• Living donation opens new doors for colo

    From ScienceDaily@1:317/3 to All on Wednesday, March 30, 2022 22:30:46
    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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