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Article

Duke Liver Transplant Expands Oncology Care

Transplant used to treat selected liver and colon cancers

Jordan McCollum

Published

October 8, 2024

For many years, transplantation has been used as an effective treatment for patients with primary hepatocellular carcinoma (HCC), but patients with other types of primary liver cancer or metastases to the liver were not considered candidates for transplant oncology. However, recent research has found that other types of cancer can also be treated effectively with transplant.

“This is a new era in liver transplant oncology,” says Duke hepatologist Bonike Oloruntoba Sanders, MD. “Now we have evidence to offer transplant as an option to treat two other patient populations who have a malignancy.” Intrahepatic cholangiocarcinoma (ICC) and colorectal cancer with liver metastases (CRLM) have both been shown to be treated well by liver transplant when resection is not an option.

Transplant as oncology treatment

For HCC, transplant has long been an effective treatment. “Even if you can use locoregional and systemic therapy, cancer can affect the whole liver,” Oloruntoba notes. “If you remove the liver, it significantly decreases the risk of recurrence to less than 10% after five to ten years.”

A significant proportion of colorectal cancer patients develop metastasis to the liver. “Survival rates have increased since these studies began because all the modalities to treat CRLM have improved,” says Oloruntoba. “But sometimes we just can’t get them to a point where the cancer is resectable.” International research has shown that that amongst carefully selected patients, liver transplantation can prolong survival.

Transplant as treatment for ICC was a discovery made during the normal course of treatment, Oloruntoba explains. Some patients with primary liver cancer received a transplant, but explant biopsy identified the cancer as ICC rather than the suspected HCC. “We observed these patients and found that they saw a benefit from transplant,” Oloruntoba explains. “Later, studies found that the transplant was an excellent treatment for subgroups of ICC patients based on tumor size and level of differentiation.”

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Duke’s multidisciplinary transplant program

Duke’s transplant team works with patients across multiple specialties to ensure the success of transplants. “It’s truly a multidisciplinary effort,” Oloruntoba says. “We don’t do anything in isolation.”

Liver transplant candidates are evaluated by an extensive team of hepatologists, surgeons, radiologists, interventional radiologists, cardiologists, medical and surgical oncologists, psychologists, social workers, and financial coordinators for transplant. The specialties confer together to make sure the patient is medically fit, surgically suited, and psychosocially supported to have the best outcome possible.

“Duke is always at the forefront in keeping up to date with advances in transplant medicine,” Oloruntoba says.

Duke Health Referring Physicians

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Transplant used to treat selected liver and colon cancers

Transplant as oncology treatment

Duke’s multidisciplinary transplant program