From the Wits Donald Gordon Medical Centre and the Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Exp Clin Transplant. 2020 Dec;18(7):842-846. doi: 10.6002/ect.2020.0064. Epub 2020 Sep 17.
Publication in 2013 of the first Secondary Cancer cohort study returned attention to liver transplant for nonresectable colorectal cancer, demonstrating excellent outcomes for a procedure that was historically contraindicated. The Wits Donald Gordon Medical Centre in Johannesburg, South Africa, hosts the largest liver transplant program in sub-Saharan Africa. The persistent shortage of deceased donor organs in our setting has compelled us to innovate solutions unique to our context, which allows us to perform as many transplants as possible and maximize our resource utilization. Therefore, we initiated a research study to transplant organs in patients with nonresectable colorectal carcinoma with expanded criteria using marginal deceased donor organs that would otherwise have been discarded.
Institutional Review Board approval was obtained for this study. We used criteria from the 2013 Secondary Cancer cohort study to determine eligibility of patients with nonresectable colorectal carcinoma for liver transplant. Unlike the study from 2013, we utilized expanded criteria and marginal liver allografts for transplant.
Five patients have undergone liver transplant for nonresectable colorectal carcinoma. At a median follow-up of 36 months (range, 10-52 months), 4 of the 5 (80%) patients are alive. The patient who died had progressive disease on chemotherapy pretransplant and was the only patient who tested positive for the Kirsten rat sarcoma viral oncogene homolog mutant. Recurrence occurred in all patients at a median time of 6 months after transplant (range, 3-13 months).
To our knowledge, this is the only published case series of patients undergoing liver transplant for nonresectable colorectal carcinoma in Africa and is internationally unique in its use of expanded criteria and marginal grafts for this type of transplant. Despite the use of such grafts in our recipients, thus far, these outcomes align with those of the 2013 Secondary Cancer cohort studies from Norway.
2013 年首次发表的次级癌症队列研究引起了人们对不可切除结直肠癌肝移植的关注，该研究为一种历史上禁忌的手术展示了出色的结果。南非约翰内斯堡的威特沃特斯兰德大学唐纳德·戈登医学中心是撒哈拉以南非洲最大的肝移植项目。在我们的环境中，由于已故供体器官持续短缺，我们不得不创新独特的解决方案，这使我们能够尽可能多地进行移植，并最大限度地利用我们的资源。因此，我们启动了一项研究，使用边缘性已故供体器官对患有不可切除结直肠癌的患者进行移植，这些器官如果不使用则会被丢弃。
本研究获得了机构审查委员会的批准。我们使用 2013 年次级癌症队列研究的标准来确定患有不可切除结直肠癌的患者是否有资格进行肝移植。与 2013 年的研究不同，我们使用了扩展标准和边缘肝移植物进行移植。
五名患有不可切除结直肠癌的患者接受了肝移植。在中位随访 36 个月（范围，10-52 个月）后，5 名患者中有 4 名（80%）存活。死亡的患者在移植前的化疗中疾病进展，是唯一检测到克氏大鼠肉瘤病毒致癌基因同源突变阳性的患者。所有患者在移植后 6 个月（范围，3-13 个月）中位时间内复发。
据我们所知，这是非洲唯一发表的不可切除结直肠癌肝移植患者病例系列，在国际上，其使用扩展标准和边缘移植物进行此类移植是独一无二的。尽管我们的受者使用了这些移植物，但到目前为止，这些结果与挪威 2013 年次级癌症队列研究的结果一致。
