Novel liver transplant technique offers new hope for colorectal cancer patients

Editor's Note

Surgeons at Northwestern Medicine have performed the first U.S. case of resection and partial liver transplantation with delayed total hepatectomy (RAPID) to treat metastatic colorectal cancer, according to a March 18 article in Healio. The procedure, which allows a transplanted liver segment to grow before fully replacing a diseased liver, enabled two patients to benefit from the same donated organ. As detailed in the article, this approach could dramatically expand treatment options for patients with liver metastases who are ineligible for traditional transplants.

The idea for RAPID came from European transplant protocols, transplant surgeon Dr. Satish Nadig told Healio. The Northwestern team adapted the approach using machine perfusion, a technique that keeps a liver segment viable outside the body by pumping blood through it.  

The first US patient to undergo RAPID was Barclay Missen, a 53-year-old with stage IV colon cancer who lacked access to a living donor after the disease spread to his liver. Facing hospice, Missen instead underwent the RAPID procedure, which involved transplanting a small section of a deceased donor’s liver next to part of his still-functioning cancerous liver. Over two weeks, the donor liver more than doubled in size, at which point surgeons removed the remaining malignant tissue. Five months later, Missen remains cancer-free, the outlet reports.

The rest of that donor organ is now sustaining Kelli Podrez. Podrez agreed to share her donor organ with Missen, relying on a partial transplant (and the liver’s capacity for regeneration) to treat her cirrhosis.  The complex procedure required two surgical teams working in parallel. One team prepared the donor liver, while the other removed part of Missen’s diseased liver and implanted the new tissue. Blood flow through the vena cava helped the donor segment grow from 360 mL to 860 mL in two weeks, at which point the remaining cancerous liver was removed. Nadig called the achievement a major milestone in US cancer care, adding that RAPID could be performed at any high-volume transplant center with strong oncology and hepatology expertise.

Northwestern has now launched the Colorectal Metastasis to Liver Extraction with Auxiliary Transplant and Delayed Resection (CLEAR) program, which will monitor the first 80 patients undergoing RAPID as part of a clinical trial. Nadig estimates the approach could save 5,000 to 10,000 patients annually. The success also raises questions about whether RAPID could reshape living donor transplants, potentially reducing surgical risks by allowing donors to give smaller portions of their liver.