First liver transplant in Maryland for bile duct cancer

In 2012, only 16 U.S. hospitals performed a combined total of 38 liver transplants for the treatment of this cancer, 13 of which occurred on the East Coast, according to data from the United Network for Organ Sharing (UNOS). Out of 138 hospitals that perform liver transplants across the country, only 50, including the University of Maryland Medical Center, are approved to perform a liver transplant for this indication.

The patient, a 49-year-old Baltimore man, also received chemotherapy and radiation before the surgery as part of the treatment protocol designed to prevent the cancer from spreading into lymph nodes and nearby organs. The transplant protocol was submitted by the University of Maryland Medical Center and approved by UNOS. The multidisciplinary treatment plan was devised and executed by medical and surgical experts across numerous specialties within the University of Maryland Liver Center, including hematology oncologist M. Naomi Horiba, M.D., M.P.H, assistant professor at the University of Maryland School of Medicine, and radiation oncologist Navesh K. Sharma, D.O., Ph.D., assistant professor at the University of Maryland School of Medicine.

"We expect the patient to do very well, but we will follow him very closely to make sure there is no recurrence of the cancer," says Steven I. Hanish, M.D., associate professor of surgery at the University of Maryland School of Medicine and director of hepatobiliary surgery at the University of Maryland Medical Center. "Data has shown that the five-year survival rate for patients with hilar cholangiocarcinoma who receive a liver transplant, combined with preoperative chemotherapy and radiation, can be as high as 70 to 80 percent. Without surgery, the survival rate at five years is nearly zero. Many patients with hilar cholangiocarcinoma die within a year."

Dr. Hanish says that another patient with this type of cancer is currently awaiting transplant and others are under evaluation.

Hilar cholangiocarcinoma originates in the ducts that drain bile from the liver into the small intestine, most frequently in an area where the ducts join together just outside the liver. Surgery to remove the tumor and in some cases part of the liver, typically is the best option, but the cancer is often diagnosed at an advanced stage and may not be operable. Patients also can be treated with radiation and chemotherapy following surgery or as the primary treatment, but the cancer may return or continue to grow. Between 3,000 and 4,000 new cases of bile duct cancer are diagnosed each year in the United States. It represents less than 1 percent of all cancers but is one of the most deadly.

Dr. Hanish says treatment with high-dose radiation may help to shrink the tumor, but ultimately can damage the liver, causing liver failure or other complications, which is why giving the patient a transplanted liver is necessary.

The patient who received the liver transplant at the University of Maryland Medical Center last month was diagnosed with hilar cholangiocarcinoma in 2011. Surgeons determined the cancer could not be removed through a traditional surgical approach. He began taking oral chemotherapy and receiving high-dose, or stereotactic, radiation treatments before being placed on a waiting list for a liver transplant in 2012. A liver became available in April of this year, and it was a match.

"Patients with hilar cholangiocarcinoma have limited treatment options, especially if their tumor is inoperable. The multidisciplinary team at the University of Maryland Liver Center has the unique capacity to bring together experts from radiation oncology, medical oncology, interventional radiology, surgery and hepatology to evaluate each patient very carefully and to devise an individualized treatment plan. To qualify for a liver transplant, patients must meet numerous criteria, but for some, it may represent their best chance for a potential cure," says Rolf N. Barth, M.D., associate professor of surgery at the University of Maryland School of Medicine and director of liver transplantation at the University of Maryland Medical Center.