A Keck Medicine liver transplant specialist explains how transplant oncology is an emerging option for patients with hepatocellular carcinoma, cholangiocarcinoma or colorectal cancer.

Transplant oncology is an emerging discipline that’s giving some cancer patients more options to address cancer and other severe illnesses. The field initially centered on using liver transplantation to treat and cure hepatocellular carcinoma. Today, specialists are expanding the practice and treating other types of liver malignancies and diseases with liver transplants.

“Transplant oncology opens a lot of possibilities,” says transplant hepatologist Jeffrey Kahn, MD, medical director of the USC Liver Transplant and Comprehensive Liver Disease Care Center, part of the USC Transplant Institute of Keck Medicine of USC. The USC Transplant Institute also provides advanced heart, liver and lung transplant care and complex hepatobiliary care to patients living in Southern Nevada at its state-of-the-art facility Keck Medicine of USC – Las Vegas.

“I think it’s a very exciting time for oncology,” Kahn adds. Here, he discusses what’s currently possible in transplant oncology — and what could come next.

Liver transplant for primary hepatobiliary diseases

“Traditionally, we would transplant patients with liver disease who were developing liver failure,” Kahn says. “The first liver transplant oncology realm was for hepatocellular carcinoma. But that’s become more expanded now.”

Kahn explains that over the past two decades, treating cholangiocarcinoma with a liver transplant has become a more recognized option. Currently, liver transplant may be an option for patients with perihilar cholangiocarcinoma.

Intrahepatic cholangiocarcinoma, located deep inside the liver, may also be considered a reason for transplant. “That’s an area that historically wasn’t transplanted, but now we look into it,” he says.

Although it’s looked at more, liver transplant for cholangiocarcinoma is still a relatively rare practice, he adds. Strict requirements mean that many patients will not qualify for a transplant. To be eligible, the lesions must be unresectable and small, and the cancer must be localized. If the lesions spread outside the liver or reach veins, then transplant isn’t recommended.

Other malignancies considered for liver transplant include epithelioid hemangioendothelioma and neuroendocrine tumors that started in the pancreas, Kahn adds.

Liver transplant for metastatic colorectal cancer

Another emerging area for transplant oncology is patients with colorectal cancer who develop metastatic disease, often to the liver.

Kahn emphasizes that oncologists and transplant teams apply strict and specific criteria to determine if a patient with metastatic colorectal cancer is eligible for a liver transplant, including:

The primary tumor must have been resected.
There should be no other metastases beyond the liver.
Patients need to have undergone systemic therapies first.
Specific tumor markers should be at relatively lower levels.

“This is still a newer area, but it’s becoming more standardized, and the United Network for Organ Sharing now recognizes liver transplant as a treatment for colorectal cancer metastasis,” Kahn says.

Transplant oncology: The importance of living organ donation

A liver with metastatic cancer may still function normally despite the presence of a tumor. Since liver allocation via the United Network for Organ Sharing is based on liver disease severity, a patient with liver metastasis is less likely to receive a transplant via the national registry, Kahn explains.

Living-donor liver transplantation has helped make transplant oncology more of an option for select patients. The USC Living-Donor Liver Program, part of the USC Transplant Institute and Keck Medicine, is just one of two programs in California performing living-donor liver transplants, and the only one in Southern California.

“There are a lot of patients who don’t qualify for a liver transplant because of tumor size or extent of the cancer, and a transplant isn’t the right option for everyone,” Kahn cautions. “However, if you have a patient with hepatocellular carcinoma, cholangiocarcinoma or colorectal cancer, consider making a referral. It never hurts to evaluate the patient and consider transplant as a possibility.”

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Transplant Oncology Is Expanding Cancer Care Possibilities