Liver Transplant for Hepatocellular Carcinoma: Collaborating for Improved Outcomes

 

Emory's Liver Tumor Clinic was created to better improve outcomes for patients with hepatocellular carcinoma and hilar cholangiocarcinoma.

Established in 2013, Emory’s Liver Tumor Clinic brings practitioners from multiple disciplines together to evaluate, confer and develop treatment plans for combatting hepatocellular carcinoma and hilar cholangiocarcinoma. The multidisciplinary care team includes transplant hepatologists, transplant surgeons, medical oncologists and interventional radiologists.

Patient Case

A 62-year-old male presented to Emory’s Liver Tumor Clinic in early October 2013 with a single 6.6-centimeter hepatocellular carcinoma without portal vein invasion in his liver’s right lobe. He had hepatitis C and cirrhosis, further complicated by ascites that was diuretic-controlled.

The patient first met with a transplant hepatologist at the Emory Transplant Center to evaluate the tumor and future transplant possibilities. The tumor’s size placed the patient outside the Milan criteria for liver transplantation, requiring down staging of the tumor to qualify for a liver transplant to cure the hepatocellular carcinoma.

After presenting the patient at the Liver Tumor Clinic and conferring with the multidisciplinary team of specialists, a strategy was proposed to downstage the tumor via liver-directed therapy, shrinking the cancer enough so that the patient would be able to meet the criteria for transplant.

The patient met with an interventional radiologist to start planning his treatment. Because of the tumor’s size, doctors wanted to treat it twice in quick succession. Five days later, he had his first treatment, the DEB-TACE procedure, followed by another round later in October.

Durable Response

A follow-up MRI several months later showed residual; therefore, the patient underwent a radioembolization (Y90), another form of liver-directed therapy. His follow-up imaging in August 2014 showed no viable tumor – he had successfully achieved down staging.

The patient soon began transplant evaluation and was placed on the transplant list in November, with exception points awarded. His exception points continued to increase for several months, and he had an organ offer in April of 2015. Before his transplant, an MRI showed no residual; doctors were pleased with his durable response to treatment.

Following a successful transplant, the explant showed no remaining living tissue of what was once a 6.6-centimeter tumor. After a routine and uncomplicated recovery, the patient to date has had no readmissions to Emory and no episodes of rejection. His regular follow up visits show normal progress with no return of his liver cancer, and he remains active, reporting that he’d been traveling the country and playing with his band.

How Emory’s Liver Tumor Clinic Works

The Liver Tumor Clinic convenes weekly, seeing up to six new patients each week. Our team of multi-specialists meets to review each patients’ case prior to seeing them in clinic. Once in clinic, physicians rotate through seeing each patient, reconvening after to develop a consensus on the initial approach to care.

The team also performs a multidisciplinary review of patient scans, discussing findings with a general radiologist. These meetings reinforce and further inform care plans they’ve already discussed with patients. Treatment approaches can include liver-directed therapy, liver transplant, surgical resection and systemic chemotherapy, among other options.

Meet Our Liver Tumor Clinic Team

Joel Wedd, MD
Director of the Emory
Liver Tumor Clinic,
Assistant Professor of
Medicine, Hepatology

Giorgio Roccaro, MD
Assistant Professor of
Medicine, Hepatology

 

Marty Sellars, MD, MPH
Associate Professor
of Surgery, Liver
Transplantation

Mehmet Akce, MD
Assistant Professor
of Medicine,
Medical Oncology

 

For more information about Emory’s Liver Tumor Clinic or to refer a patient, call 404-712-2769 or visit emoryhealthcare.org/txrefer.

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