First Evidence-Based Liver Transplant for Aggressive Cancer Achieved at OU Health

Experts at OU Health recently completed the state's first evidence-based liver transplant for a particularly challenging and oftentimes deadly form of a bile duct cancer known as cholangiocarcinoma. This achievement not only places OU Health among the few elite programs in the country that treat bile duct cancers with transplantation, but means patients with this rare form of cancer do not need to leave the state for advanced treatment. 

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.

Only 20 to 30% of patients are eligible for a surgical option due to how aggressive and advanced the cancer can be at the time of diagnosis. For the few patients who are candidates for surgery, the complex operation requires removing up to 70% of the liver, resulting in a high risk of morbidity and mortality. The procedure is only performed at a few high-volume centers with expertise and resources for complex hepatobiliary surgery, which now includes OU Health.

The patient at OU Health was first treated with a complex regimen of preoperative chemotherapy and radiation, said OU Health Stephenson Cancer Center surgical oncologist Dr. Ajay Jain M.D., FACS, core medical director for Stephenson Cancer Center and professor of surgery and chief of the Division of Surgical Oncology in the Department of Surgery at The University of Oklahoma College of Medicine. Dr. Jain also serves as Oklahoma State Chair for the American College of Surgeons Commission on Cancer.

However, Dr. Jain recognized that a liver transplant would offer the highest chance of success and thanks to OU Health's ability to perform a liver transplant for this complicated disease, the patient now has a higher chance of long-term survival.

The Most Challenging of All Cancers

Cholangiocarcinoma is a type of cancer affecting the bile ducts carrying the digestive fluid bile from the liver to the gallbladder and small intestine. It typically occurs in individuals over the age of 50, though it can occur at any age.

Because of its aggressive nature, cholangiocarcinoma is often diagnosed when the cancer is advanced, making successful treatment difficult to achieve.

“Only 20 to 30% of patients with this cancer will be able to receive surgical treatment options because the disease is silent, and when it gets diagnosed, most patients will be at an advanced state where surgical resections or transplants are not possible,” said OU Health Transplant Institute surgeon Dr. Narendra Reddy Battula, MBBS, MRCS, M.D., FRCS, assistant professor in the Division of Transplant Surgery in the Department of Surgery at OU College of Medicine.

“The transplant technique for bile duct cancers differs from liver transplant done for liver failure or liver cell-based cancer. When we do routine liver transplants, we disconnect the bile ducts. But when we treat bile duct cancer, we need to do an extensive removal of the bile duct, which joins the liver to the bowels near the pancreas. We must make sure no cancer has spread beyond the liver.”

In the late 1990s, Mayo Clinic began the first clinical trials to assess the use of liver transplantation as a treatment for hilar cholangiocarcinoma. Over several years and multiple clinical trials, data has shown that patients who undergo successful transplants have five-year survival rates of 65 to 68%, and 10-year survival rates reaching up to 60%. This marks a significant improvement compared to the usual 10% five-year survival rate associated with the diagnosis.

Despite the improved survival rates, only roughly 20 programs in the country offer transplantation for cholangiocarcinoma. This limitation stems from the demanding nature of the procedure which requires specialized, multidisciplinary expertise from various fields, including interventional radiology, advanced gastrointestinal, medical oncology, radiation oncology, hepatobiliary surgery, transplant surgery, and transplant medicine, to name a few.

OU Health Makes History in Oklahoma

“OU Health now performs more than 50 traditional liver transplants a year, and because of the expertise at Stephenson Cancer Center and our outstanding transplant program at OU Health already doing some of the most complicated transplants in the country, we felt we could start doing liver transplants for cholangiocarcinoma,” said Dr. Jain. “This transplant was the first one of its kind done in the state.”

Dr. Battula and his colleague, transplant surgeon Dr. Maheswaran Pitchaimuthu, MBBS, MRCS (Edin.), FRCS (Eng.), assistant professor in the Division of Transplant Surgery in the Department of Surgery at OU College of Medicine, worked alongside a team of medical oncologists, radiation oncologists and transplant hepatologists to implement diagnostic, chemotherapy and radiation protocols needed for this innovative treatment.

Other key medical professions included Stephenson Cancer Center oncologists Dr. Hassan Hatoum, M.D., Dr. Ryan Nipp, M.D., MPH, and Dr. Susanna Ulahannan, M.D., MMed, as well as radiation oncologists Dr. Andrea Johnston, M.D., and Dr. Christopher Bozarth, M.D.; advanced endoscopy specialist Dr. Amir Rumman, M.D., and transplant hepatologists Dr. Abdul M. Oseini, M.D., MSc and Dr. Sidra Ahsan, M.D.

“All these patients were being referred to other centers out of state to be considered for transplant, and we had to question ourselves as to why we weren’t offering this,” Dr. Battula said. “We have an amazing cancer center and an amazing transplant center here. It’s a huge emotional burden for the patient and their families to be far away in an unfamiliar environment. We have all the components, and now we are the only center in the state who can offer this type of liver transplant.”

Learn more about hepatobiliary, pancreas and gastrointestinal cancer treatment and surgery options at OU Health, or speak with one of our experts at (405) 271-1632.