Oncology: ISMETT at the forefront of liver cancer treatment with transplants

An Italian woman from Catania with a cholangiocarcinoma, a liver cancer affecting the biliary tract, could not undergo a surgical resection that represents the standard treatment for this type of disease. For this reason, the medical team at IRCCS ISMETT in Palermo opted for a liver transplant, after administering a neoadjuvant treatment to reduce the volume of the tumor. An unconventional therapeutic approach that ensured the patient was able to resume a good quality of life. “The patient was discharged a few days after the surgery,” said Dr. Salvatore Gruttadauria, Director of the IRCCS ISMETT Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation. “Now she is in excellent conditions and can return living a full life.”

Although the surgery took place a year ago, doctors wanted to make sure this unconventional therapeutic approach worked before releasing the news. Liver transplantation as a treatment for liver tumors in early or metastatic phase is, in fact, the subject of new multicenter studies started by IRCCS ISMETT in collaboration with the Sicilian network of cancer centers.

The Lancet Oncology published the first multicenter study, which also included IRCCS ISMETT, which showed the therapeutic validity of liver transplantation in cases of liver cancer. The case of the Catania patient falls within the scope of a series of multicenter studies that, in line with the indications of Lancet Oncology, aim at treating primitive and metastatic liver tumors with transplantation, usually not the standard treatment in these cases. “In selected cases, when patients with a cholangiocarcinoma cannot be treated with a liver resection, which remains the ideal approach, a liver transplant can represent an effective therapeutic option,” said Dr. Gruttadauria.

Liver transplant has been demonstrated to be the best choice also in the case of living donation. The possibility to receive a living-related liver transplant has proven particularly favorable for patients before their liver disease deteriorates.  The Italian National Transplant Center (CNT) in agreement with the Italian transplant centers is very seriously considering using this therapy to treat some metastatic tumors of the liver. IRCCS ISMETT is leading this path.

The center in Palermo ranks first among the Italian centers for living-related liver transplants with 156 transplants performed to date, of which 104 in adult recipients. The latest one was made possible thanks to a 31-year-old man from Caltagirone (Sicily) who donated 60% of his liver to his mother suffering from an end-stage liver disease. The donor was discharged 10 days after the procedure and is now back to his normal life, and so is his mother. “The outcomes of living-related transplants are better compared to deceased donor transplants.” said Dr. Gruttadauria. “According to a research recently published by a team from the University of Pittsburgh, partner of ISMETT and world leader in this surgical procedure, the three-year survival rate after a living donor transplant is 86% compared to 80% of organ recipients from a deceased donor.”

Offrire la possibilità di un trapianto di fegato da vivente si è rilevato particolarmente favorevole in pazienti trapiantati (?) prima che le condizioni della propria malattia di fegato peggiorino e diventino gravi.