An Unexpected Gift: Unique Liver Transplant at OU Health Highlights One Woman’s Journey from Bile Duct Cancer to New Life

When Kelly Darden and her husband packed up their life in Albuquerque to move to Oklahoma in June 2022, they had no idea their world was about to be turned upside down. What started as an unexplained episode during their drive would lead to a harrowing medical journey, culminating in a complex liver transplant that saved Kelly's life.

"On my drive from New Mexico to here, I had to pull over," Kelly said. "I didn't know what it was. It wasn't a panic attack, but it was just ‘Bam!’ Something was really off about me."

Little did Kelly know; this was the first sign of a rare and aggressive cancer growing inside her. Over the next few months, her health steadily declined. A routine check-up with a new primary care physician raised concerns about her liver function, but it wasn't until a family trip to Dallas in December 2022 that the severity of her condition became impossible to ignore.

"We're in a big furniture store, and everybody was staring at me," Kelly said. "Maybe they don’t like my outfit. What's going on here?"

Kelly's skin had taken on a distinct yellow hue – a telltale sign of jaundice that would send her rushing to urgent care and then the hospital by ambulance.

After a battery of tests, Kelly received devastating news on February 2, 2023. Her physician delivered a diagnosis she could barely pronounce, let alone comprehend cholangiocarcinoma, a rare cancer of the bile ducts.

"I'm like, ‘What is that?" Kelly said. "What does this long word mean? What are you telling me?"

The reality was grim. Kelly had Stage II bile duct cancer, a notoriously difficult disease to treat. Her bilirubin levels – a key indicator of liver function – were skyrocketing. Normal levels typically fall below 1.2 milligrams per deciliter; Kelly's had reached a staggering 19.

Hilar cholangiocarcinoma – bile duct cancer that occurs where the ducts exit the liver – is one of the most lethal cancers and among the hardest to treat. The overall five-year survival for those diagnosed with this disease is less than 10%. Historically, the only chance at a cure is to surgically remove part of the organ.

Kelly was referred to OU Health Stephenson Cancer Center for treatment, and over the proceeding months, had 40 rounds of radiation therapy, administered twice daily. She underwent chemotherapy that left her severely weakened. Doctors attempted to place stents to improve her bile flow, but these provided only temporary relief.

"I had so many surgeries on that little thing," Kelly said, referring to her bile duct. Despite the aggressive treatment, her condition continued to deteriorate. By late 2023, Kelly's doctors estimated she had only three to four months left to live.

Kelly's cancer care team at OU Health wasn’t giving up, combining expertise with compassion throughout her journey. Stephenson Cancer Center hematologist-oncologist Dr. Ryan Nipp, M.D., MPH, associate professor in the Section of Hematology/Oncology in the Department of Internal Medicine at the University of Oklahoma College of Medicine, stood out as a beacon of support.

"Dr. Nipp was amazing," Kelly said. "He was just amazing with my journey, and he did everything he could."

Finding New Hope

More aggressive options were needed when conventional treatments proved insufficient, Dr. Nipp continued to collaborate with other specialists, including Stephenson Cancer Center surgical oncologist Dr. Ajay Jain, M.D., FACS, G. Rainey Williams Chair in Surgical Research and professor and Chief of the Division of Surgical Oncology in the Department of Surgery at the OU College of Medicine.

Historically, the only chance at a cure for hilar cholangiocarcinoma was to surgically remove part of the organ. For the few patients who are candidates for surgery, the complex operation requires removing up to 70% of the liver, resulting in a higher risk for continued problems or death. The procedure is only performed at a few high-volume centers with expertise and resources for complex hepatobiliary surgery, which now includes OU Health.

Kelly was initially thought to be a candidate for removing 70% of her liver, and she underwent a procedure to divert blood flow from the right side of the liver (the part to be removed) to the far left side of the liver in order to make it grow. The procedure worked, but unfortunately the cancer progressed, and the surgery was no longer an option.

“This is when the discussion of transplant became robust,” said Dr. Jain. “Only a few centers in country offered it. Our multidisciplinary group (surgical oncology, transplant, medical oncology and radiation oncology) had discussed starting a transplant program for some time and had set up the infrastructure, but we didn't have a good candidate. Given her young age, good health and more, Kelly was deemed a good candidate by the group.”

The transplant technique for bile duct cancers differs from liver transplant done for liver failure or liver cell-based cancer. A standard liver transplant disconnects the bile ducts, but for Kelly’s transplant, the team needed an extensive removal of the bile duct, which joins the liver to the bowels near the pancreas.

The transplant team was led by OU Health Transplant Institute surgeon Dr. Narendra R. Battula, MBBS, MRCS, M.D., FRCS, associate professor in the Division of Transplant Surgery in the Department of Surgery at the OU College of Medicine, and assisted by transplant surgeon Dr. Maheswaran Pitchaimuthu, M.D., assistant professor in the Division of Transplant Surgery in the Department of Surgery at the OU College of Medicine.

Dr. Battula and his team took on the task of performing Oklahoma's first liver transplant for bile duct cancer using the latest science and an approach developed by Mayo Clinic in Minnesota in the early 1990s that includes a stringent selection process, treatment protocol, and use of multidisciplinary team collaboration ahead of the transplant. The approach not only saved Kelly's life but also opened new possibilities for treating this rare and aggressive form of cancer in the state.

A Gift of Life Changes Everything

While liver transplants are not uncommon, performing one on a patient with active bile duct cancer is typically only done at academic health systems with high-volume programs and expertise not only in surgical transplant, but in managing complex cancers. Another major challenge, however, was getting on the transplant list, a process typically reserved for patients who are sick enough to urgently need a new organ, but healthy enough to survive the surgery.

Kelly's cancer had progressed to the point where she qualified for the list, but time was not on her side. The average wait for a liver is around six months.

"I don't have six months," Kelly remembers thinking.

On January 14, 2024, the call came. A compatible liver was available, and Kelly needed to get to the hospital immediately. The surgery began just after midnight on January 15, marking the first time a liver transplant for bile duct cancer had been performed in Oklahoma using the latest science and treatment protocols. Previously, patients were leaving the state for these surgeries and going to academic medical centers in other states.

The operation was a success, but Kelly's journey was far from over. She spent two weeks in intensive care, followed by nearly two months in the hospital. The physical recovery, which is still ongoing, was challenging. Even more difficult was the emotional toll.

"I just bawled every night," Kelly said, describing the complex feelings of gratitude and guilt that overwhelmed her. "I cried myself to sleep at night thinking that somebody died to give this gift to me, and how unfair that was."

Kelly later learned her liver came from a 21-year-old donor. This knowledge has profoundly impacted her outlook on life and her plans for the future.

"I'm excited for what it will bring," she says. "I'm so grateful, and I'm actually getting a little more spiritual as a result."

As Kelly approaches the six-month mark post-transplant, she's regaining her strength and adjusting to her new normal, thanks in part to the emotional therapy she also receives at OU Health. Her cancer is gone, but she still takes a host of medications to prevent rejection of her new liver and must be vigilant about infection risks due to her compromised immune system.

Yet, Kelly's focus is increasingly on the future and how she can honor her donor's gift. She dreams of starting a campaign in her donor’s name to encourage restaurants to offer bottled water, a safer option for transplant recipients who must avoid potential contaminants in tap water and ice.

For others facing a similar diagnosis, Kelly offers words of encouragement.

"You are strong enough, and if you give it to God, He will take care of you,” she said. “Just let it go. People are praying for you.”

Kelly's story highlights the critical importance of organ donation. One person's decision to be a donor gave Kelly a second chance at life – a gift she intends to make the most of every single day.

As Kelly looks to the future, she carries with her not just a new liver, but a renewed appreciation for life and a desire to make a difference. Her journey from a dire prognosis to a groundbreaking transplant is a beacon of hope for others battling rare and aggressive cancers.

Kelly's appreciation extends beyond the OU Health surgeons to encompass the entire care team.

"The nurses I had were fantastic in the ICU, and I had some great ones on the floor," she said.

This comprehensive, patient-centered approach to care helped Kelly navigate the physical and emotional challenges of her treatment, leaving her with a deep sense of gratitude for the team at Stephenson Cancer Center that gave her a second chance at life.

Find expert cancer care at OU Health Stephenson Cancer Center - Oklahoma’s only National Cancer Institute-Designated Cancer Center – or learn more about transplant services at the OU Health Transplant Institute.