liver transplant is not a viable option
for most of these patients because, despite their tumors, their liver
function is fairly normal, which lands them toward the bottom of the
national organ transplant waiting list. In North America, one in six
patients dies each year while waiting for an organ on this list.
Thanks to recent advances in cancer treatments, many of these patients
are able to get their cancer under systemic control, which means their
liver tumors are the only things standing between them and a "cancer free" label. It also increases the odds that these patients -- and their new
livers -- will remain cancer free, which is crucial when balancing the
benefit to the patient with the risk to a living donor.
========================================================================== "I've seen so many cancer patients, whose cancers were not spreading, but
we couldn't remove the tumors from their livers and we knew they would
die," said first study author Dr. Roberto Hernandez-Alejandro, who is
chief of the Abdominal Transplant and Liver Surgery Division at URMC. "We
hoped living-donor liver transplant could give them another chance."
Because it offered a last resort, the study attracted patients from
near and far. All patients and donors went through a rigorous screening
process to ensure they were good candidates for the procedure, and they
were educated about the risks of the surgery and the possibility of
cancer recurrence.
Patients and donors underwent staggered surgeries to fully remove
patients' diseased livers and replace them with half of their donors'
livers. Over time, both patients' and donors' livers regenerate and
regain normal function.
Patients have been closely monitored via imaging and blood analysis for
any signs of cancer recurrence and will continue to be followed for up
to five years after their surgery. At the time the study was published,
two patients had follow-up of two or more years and both remained alive
and well, cancer- free.
"This [study] brings hope for patients who have a dismal chance
of surviving a few more months," said Dr. Hernandez-Alejandro, who
is also an investigator at the Wilmot Cancer Institute. "With this,
we're opening opportunities for patients to live longer -- and for
some of them, to be cured." "We have seen very good outcomes with
this protocol, with 100 percent survival and 62 percent of patients
remaining cancer free one year and a half after surgery," said study
author Dr. Mark Cattral, surgical director of the Living Donor Liver
Program at UHN's Ajmera Transplant Centre and a surgeon in the Sprott Department of Surgery at UHN. "It is very strong data to support that
we can offer this treatment safely and make appropriate use of scarce life-saving organs." The authors have no competing interests to disclose.
This work was supported by generous donors to UHN Foundation.
========================================================================== Story Source: Materials provided by University_Health_Network. Note:
Content may be edited for style and length.
========================================================================== Journal Reference:
1. Roberto Hernandez-Alejandro, Luis I. Ruffolo, Kazunari Sasaki, Koji
Tomiyama, Mark S. Orloff, Karen Pineda-Solis, Amit Nair, Jennie
Errigo, M. Katherine Dokus, Mark Cattral, Ian D. McGilvray, Anand
Ghanekar, Steven Gallinger, Nazia Selzner, Marco P. A. W. Claasen,
Ron Burkes, Koji Hashimoto, Masato Fujiki, Cristiano Quintini,
Bassam N. Estfan, Choon Hyuck David Kwon, K. V. Narayanan
Menon, Federico Aucejo, Gonzalo Sapisochin. Recipient and Donor
Outcomes After Living-Donor Liver Transplant for Unresectable
Colorectal Liver Metastases. JAMA Surgery, 2022; DOI:
10.1001/jamasurg.2022.0300 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/03/220330121407.htm
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