Transplantation – where are we?
Liver transplantation for CC in the UK – where are we?
The Mayo Clinic in the US has for some time shown very positive results with their programme of liver transplantation for cholangiocarcinoma, albeit with very carefully selected patients who are subjected to a stringent pre-transplant treatment protocol. (Five year survivals of over 70% of these patients has now been reported.)
In the autumn of 2011, Dr Shahid Khan and Dr Chris Wadsworth of Imperial College London, visited the Mayo to study this first hand. Although very impressed, Dr Khan commented, “ … transplantation for CC is unlikely to be used routinely in the UK or Europe until further studies on its effectiveness have been shown in other centres.”
Later in the summer of 2012, opinion had changed somewhat, with the new Guidelines for the Diagnosis and Treatment for CC (UK)* stating in its recommendations, “Increasing data suggest that liver transplantation for CC can be successful in rigorously selected patients undergoing neoadjuvant therapy in highly specialsed centres.”
Hopes were then raised that a UK trial for transplantation would be forthcoming. Professor Brian Davidson, in his “Viewpoint” article** written for AMMF, expressed the opinion that there is a need for centres of excellence for CC treatments, and that such centres, “… need to be part of or linked with a Liver Transplant Unit as the results for liver transplantation following chemotherapy and radiotherapy for unresectable CC (The Mayo Clinic Protocol) have been improving steadily and require to be evaluated in the UK.”
However, it seems there is still no UK trial on the near horizon. Amongst the reasons given:
• insufficient liver organs for current needs
• no-one outside the US has yet replicated the US data
• the Dublin transplant unit trial showed poor results
• far more expensive than standard transplantation
AMMF will keep asking the questions …
To read “Current thoughts on transplantation” as at Feb 2012, click here
* Link to the Guidelines, click here
** Link to Professor Davidson’s “Viewpoint” article, click here