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Living donor liver transplant viable option for colorectal cancer patients

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A study published in the Journal of the American Medical Association Surgery today 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.        

According to the study, a year and a half after their living-donor liver transplants, all 10 patients were alive and 62 percent remained cancer free.

“This [study] brings hope for patients who have a dismal chance of surviving a few more months,” said the study’s first author, Roberto Hernandez-Alejandro, M.D., who is chief of the Abdominal Transplant and Liver Surgery Division at URMC, which has performed more living donor liver transplants for patients with colorectal liver metastases than any other center in North America. 

“With this, we’re opening opportunities for patients to live longer – and for some of them to be cured,” adds Hernandez-Alejandro, who is also an investigator at URMC’s Wilmot Cancer Institute.

The study, which was conducted across URMC, the University Health Network (UHN) and the Cleveland Clinic, focused on colorectal cancer because it tends to spread to the liver and often cannot be removed from the liver without a full transplant. Unfortunately, these patients are highly unlikely to receive a deceased-donor liver transplant due to chronic organ shortages in North America.

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. Study authors hoped that living-donor liver transplant could give these patients a second chance. 

The study attracted over 90 patients from near and far. All patients and donors went through a rigorous screening process and those who met the specific criteria underwent staggered surgeries to fully remove patients’ diseased livers and replace them with half of their donors’ livers.

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 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 Gonzalo Sapisochin, M.D., a transplant surgeon at the Ajmera Transplant Centre and the Sprott Department of Surgery at 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 Sapisochin, who is also a clinician investigator at the Toronto General Hospital Research Institute and an associate professor in the Department of Surgery at the University of Toronto.

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