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Thread: Any experience or advice about liver transplant?

  1. #1
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    Any experience or advice about liver transplant?

    Dear all,

    I am writing here in a desperate attempt to try and do whatever i can do for my Dad as I just cannot cope with the fact that he has liver cancer and that i might possibly lose him soon.

    My father was diagnosed with stage IV B localised primary liver cancer first week of Dec.After doing laparoscopy and biopsy it was decided that the tumour was inoperable as it is very large (12 cms). So he was chemoembolised on 14 dec with the hope that the tumour might shrink and maybe then he can be operated.I was told to wait for 4-6 weeks and do a scan and check his progress.

    Now in the meanwhile i met another liver expert who put me in a dilemma, as according to him he would have gone for liver transplant (living donor) rather than chemoemoblisation.Now i am really worried, i can still possibly look into liver transplant for him, but not sure how feasible it is after chemoembolisation.Also, the first doctor who has treated him so far had earlier said transplant was out of question for my father as because of the size it will come back.

    I am confused.My questions are: Does anyone know when a liver transplant is possible? And foes anyone know if surgey has been possible after the tumour has been shrunk by chemoembolisation?

    Please help if possible.Any suggestions will be deeply appreciated.

    Regards,

    Doting Son

  2. #2
    Administrator Top User Kermica's Avatar
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    Hi Chit and welcome. I am no expert (at all) regarding liver cancer but did find a wealth of information on this subject when I did a bit of searching. It seems that ttransplantation is a relatively common therapuetic approach to dealing with hepatatic carcinoma. As to who is a good candidate it depends on tumor size and whether the cancer is still confined to the liver. I did see reference to the use of chemoembolization as a preparatory therapy for transplantation when tumors are large so it does not appear to be out of the question but your Dad is not an ideal candidate from what I read. Here is a link to an article from Cancer Research UK regarding who is a good candidate for tranplantation and why: http://cancerhelp.cancerresearchuk.o...ver-transplant and here is the American Cancer Society's view on the same subject: http://www.cancer.org/Cancer/LiverCa...eating-surgery

    Regrettably, it doesn't sound to me like your Dad is an ideal subject for transplant as his tumor is large at 12cm but that doesn't mean that the subject doesn't deserve to be fully explored. I wish both you and your Dad well and hope that his therapy is successful.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 67
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxan, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.
    February 2015 - Doc and I agreed to stop R maintenance as it is depressing my immune system too much.
    June 2015 - Confirm that the beast is back by physical exam, will scan in August after esophageal issues settle down so we can get a clear view.
    August 2015 - physical exam in error, PET/CT shows no evidence of disease. Remission continues well into second year!
    December 2015 - Cardiologist tells me I have plaque buildup growing at an alarming rate. Stent or bypass down the road but not yet...
    March 2016 - new tumor below the jaw so remission is over. Back to active surveillance until treatment is needed.
    June 2016 - C/T scan indicates presence of multiple lesions in iliac chain.
    August 2016 - PET/CT shows multiple areas of lymphoma as expected plus new areas of concern in bowel.
    January 2017 - C/T scan shows significant progression in cervical and inguinal lymph chains, largest tumor is impacting hearing, measures 2.1x4.6 cm. 4 to 8 cycles of R-CVP, 1x3weeks to commence 2/6/17.
    April 2017 - Mid treatment scan shows about 1/3 reduction in multiple tumors. Also shows abdominal aortic aneurysm with peripheral thrombus. Cardiologist changed meds, spoke of need for surgical repair down the road.
    September 2017 - finished 10 rounds of R-CP, V was stopped due to neuropathy in feet. No further treatment planned at this time, at least 10 tumors can be felt which seem to be growing again.
    December 2017 - Biopsy of external iliac node with SUV of 13.1 shows no transformation! However, the FL grade is now 3A instead of Gr 1-2. Will start indefinite protocol using Copanlisib, one of the new targeted therapies. I remain hopeful.
    March 2018 - Copanlisib failed, treatment stopped 3/28. New plan is to go to Dana Farber on 4/16 for case review and treatment recommendation.

    May 2018 - did not qualify for clinical trials at Dana Farber. Tumors need to get larger to be considered. On consultation w/Dr. Armand at DF and my onc, have decided to take a break from cancer treatments. Will have a biopsy of the mass in my sinus discovered in scan at DF and to get the aneurysm repaired as it has developed a potentially catastrophic penetrating ulcer. Surgery scheduled for 7/12.

    September 2018 - biopsy of mass in nose shows transformed DLBCL throughout. Assessing options for this negative development.

    October 2018 - started 6 to 8 cycles of R-CHOP. Goal is to get to full remission to open up other options.

    February/March 2019 - PET shows four hot spots following R-CHOP. referred to Dana Farber for stem cell transplant. Pre testing all good, accepted for Auto Transplant. Will begin inpatient process about April 1.

  3. #3
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    Dear Kermica,

    Thanks a lot for your reply.The links you had posted were really helpful.I know it doesn't sound very hopeful in terms of transplantation for my dad, but i am still trying to get as much information as i can.I have an appointment soon with a liver transplant expert ( i am based in India).Will see what he thinks of my father's situation.Thanks for your kind words.Will post any details that i get.

    Regards,

    Chit

  4. #4
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    Hi Chit. My father was diagnosed primary liver cancer last August and had a surgery on August 23. I did some homework about liver cancer which I hope can be of any help for you.
    Whether your father is OK for liver transplant depends on 1. tumor size 2. number of tumors 3. any spread with blood vessel and lymph? 4. any other tumor outside liver. This is called Milan Standard. For individual tumer, if it's less than 5 cm, or for multiple tumers, but less than 3 in total, and the total size (the sum of the size of each tumor) is less than 5 cm, no spread with blood vessel or lymph, no other tumors outside liver, it will be optimistic for liver plant. The 5-year survival rate will be over 80% and the return rate will be as low as 10-15%. So, would you pls provide more information of your father's liver cancer?

    BTW, I am here in China and my English is not very good and hope you may understand my post above. Best wishes for you and your father!

  5. #5
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    Hi yorklee,

    Thanks for your reply and your english is great!

    With regards to the questions, he has a large tumour which is about 12 cms, localised in the liver, not spread to the blood vessels or lymph nodes.There are no tumours outside his liver.But as kermica pointed out his tumour is too big.Hence they could not resect it either.So he underwent chemoembolisation in Dec 2011.We are waiting for the scans which will be after about a month.I am hoping the process would have shrunk his tumour and we can look into surgery or transplant.

    I might sound naive,but i still dont get why the size of the tumour matters for transplant.If the idea is to take out the liver itself and replace it with a donor liver? is it because there is a high probability of recurrence?

    Sorry to her about your father.How is he doing now and how how big was his tumour?

    Regards,

    Chit

  6. #6
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    I don't know why the post became messy after I re-edited. So I delete this reply here.
    Last edited by yorklee; 01-11-2012 at 03:43 PM.

  7. #7
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    Sorry I had trouble post my message here. The words became messy after I posted, but they were normal when I edited...

 

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