Patients with colorectal cancer that has spread to the liver tend to have poor outcomes and are typically not candidates to receive liver transplants from deceased donors. However, results from a small study on transplanting livers from live-donors could "change this paradigm," an expert said.
Patients with unresectable colon cancer that has spread to the liver tend to have poor outcomes and diminished quality of life.
Transplants from deceased donors are typically reserved for patients who have liver disease or have impaired liver function, and unfortunately most patients with colon cancer that has metastasized to their liver have normal liver functions and are therefore not a priority on transplant lists.
However, recently published study findings have shown that taking parts of a liver from a living donor and transplanting it into a patient with colon cancer that has spread to the liver can lead to prolonged survival and better quality of life.
“These patients (tend to) have a dismal survival. Their treatment is usually only chemotherapy, which can help them get a few months or another extra year of survival. However, with (living-donor) liver transplantation, we’re able to completely change this paradigm and increase survival significantly,” study author Dr. Roberto Hernandez-Alejandro, chief of the Abdominal Transplant and Liver Surgery Division at the University of Rochester Medical Center in New York, said in an interview with CURE®.
Improving Patient Outcomes
The study included 10 patients with colon cancer with unresectable liver metastases who had their liver completely removed and replaced with half of the living donor’s liver. Every patient enrolled on the study had previously received multiple prior lines of treatment. Four patients had previously underwent surgery to remove a part of their liver; three patients received hepatic artery infusion chemotherapy; and three patients underwent tumor ablation, which is a minimally invasive surgical procedure used to treat solid tumors. The average number of chemotherapy cycles before liver transplant was 22.5.
The researchers said that after transplant, both the patients’ and the donors’ liver regenerated and regained full function over time.
A year and a half after the transplant, all patients with colon cancer were still alive, and 62% were cancer-free.
“Our program has been open for three years. It’s too early to be able to call for long-term results, but so far, we have very good results with excellent survival in these patients — around 82% at three years,” Hernandez-Alejandro said. “Also, the recurrence of these patients (meaning when the cancer comes back) is slow.”
Improved Quality of Life
After receiving the transplant, the cancer survivors must undergo immunosuppression, meaning that they inhibit their immune system so that it does not attack the donated organ. This tends to be better tolerated than the typical care for these patients, which is chemotherapy.
“Immunosuppression is pretty well-tolerated, and their quality of life is great,” Hernandez-Alejandro said. “It’s not like having chemotherapy, which is more complex for patients.”
Seven of the 10 patients experienced some form of complication after transplant, including liver complications, acute rejection (better known as the recipient’s body rejecting the transplanted organ), ileus (temporary lack of normal muscle contractions in the intestine), organ space infection and a blood clot in the arteries that provide blood flow to the liver.
Donor Selection Is Crucial
In the study, patients and donors were matched based on blood type, and Hernandez-Alejandro said that the donors went through vigorous screening to ensure that they were eligible to give half of their liver.
“It’s also very important (for) these donors to be really mentally and emotionally fit for being able to donate …. Normally, a donor needs to be someone who is healthy enough and whose blood group matches (the patient) for being a donor. We go for a very detailed workup for these donors as well,” Hernandez-Alejandro said.
On average, liver donors stayed in the hospital for about six days, and while five had post-operative complications, all had a complete recovery and were alive and well at the last follow-up.
“It’s impressive to see how many people want to give this opportunity of life for others,” Hernandez-Alejandro said.
While the patient population was small, and there is still more work to be done, Hernandez-Alejandro said that live-donor liver transplants could eventually change the treatment landscape of patients with colon cancer who have unresectable liver metastases.
“I hope we can present these data soon at a national oncology meeting. This will be a big eye-opener because the oncologists and many colleagues are learning about these (data) and are excited, and they want to learn (about it),” Alejandro-Hernandez said. “This is an option for their patients to have a better outcome.”
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