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.”

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.