Any use of transplant surgery and medicine to increase the survival and/or quality of life for cancer patients is referred to as transplant oncology. The current knowledge and trends gained in transplant oncology have provided profound solutions for some of the most aggressive liver diseases including metastatic colon cancer. The success of liver transplantation for hepatocellular carcinoma and cholangiocarcinoma, together with developments in the treatment of colorectal liver metastases and immunosuppression, has rekindled interest in liver transplantation as a potential gamechanger for selective patients with non-resectable colorectal liver metastases.
Dr. Cristiano Quintini, Institute Chair, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, says, “The first prospective trial evaluating liver transplantation for non-resectable colorectal liver metastases was the SECA-I study, which proved liver transplantation could be an excellent option in selected patients with unresectable metastatic colon cancer with an estimated five-year survival of 60 percent. By employing stricter selection criteria, the SECA-II trial increased the projected five-year survival to 83 percent. This is in sharp contrast to a 5-year overall survival rate of about 10 percent of patients receiving palliative chemotherapy.”
Slated as a promising area in cancer management, transplant oncology is improving patient outcomes and with it, a surge in activity in this emerging field, with a shift from treating the less aggressive cancers such as hepatocellular carcinoma, to focusing on the more aggressive, such as metastatic colon cancer and cholangiocarcinoma.
As the first comprehensive multiorgan transplant center in the country and with the Oncology Institute, Cleveland Clinic Abu Dhabi’s state-of-the-art facility and renowned expertise is well positioned through transplant oncology to provide care for many advanced stage liver cancers previously deemed incurable. The transplant oncology program benefits from some of the most advanced surgical techniques and innovations in the field of liver transplantation such as a living donor liver transplantation and advanced systemic chemotherapy and locoregional radiation oncology treatment that are offered before the transplant process begins.
Dr. Quintini says, “Transplant oncology as an evolving field for the management of hepatocellular carcinoma, intrahepatic biliary cancer, and liver-only metastasis of non-hepatobiliary origin seems promising. Treatments include the standard allotransplantation procedure, where we transplant an organ or tissue from one individual to another with a different genotype, also called an allograft, to more complex treatment procedures such as ex-vivo liver resection and auto transplantation as alternatives to allotransplantation for end-stage metastatic colon cancer or cholangiocarcinoma. Cleveland Clinic Abu Dhabi is the only regional institute that has the necessary know-how and expertise to lead this transformational treatment paradigm shift.”
Additionally, Cleveland Clinic Abu Dhabi is soon starting a program to revive and assess injured organs in what will be the first regional organ perfusion center. Ex-vivo machine perfusion of the liver has been an effective approach in recent years for both improved organ preservation and evaluation of organs before transplantation. Lung and kidney perfusion, similarly, has allowed thousands of transplants to be successfully transplanted. Through this method Cleveland Clinic Abu Dhabi can save and enhance the performance of organs that otherwise would be discarded. This preservation technology allows to keep organs functional outside the body by recreating a near physiologic environment with blood and nutrients pumped through the organ.
“We have a unique ability to treat all levels of colon cancer, from the simplest version to the most complex, advanced case. How we do that is by offering multidisciplinary oncology care that is assisted by a recognized transplant program. With more research being conducted in the transplant oncology area worldwide, survival outcomes for liver transplantation in selected patients with non-resectable colorectal liver metastases will see improved numbers in the foreseeable future and give hope to many patients,” says Dr. Quintini.
With the help of such cutting-edge technology, and as transplant oncology evolves, Cleveland Clinic Abu Dhabi will continue to pioneer innovative technologies and treatments which solve medical dilemmas which had previously been considered improbable.