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Dueland S, Smedman TM, Syversveen T, Grut H, Hagness M, Line PD. Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial. JAMA Surg 2023; 158:e232932. [PMID: 37494056 PMCID: PMC10372758 DOI: 10.1001/jamasurg.2023.2932] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
Importance Liver transplant for colorectal cancer with liver metastases was abandoned in the 1990s due to poor overall survival. From 2006, liver transplant for in nonresectable colorectal liver metastases has been reexamined through different prospective trials. Objective To determine predictive factors for transplant long-term survival and cure after liver transplant. Design, Setting, and Participants This was a prospective, nonrandomized controlled cohort study derived from different clinical trials on liver transplant for colorectal liver metastases from 2006 to 2020 at Oslo University Hospital. The trials differed in prognostic inclusion criteria, but the design was otherwise identical regarding follow-up scheme to determine disease recurrence, overall survival, and survival after relapse. Final data analysis was performed on December 31, 2021. All patients with colorectal liver metastases from comparable prospective liver transplant studies were included. Exposure Liver transplant. Main outcomes and measures Disease-free survival, overall survival, and survival time after recurrence were determined in all participants. Results A total of 61 patients (median [range] age, 57.8 [28.7-71.1] years; 35 male [57.4%]) underwent liver transplant at Oslo University Hospital. Posttransplant observation time ranged from 16 to 165 months, and no patient was lost to follow-up. Median disease-free period, overall survival, and survival after relapse were 11.8 (95% CI, 9.3-14.2) months, 60.3 (95% CI, 44.3-76.4) months, and 37.1 (95% CI, 4.6-69.5) months, respectively. Negative predictive factors for overall survival included the following: largest tumor size greater than 5.5 cm (median OS, 25.3 months; 95% CI, 15.8-34.8 months; P <.001), progressive disease while receiving chemotherapy (median OS, 39.8 months; 95% CI, 28.8-50.7 months; P = .02), plasma carcinoembryonic antigen values greater than 80 μg/L (median OS, 26.6 months; 95% CI, 22.7-30.6 months; P <.001), liver metabolic tumor volume on positron emission tomography of greater than 70 cm3 (26.6 months; 95% CI, 11.8-41.5 months; P <.001), primary tumor in the ascending colon (17.9 months; 95% CI, 0-37.5 months; P <.001), tumor burden score of 9 or higher (23.3 months; 95% CI, 19.2-27.4 months; P = .02), and 9 or more liver lesions (42.5 months; 95% CI, 17.2-67.8 months; P = .02). An Oslo score of 0 or Fong Clinical Risk Score of 1 yielded 10-year survival of 88.9% and 80.0%, respectively. Conclusions and relevance Results of this nonrandomized controlled trial suggest that selected patients with liver-only metastases and favorable pretransplant prognostic scoring had long-term survival comparable with conventional indications for liver transplant, thus providing a potential curative treatment option in patients otherwise offered only palliative care.
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Affiliation(s)
- Svein Dueland
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Magnus Smedman
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Morten Hagness
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Gripheim JM, Åsberg A, Hagness M, Heldal K, Midtvedt K. Nyretransplantasjon – en pågående suksesshistorie. Tidsskr Nor Laegeforen 2023; 143:23-0383. [PMID: 37589365 DOI: 10.4045/tidsskr.23.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
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Skauby MH, Heldal K, Line PD, Sørensen DW, Fiane AE, Hagness M. Lengre ventelister for organtransplantasjon. Tidsskr Nor Laegeforen 2023; 143:22-0777. [PMID: 37341402 DOI: 10.4045/tidsskr.22.0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
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Clift AK, Hagness M, Lehmann K, Rosen CB, Adam R, Mazzaferro V, Frilling A. Transplantation for metastatic liver disease. J Hepatol 2023; 78:1137-1146. [PMID: 37208101 DOI: 10.1016/j.jhep.2023.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The liver is a common site of metastases from many cancers, particularly those originating in the gastrointestinal tract. Liver transplantation is an uncommonly used but promising and at times controversial treatment option for neuroendocrine and colorectal liver metastases. Transplantation with meticulous patient selection has been associated with excellent long-term outcomes in individuals with neuroendocrine liver metastases, but questions remain regarding the role of transplantation in those who could also be eligible for hepatectomy, the role of neoadjuvant/adjuvant treatments in minimising recurrence, and the optimal timing of the procedure. A prospective pilot study of liver transplantation for unresectable colorectal liver metastases that reported a 5-year overall survival rate of 60% reinvigorated interest in this area following initially dismal outcomes. This has been followed by larger studies, and prospective trials are ongoing to quantify the potential benefits of liver transplantation over palliative chemotherapy. This review provides a critical summary of currently available knowledge on liver transplantation for neuroendocrine and colorectal liver metastases, and highlights avenues for further study to address gaps in the evidence base.
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Affiliation(s)
- Ashley Kieran Clift
- Cancer Research UK Oxford Centre, University of Oxford, United Kingdom; Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Kuno Lehmann
- Department of Surgery and Transplantation, University Hospital and University of Zurich, Zurich, Switzerland
| | - Charles B Rosen
- Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, United States; Research Unit of Chronotherapy, Cancers and Transplantation, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Rene Adam
- Research Unit of Chronotherapy, Cancers and Transplantation, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Andrea Frilling
- Department of Surgery & Cancer, Imperial College London, United Kingdom.
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5
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Chellappa S, Kushekhar K, Hagness M, Horneland R, Taskén K, Aandahl EM. The Presence of Activated T Cell Subsets prior to Transplantation Is Associated with Increased Rejection Risk in Pancreas Transplant Recipients. J Immunol 2021; 207:2501-2511. [PMID: 34607938 DOI: 10.4049/jimmunol.2001103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/04/2021] [Indexed: 12/14/2022]
Abstract
Pancreas and islet transplantation (PTx) are currently the only curative treatment options for type 1 diabetes. CD4+ and CD8+ T cells play a pivotal role in graft function, rejection, and survival. However, characterization of immune cell status from patients with and without rejection of the pancreas graft is lacking. We performed multiparameter immune phenotyping of T cells from PTx patients prior to and 1 y post-PTx in nonrejectors and histologically confirmed rejectors. Our results suggest that rejection is associated with presence of elevated levels of activated CD4+ and CD8+ T cells with a gut-homing phenotype both prior to and 1 y post-PTx. The CD4+ and CD8+ T cells were highly differentiated, with elevated levels of type 1 inflammatory markers (T-bet and INF-γ) and cytotoxic components (granzyme B and perforin). Furthermore, we observed increased levels of activated FOXP3+ regulatory T cells in rejectors, which was associated with a hyporesponsive phenotype of activated effector T cells. Finally, activated T and B cell status was correlated in PTx patients, indicating a potential interplay between these cell types. In vitro treatment of healthy CD4+ and CD8+ T cells with tacrolimus abrogated the proliferation and cytokine (INF-γ, IL-2, and TNF-α) secretion associated with the type 1 inflammatory phenotype observed in pre- and post-PTx rejectors. Together, our results suggest the presence of activated CD4+ and CD8+ T cells prior to PTx confer increased risk for rejection. These findings may be used to identify patients that may benefit from more intense immunosuppressive treatment that should be monitored more closely after transplantation.
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Affiliation(s)
- Stalin Chellappa
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Kushi Kushekhar
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Rune Horneland
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kjetil Taskén
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Einar Martin Aandahl
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; .,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and.,Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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6
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Bonney GK, Chew CA, Lodge P, Hubbard J, Halazun KJ, Trunecka P, Muiesan P, Mirza DF, Isaac J, Laing RW, Iyer SG, Chee CE, Yong WP, Muthiah MD, Panaro F, Sanabria J, Grothey A, Moodley K, Chau I, Chan ACY, Wang CC, Menon K, Sapisochin G, Hagness M, Dueland S, Line PD, Adam R. Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol 2021; 6:933-946. [PMID: 34506756 DOI: 10.1016/s2468-1253(21)00219-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
Colorectal cancer is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Despite advances in improving resectability, most patients present with non-resectable colorectal liver metastases requiring palliative systemic therapy and locoregional disease control strategies. There is a growing interest in the use of liver transplantation to treat non-resectable colorectal liver metastases in well selected patients, leading to a surge in the number of studies and prospective trials worldwide, thereby fuelling the emerging field of transplant oncology. The interdisciplinary nature of this field requires domain-specific evidence and expertise to be drawn from multiple clinical specialities and the basic sciences. Importantly, the wider societal implication of liver transplantation for non-resectable colorectal liver metastases, such as the effect on the allocation of resources and national transplant waitlists, should be considered. To address the urgent need for a consensus approach, the International Hepato-Pancreato-Biliary Association commissioned the Liver Transplantation for Colorectal liver Metastases 2021 working group, consisting of international leaders in the areas of hepatobiliary surgery, colorectal oncology, liver transplantation, hepatology, and bioethics. The aim of this study was to standardise nomenclature and define management principles in five key domains: patient selection, evaluation of biological behaviour, graft selection, recipient considerations, and outcomes. An extensive literature review was done within the five domains identified. Between November, 2020, and January, 2021, a three-step modified Delphi consensus process was undertaken by the workgroup, who were further subgrouped into the Scientific Committee, Expert Panel, and Transplant Centre Representatives. A final consensus of 44 statements, standardised nomenclature, and a practical management algorithm is presented. Specific criteria for clinico-patho-radiological assessments with molecular profiling is crucial in this setting. After this, the careful evaluation of biological behaviour with bridging therapy to transplantation with an appropriate assessment of the response is required. The sequencing of treatment in synchronous metastatic disease requires special consideration and is highlighted here. Some ethical dilemmas within organ allocation for malignant indications are discussed and the role for extended criteria grafts, living donor transplantation, and machine perfusion technologies for non-resectable colorectal liver metastases are reviewed. Appropriate immunosuppressive regimens and strategies for the follow-up and treatment of recurrent disease are proposed. This consensus guideline provides a framework by which liver transplantation for non-resectable colorectal liver metastases might be safely instituted and is a meaningful step towards future evidenced-based practice for better patient selection and organ allocation to improve the survival for patients with this disease.
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Affiliation(s)
- Glenn K Bonney
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore.
| | - Claire Alexandra Chew
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Peter Lodge
- Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Karim J Halazun
- Division of Liver Transplantation and Hepato-Pancreato-Biliary Surgery, Department of Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Pavel Trunecka
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, Florence, Italy
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard W Laing
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Mark Dhinesh Muthiah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Fabrizio Panaro
- Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Saint Eloi Hospital, Montpellier University Hospital-School of Medicine, Montpellier, France
| | - Juan Sanabria
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Axel Grothey
- Department of Medical Oncology, West Cancer Center and Research Institute, Germantown, TN, USA
| | - Keymanthri Moodley
- The Centre of Medical Ethics and Law, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Albert C Y Chan
- Division of Liver Transplantation, Hepatobiliary & Pancreatic Surgery, Queen Mary Hospital, Hong Kong
| | - Chih Chi Wang
- Department of Surgery, Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Krishna Menon
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Gonzalo Sapisochin
- Abdominal Transplant and Hepato-Pancreato-Biliary Surgical Oncology, Multi-Organ Transplant Program, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - René Adam
- Hepato Biliary Surgery, Cancer and Transplantation Unit, AP-HP Paul Brousse Hospital, University Paris-Saclay, Villejuif, France
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7
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Lanari J, Hagness M, Sartori A, Rosso E, Gringeri E, Dueland S, Cillo U, Line PD. Liver transplantation versus liver resection for colorectal liver metastasis: a survival benefit analysis in patients stratified according to tumor burden score. Transpl Int 2021; 34:1722-1732. [PMID: 34448271 DOI: 10.1111/tri.13981] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022]
Abstract
Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA-I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5-year OS after LR and LT was 40.5% and 54.7% (P = 0.102). In the high TBS cohort, 5-year OS after LR and LT was 22.7% and 52.2% (P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5-year OS after LR and LT was 14.6% and 69.1% (P = 0.002). The corresponding disease-free survival (DFS) was 0% and 22.9% (P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR.
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Affiliation(s)
- Jacopo Lanari
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.,Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Alessandra Sartori
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Eugenia Rosso
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Svein Dueland
- Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
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Dueland S, Syversveen T, Hagness M, Grut H, Line PD. Liver transplantation for advanced liver-only colorectal metastases. Br J Surg 2021; 108:1402-1405. [PMID: 34117498 DOI: 10.1093/bjs/znab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/05/2021] [Indexed: 11/14/2022]
Abstract
Liver transplantation provided a 5-year overall survival rate of 100 per cent in patients with colorectal cancer who had undergone liver resection previously. Patients with extensive liver metastases (over 20 lesions) and a left-sided primary tumour had long survival, whereas those with an ascending colonic primary tumour had inferior survival after liver transplantation.
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Affiliation(s)
- S Dueland
- Division of Surgery, Inflammatory Diseases and Transplantation, Experimental Transplantation and Malignancy Research Group, Oslo University Hospital, Oslo, Norway
| | - T Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - M Hagness
- Department of Transplantation Medicine, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - H Grut
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - P-D Line
- Division of Surgery, Inflammatory Diseases and Transplantation, Experimental Transplantation and Malignancy Research Group, Oslo University Hospital, Oslo, Norway.,Department of Transplantation Medicine, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Dueland S, Yaqub S, Syversveen T, Carling U, Hagness M, Brudvik KW, Line PD. Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases. JAMA Surg 2021; 156:550-557. [PMID: 33787838 DOI: 10.1001/jamasurg.2021.0267] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Portal vein embolization (PVE) has been implemented in patients with extensive colorectal liver metastases to increase the number of patients able to undergo liver resection. Liver transplant could be an alternative in selected patients with extensive liver-only disease, and we have recently shown promising survival outcomes. Objective To compare overall survival (OS) among patients with colorectal cancer and high liver metastasis tumor load who were treated with liver transplant or with PVE and liver resection. Design, Setting, and Participants This comparative effectiveness research study assessed 50 patients with colorectal cancer liver metastases who were previously enrolled in liver transplant studies between November 2006 and August 2019 at Oslo University Hospital in Norway. Those patients were compared with a retrospective cohort of 53 patients in the Oslo University Hospital PVE database from March 2006 through November 2015 with similar selection criteria who underwent PVE and liver resection. Main Outcomes and Measures The OS among patients with high tumor load after liver transplant was compared with that among patients with high tumor load who underwent PVE and liver resection. High tumor load was defined as 9 or more metastatic tumors or a diameter of 5.5 cm or longer for the largest liver lesion. Results In the PVE cohort of 53 patients, the median age was 61.8 years (range, 34.3-71.3 years), and 36 patients (68%) were men. The 5-year OS rate among 38 patients who underwent liver resection after PVE was 44.6%. The 5-year OS rate for patients with high tumor load was 33.4% for those who underwent liver transplant and 6.7% for those who underwent PVE. Among patients with high tumor load and left-sided primary tumors, the 5-year OS rate was 45.3% for those receiving a liver allograft and 12.5% for those treated with PVE and liver resection. Conclusions and Relevance Patients with nonresectable disease, an extensive liver tumor load, and left-sided primary tumors had long OS after liver transplant, exceeding the survival outcome for those patients treated with PVE and liver resection.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Sheraz Yaqub
- Department of Hepatobiliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ulrik Carling
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Smedman TM, Line PD, Hagness M, Syversveen T, Grut H, Dueland S. Liver transplantation for unresectable colorectal liver metastases in patients and donors with extended criteria (SECA-II arm D study). BJS Open 2020; 4:467-477. [PMID: 32333527 PMCID: PMC7260412 DOI: 10.1002/bjs5.50278] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background Patients with metastatic colorectal cancer receiving palliative chemotherapy have a 5‐year survival rate of approximately 10 per cent. Liver transplantation using strict selection criteria in patients with colorectal cancer and unresectable liver‐only disease will result in a 5‐year survival rate of 56–83 per cent. The aim of this study was to evaluate survival of patients with colorectal liver metastases (CRLM) after liver transplantation using extended criteria for both patients and donors. Methods This was a prospective single‐arm study. Patients with synchronous unresectable CRLM who were not suitable for arms A, B or C of the SEcondary CAncer (SECA) II study who had undergone radical resection of the primary tumour and received chemotherapy were included; they underwent liver transplantation with extended criteria donor grafts. Patients who had resectable pulmonary metastases were eligible for inclusion. The main exclusion criteria were BMI above 30 kg/m2 and liver metastases larger than 10 cm. Survival was estimated using Kaplan–Meier analysis. Results Ten patients (median age 54 years; 3 women) were included. They had an extensive liver tumour load with a median of 20 (range 1–45) lesions; the median size of the largest lesion was 59 (range 15–94) mm. Eight patients had (y)pN2 disease, six had poorly differentiated or signet ring cell‐differentiated primary tumours, and five had primary tumour in the ascending colon. The median Fong clinical risk score was 3 (range 2–5) and the median Oslo score was 1 (range 1–4). The median plasma carcinoembryonic antigen level was 4·3 (range 2–4346) μg/l. Median disease‐free and overall survival was 4 and 18 months respectively. Conclusion Patients with unresectable liver‐only CRLM undergoing liver transplantation with extended patient and donor criteria have relatively short overall survival.
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Affiliation(s)
- T M Smedman
- Department of Oncology, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P-D Line
- Department of Transplantation Medicine, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Hagness
- Department of Transplantation Medicine, Oslo, Norway
| | | | - H Grut
- Radiology and Nuclear Medicine, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S Dueland
- Department of Oncology, Oslo, Norway.,Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
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11
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Dueland S, Grut H, Syversveen T, Hagness M, Line PD. Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis. Am J Transplant 2020; 20:530-537. [PMID: 31674105 DOI: 10.1111/ajt.15682] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/02/2019] [Accepted: 10/19/2019] [Indexed: 01/25/2023]
Abstract
Patients with nonresectable colorectal cancer receiving palliative chemotherapy have a 5-year overall survival rate of about 10%. Liver transplant provided a Kaplan-Meier-estimated 5-year overall survival of up to 83%. The objective of the study was to evaluate the ability of different scoring systems to predict long-term overall survival after liver transplant. Patients with colorectal cancer with nonresectable liver-only metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography (PET)-CT scans from 2 prospective studies (SECA-I and -II) were included. All included patients had previously received chemotherapy. PET-CT was performed within 90 days of the liver transplant. Overall survival, disease-free survival, and survival after relapse based on the Fong Clinical Risk Score, total PET liver uptake (metabolic tumor volume), and Oslo Score were compared. At median follow-up of 85 months for live patients, Kaplan-Meier overall survival rates at 5 years were 100%, 78%, and 67% in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low group, and Oslo Score 0 to 2, respectively. Median overall survival was 101, 68, and 65 months in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low, and Oslo Score 0 to 2. These selection criteria may be used to obtain 5-year overall survival rates comparable to other indications for liver transplant.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Harald Grut
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Hagness M, Foss S, Sørensen DW, Syversen T, Bakkan PA, Dahl T, Fiane A, Line P. Liver Transplant After Normothermic Regional Perfusion From Controlled Donors After Circulatory Death: The Norwegian Experience. Transplant Proc 2019; 51:475-478. [PMID: 30879571 DOI: 10.1016/j.transproceed.2019.01.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In order to meet the increasing demand for donor organs, the concept of donation after circulatory death (DCD) was reintroduced in Norway, first as a pilot study, followed by the use of DCD as institutional practice. We report the current Norwegian experience with liver transplant after DCD. METHODS After acceptance from next of kin, life support was withdrawn from patients with devastating brain injury and cardiac arrest observed. After a 5-minute "no-touch" period, extracorporeal membrane oxygenation for post mortem normothermic regional perfusion (NRP) by extracorporeal membrane oxygenator circuit was established. Data from all liver transplant recipients receiving controlled DCD (cDCD) livers in Oslo were analyzed. RESULTS From 2015 to 2017, a total of 8 patients underwent liver transplant with cDCD and NRP liver grafts in Norway. Median Model for End-Stage Liver Disease score was 26 (range, 6-40). There were no cases of delayed graft function or graft loss. Seven patients have reached 1 year of follow-up, and 1 patient has reached 6 months. Two patients have recurrence of primary disease (primary sclerosing cholangitis and steatohepatitis). All patients had normalized liver function at last follow-up. Two patients underwent procedures for biliary complications. In 1 patient, leakage from the cystic duct was successfully handled endoscopically by stenting. In the other patient, a suspected stricture on magnetic resonance imaging led to an endoscopic retrograde cholangiopancreatography, which did not confirm signs of biliary stenosis. There was 1 instance of hepatic artery stenosis, which was managed with endovascular technique. CONCLUSION The results after liver transplant using cDCD with NRP are good. The rate of complications seems to be within the same range as when using conventional donation after brain death grafts.
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Affiliation(s)
- M Hagness
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway.
| | - S Foss
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway
| | - D W Sørensen
- Department of Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - T Syversen
- Department of Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - P A Bakkan
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway
| | - T Dahl
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - A Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - P Line
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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13
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Nordheim E, Olafsson Storrø M, Natvik AK, Birkeland Kro G, Midtvedt K, Varberg Reisaeter A, Hagness M, Fevang B, Pettersen FO. Donor-derived strongyloidiasis after organ transplantation in Norway. Transpl Infect Dis 2018; 21:e13008. [PMID: 30295406 DOI: 10.1111/tid.13008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/28/2018] [Accepted: 10/02/2018] [Indexed: 01/07/2023]
Abstract
Strongyloides stercoralis is an intestinal helminth which in humans can cause asymptomatic chronic infection maintained for decades through its auto-infective cycle. During solid organ transplantation, recipients may unintentionally receive an organ infected with strongyloides. This is a very rare complication but may have deadly outcome if not detected. We hereby report two transplant recipients whom developed Strongyloides hyperinfection syndrome after organ transplantation from the same deceased donor. Recipient 1 was kidney transplanted and presented at day 65 post engraftment with diarrhea and subsequent septicemia and gastric retention. Larvae were detected in gastric aspirate. Recipient 2 was simultaneously kidney and pancreas transplanted and presented at day 90 post engraftment also with gastric retention and septicemia. Larvae were demonstrated on duodenal biopsy and stool sample. The clinical course was complicated with severe duodenal bleedings, gastric retention, meningitis, and prolonged hospitalization. Retrospective testing of pre-transplant donor serum was positive for Strongyloides stercoralis antibodies. As a result of disease severity and gastric retention albenazole was administered via a jejunal tube and ivermectin subcutaneously in both recipients. S stercoralis was successfully eradicated and the transplants ended up with unaffected graft function. Following these two cases, we started systematic screening of all deceased donors for serum Strongyloides IgG in October 2016. After having screened 150 utilized donors one tested positive for Strongyloides, which initiated prophylactic ivermectin treatment to organ recipients. No symptoms or disease developed. Our center will continue to screen all donors as prophylactic treatment may avert this potentially lethal complication in cases of donor-derived Strongyloides infection.
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Affiliation(s)
- Espen Nordheim
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Olafsson Storrø
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ane Kristine Natvik
- Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway
| | - Grete Birkeland Kro
- Department of Microbiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Frank O Pettersen
- Regional Advisory Unit for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway
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14
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Dueland S, Line PD, Hagness M, Foss A, Andersen MH. Long-term quality of life after liver transplantation for non-resectable colorectal metastases confined to the liver. BJS Open 2018; 3:180-185. [PMID: 30957065 PMCID: PMC6433324 DOI: 10.1002/bjs5.50116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/20/2018] [Indexed: 01/09/2023] Open
Abstract
Background Liver transplantation for patients with non‐resectable colorectal liver metastases offers increased survival, with median overall survival of more than 5 years. The aim of this study was to compare quality of life before and up to 3 years after liver transplantation for colorectal liver metastases. Methods Quality of life was assessed using the European Organisation for Research and Treatment of Cancer QLQ‐C30 questionnaire version 3.0. The patients received the questionnaire before and up to 3 years after liver transplantation. Results Some 23 patients were included in the analysis. Three months after liver transplantation they reported reduced quality of life (global health status scale), physical function and role function, and increased dyspnoea. At 6 months, global health status, physical function and role function had returned to pretransplant values. Three years after liver transplantation all symptom and function scores were comparable to baseline values. Patients with high scores for fatigue, pain and appetite loss at baseline had reduced 3‐year overall survival. Conclusion Patients with non‐resectable colorectal liver‐only metastases receiving liver transplantation had good long‐term quality of life. Patients with high symptom scores before transplantation had reduced 3‐year overall survival.
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Affiliation(s)
- S Dueland
- Department of Oncology, Oslo University Hospital Oslo Norway
| | - P-D Line
- Department of Transplantation Medicine, Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - M Hagness
- Department of Transplantation Medicine, Oslo University Hospital Oslo Norway
| | - A Foss
- Department of Transplantation Medicine, Oslo University Hospital Oslo Norway
| | - M H Andersen
- Department of Transplantation Medicine, Oslo University Hospital Oslo Norway.,Institute of Health and Society, University of Oslo Oslo Norway
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15
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Dueland S, Foss A, Solheim JM, Hagness M, Line PD. Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma. Br J Surg 2018. [DOI: 10.1002/bjs.10769] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Background
Liver transplantation is considered the standard of care for patients with hepatocellular carcinoma (HCC) within the Milan criteria. Liver transplantation in patients with unresectable colorectal cancer with liver-only disease has been shown to be associated with a 5-year overall survival rate of 56 per cent, compared with 9 per cent in patients receiving standard palliative chemotherapy. The aim of the present study was to compare disease-free (DFS) and overall (OS) survival after liver transplantation in patients with HCC and those with colorectal metastases.
Methods
Data were collected from the SEcondary CAncer (SECA) study database and an institutional (national) database of patients undergoing liver transplantation for HCC; all liver-transplanted patients were included. Patients with colorectal metastases treated by liver transplantation were divided into high- and low-risk groups for mortality based on carcinoembryonic antigen levels, response to chemotherapy, largest lesion at time of transplantation and time from primary surgery to transplantation.
Results
Patients with colorectal metastases had a median of 8 lesions, compared with 1 in patients with HCC within the Milan criteria. DFS was shorter in both the high-risk and the low-risk colorectal cancer groups compared with that in patients with HCC. The 5-year OS rate in the low-risk colorectal cancer group was 75 per cent, compared with 76 per cent in patients with HCC within the Milan criteria. The 5-year OS rate in patients with HCC beyond the Milan criteria was 56 per cent.
Conclusion
The low-risk group of patients with colorectal cancer and unresectable liver-only disease had a 5-year OS rate following liver transplantation similar to that of patients with HCC with lesions within the Milan criteria.
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Affiliation(s)
- S Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
| | - A Foss
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J M Solheim
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - M Hagness
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - P-D Line
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Line PD, Hagness M, Dueland S. The Potential Role of Liver Transplantation as a Treatment Option in Colorectal Liver Metastases. Can J Gastroenterol Hepatol 2018; 2018:8547940. [PMID: 29623266 PMCID: PMC5829437 DOI: 10.1155/2018/8547940] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/19/2017] [Indexed: 12/29/2022] Open
Abstract
Liver resection is the only potentially curative treatment option in patients with liver metastases from colorectal cancer, but only about 20% of the patients are resectable. Liver transplantation of patients with unresectable liver metastases was attempted in the early era but it was abandoned due to poor survival. During the last decade, several case reports, a controlled pilot study, and a retrospective cohort study indicated that prolonged disease-free survival and overall survival can be obtained in a proportion of these patients. Strict selection criteria have not yet been well defined, but tumor load, response to chemotherapy, pretransplant carcinoembryonic antigen level, and time interval from resection of the primary tumor to transplant are all factors related to outcome. Carefully selected patients may obtain 5-year overall survival that approaches conventional indications for liver transplant. The scarcity of liver grafts is a significant problem, but this can possibly to some extent be addressed by use of extended criteria grafts and novel surgical techniques. There is an increasing interest in liver transplantation in these patients in the transplant community, and currently 4 clinical trials are active and are recruiting.
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Affiliation(s)
- Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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17
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Chellappa S, Hugenschmidt H, Hagness M, Subramani S, Melum E, Line PD, Labori KJ, Wiedswang G, Taskén K, Aandahl EM. CD8+ T Cells That Coexpress RORγt and T-bet Are Functionally Impaired and Expand in Patients with Distal Bile Duct Cancer. J Immunol 2017; 198:1729-1739. [PMID: 28053236 DOI: 10.4049/jimmunol.1600061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 12/03/2016] [Indexed: 01/15/2023]
Abstract
CD8+ T cells that express retinoic acid-related orphan receptor (ROR)γt (TC17 cells) have been shown to promote procarcinogenic inflammation and contribute to a tolerogenic microenvironment in tumors. We investigated their phenotype and functional properties in relationship to the pathogenesis of human distal bile duct cancer (DBDC). DBDC patients had an elevated level of type 17 immune responses and the frequency of CD8+RORγt+ T cells (TC17 cells) was increased in peripheral blood. The CD8+RORγt+ T cells represented a highly activated subset and produced IL-17A in equal amount as CD4+RORγt+ T cells (TH17 cells). Most CD8+RORγt+ T cells coexpressed T-bet, a lineage transcription factor for TH1 and TC1 development, suggesting that CD8+RORγt+ T cells undergo plasticity toward a TC17/1-like phenotype with coproduction of IL-17A and INF-γ. In comparison with CD8+RORγt- T cells, the CD8+RORγt+ T cells had a higher level of TCR signaling and were terminally differentiated and exhausted. These cells also had impaired ability to re-express perforin after degranulation and reduced cytotoxic immune function. A subset of CD8+RORγt+ T cells expressing a low level of programmed cell death protein 1 and a high level of OX40 were associated with reduced patient survival. In conclusion, CD8+RORγt+ T cells are proinflammatory and functionally impaired and may contribute to the pathogenesis of DBDC.
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Affiliation(s)
- Stalin Chellappa
- Center for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership, University of Oslo and Oslo University Hospital, 0318 Oslo, Norway.,Biotechnology Center, University of Oslo, 0316 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0424 Oslo, Norway.,K.G. Jebsen Center for Cancer Immunotherapy, University of Oslo, 0379 Oslo, Norway
| | - Harald Hugenschmidt
- Section for Transplantation Surgery, Oslo University Hospital, 0424 Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, 0424 Oslo, Norway
| | - Morten Hagness
- Center for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership, University of Oslo and Oslo University Hospital, 0318 Oslo, Norway.,Biotechnology Center, University of Oslo, 0316 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0424 Oslo, Norway.,Section for Transplantation Surgery, Oslo University Hospital, 0424 Oslo, Norway
| | - Saranya Subramani
- Center for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership, University of Oslo and Oslo University Hospital, 0318 Oslo, Norway
| | - Espen Melum
- K.G. Jebsen Inflammation Research Center, University of Oslo, 0424 Oslo, Norway.,Norwegian Primary Sclerosing Cholangitis Research Center, Research Institute of Internal Medicine, Section of Gastroenterology, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, 0424 Oslo, Norway
| | - Pål Dag Line
- Section for Transplantation Surgery, Oslo University Hospital, 0424 Oslo, Norway
| | - Knut-Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, 0424 Oslo, Norway
| | - Gro Wiedswang
- Department of Gastrointestinal Surgery, Oslo University Hospital, 0317 Oslo, Norway; and
| | - Kjetil Taskén
- Center for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership, University of Oslo and Oslo University Hospital, 0318 Oslo, Norway.,Biotechnology Center, University of Oslo, 0316 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0424 Oslo, Norway.,K.G. Jebsen Center for Cancer Immunotherapy, University of Oslo, 0379 Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, 0424 Oslo, Norway
| | - Einar Martin Aandahl
- Center for Molecular Medicine Norway, Nordic European Molecular Biology Laboratory Partnership, University of Oslo and Oslo University Hospital, 0318 Oslo, Norway; .,Biotechnology Center, University of Oslo, 0316 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0424 Oslo, Norway.,Section for Transplantation Surgery, Oslo University Hospital, 0424 Oslo, Norway
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18
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Chellappa S, Lieske NV, Hagness M, Line PD, Taskén K, Aandahl EM. Human regulatory T cells control TCR signaling and susceptibility to suppression in CD4+ T cells. J Leukoc Biol 2015; 100:5-16. [PMID: 26715685 DOI: 10.1189/jlb.2hi0815-334r] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/04/2015] [Indexed: 01/24/2023] Open
Abstract
Human CD4(+)CD25(hi)FOXP3(+) regulatory T cells maintain immunologic tolerance and prevent autoimmune and inflammatory immune responses. Regulatory T cells undergo a similar activation cycle as conventional CD4(+) T cells upon antigen stimulation. Here, we demonstrate that T cell receptors and costimulation are required to activate the regulatory T cell suppressive function. Regulatory T cells suppressed the T cell receptor signaling in effector T cells in a time-dependent manner that corresponded with inhibition of cytokine production and proliferation. Modulation of the activation level and thereby the suppressive capacity of regulatory T cells imposed distinct T cell receptor signaling signatures and hyporesponsiveness in suppressed and proliferating effector T cells and established a threshold for effector T cell proliferation. The immune suppression of effector T cells was completely reversible upon removal of regulatory T cells. However, the strength of prior immune suppression by regulatory T cells and corresponding T cell receptor signaling in effector T cells determined the susceptibility to suppression upon later reexposure to regulatory T cells. These findings demonstrate how the strength of the regulatory T cell suppressive function determines intracellular signaling, immune responsiveness, and the later susceptibility of effector T cells to immune suppression and contribute to unveiling the complex interactions between regulatory T cells and effector T cells.
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Affiliation(s)
- Stalin Chellappa
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway; Biotechnology Centre, University of Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Norway; K.G. Jebsen Centre for Cancer Immunotherapy, University of Oslo, Norway
| | - Nora V Lieske
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway; Biotechnology Centre, University of Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Norway; K.G. Jebsen Centre for Cancer Immunotherapy, University of Oslo, Norway
| | - Morten Hagness
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway; Biotechnology Centre, University of Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Norway; Section for Transplantation Surgery Oslo University Hospital, Oslo, Norway; and
| | - Pål D Line
- Section for Transplantation Surgery Oslo University Hospital, Oslo, Norway; and
| | - Kjetil Taskén
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway; Biotechnology Centre, University of Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Norway; K.G. Jebsen Centre for Cancer Immunotherapy, University of Oslo, Norway; Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Einar M Aandahl
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway; Biotechnology Centre, University of Oslo, Norway; K.G. Jebsen Inflammation Research Centre, University of Oslo, Norway; Section for Transplantation Surgery Oslo University Hospital, Oslo, Norway; and
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19
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Chellappa S, Hugenschmidt H, Hagness M, Line PD, Labori KJ, Wiedswang G, Taskén K, Aandahl EM. Regulatory T cells that co-express RORγt and FOXP3 are pro-inflammatory and immunosuppressive and expand in human pancreatic cancer. Oncoimmunology 2015; 5:e1102828. [PMID: 27141387 DOI: 10.1080/2162402x.2015.1102828] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/21/2015] [Accepted: 09/26/2015] [Indexed: 12/20/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is highly infiltrated by CD4+T cells that express RORγt and IL-17 (TH17). Compelling evidence from the tumor microenvironment suggest that regulatory T cells (Treg) contribute to TH17 mediated inflammation. Concurrently, PDAC patients have elevated levels of pro-inflammatory cytokines that may lead to TH17 associated functional plasticity in Treg. In this study, we investigated the phenotype and functional properties of Treg in patients with PDAC. We report that PDAC patients have elevated frequency of FOXP3+Treg, which exclusively occurred within the FOXP3+RORγt+Treg compartment. The FOXP3+RORγt+Treg retained FOXP3+Treg markers and represented an activated subset. The expression of RORγt in Treg may indicate a phenotypic switch toward TH17 cells. However, the FOXP3+RORγt+Treg produced both TH17 and TH2 associated pro-inflammatory cytokines, which corresponded with elevated TH17 and TH2 immune responses in PDAC patients. Both the FOXP3+Treg and FOXP3+RORγt+Treg from PDAC patients strongly suppressed T cell immune responses, but they had impaired anti-inflammatory properties. We conclude that FOXP3+RORγt+Treg have a dual phenotype with combined pro-inflammatory and immunosuppressive activity, which may be involved in the pathogenesis of PDAC.
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Affiliation(s)
- Stalin Chellappa
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo, Norway; Biotechnology Center, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cancer Immunotherapy, University of Oslo, Oslo, Norway
| | - Harald Hugenschmidt
- Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo, Norway; Biotechnology Center, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway; Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - Pål D Line
- Section for Transplantation Surgery, Oslo University Hospital , Oslo, Norway
| | - Knut J Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital , Oslo, Norway
| | - Gro Wiedswang
- Department of Gastrointestinal Surgery, Oslo University Hospital , Oslo, Norway
| | - Kjetil Taskén
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo, Norway; Biotechnology Center, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cancer Immunotherapy, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Einar M Aandahl
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo, Norway; Biotechnology Center, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway; Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
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20
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Dueland S, Guren TK, Hagness M, Glimelius B, Line PD, Pfeiffer P, Foss A, Tveit KM. Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer? Ann Surg 2015; 261:956-60. [PMID: 24950280 DOI: 10.1097/sla.0000000000000786] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy. BACKGROUND CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years. METHODS Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method. RESULTS DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group. CONCLUSIONS Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.
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Affiliation(s)
- Svein Dueland
- *Department of Oncology, Oslo University Hospital, Oslo, Norway †Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway ‡Institute of Clinical Medicine, University of Oslo, Oslo, Norway §Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden; and ¶Department of Oncology, Odense University Hospital, Odense, Denmark
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Abstract
Surgical resection is the only curative modality for colorectal liver metastases (CLM) and 5-year overall survival after resection is about 40%. Nonresectable CLM is not curable and 5-year overall survival is currently about 10%. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%). Liver transplantation for CLMs was abandoned and CLMs were even considered a contraindication to the procedure. Since then, the survival rate after liver transplantation in general has improved by almost 30%. In a prospective pilot study of liver transplantation for nonresectable CLM, a 5-year overall survival rate of 60% was demonstrated, however 19 of 21 patients experienced recurrence of disease. Here, current knowledge and ongoing research in this field is reviewed, and the potential role for liver transplantation as one of several treatment modalities for CLM discussed.
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Affiliation(s)
- Morten Hagness
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
- Oslo Biotechnology Center, University of Oslo, Oslo, Norway
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Dueland S, Hagness M, Line PD, Guren TK, Tveit KM, Foss A. Is Liver Transplantation an Option in Colorectal Cancer Patients with Nonresectable Liver Metastases and Progression on All Lines of Standard Chemotherapy? Ann Surg Oncol 2014; 22:2195-200. [DOI: 10.1245/s10434-014-4137-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Indexed: 12/18/2022]
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Dueland S, Guren TK, Hagness M, Glimelius B, Line PD, Pfeiffer P, Foss A, Tveit KM. Outcome after liver transplantation compared with chemotherapy in colorectal cancer patients with nonresectable liver-only disease. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
531 Background: Surgical treatment of colorectal liver metastases (CLM) is the only treatment option with curative potential; however, only about 10-20% of the patients are candidates for surgical resection. The majority of CLM patients has non-resectable disease, and receives palliative chemotherapy. These patients have poor prognosis with median OS of about 20-24 months after starting first-line chemotherapy and only about 10% survive five years. Methods: Individual data from patients with non-resectable liver only disease who had received liver transplantation (Ltx) (SECA-study, Hagness et al., Ann Surg. 2013) were compared to a similar group of patients with non-resectable liver only metastases included in the NORDIC VII study (first-line Flox chemotherapy ± Cetuximab, Tveit et al., J Clin Oncol. 2012). Twenty one patient included in the Ltx study were compared to 47 patients with liver only metastases included in the NORDIC VII study. All patients in the NORDIC VII study started first-line chemotherapy, whereas 57% of patients in the Ltx study had received second- or third-line chemotherapy at time of Ltx. Results: Median age of the Ltx group was 56 years (range 45-65 years) and 57 years (range 34-65 years) in the Nordic VII study. Median tumor size was 4.5cm (range 2.8-13.0cm) and 5.0cm (range 1.4-16.0cm) in the Ltx and Nordic VII groups, respectively. 5 year OS in the Ltx group was 60% compared to a 5 year OS of 9% in the NORDIC VII group. The 5 year OS of the 21 patients in the NORDIC VII data set with the longest OS was 19%. The patients in the Ltx study who had received only first-line chemotherapy at time of Ltx had a 5 year OS of 80%. Patients in the NORDIC VII study had an OS from end of second-line chemotherapy of 6-7 months. In comparison, patients with progressive disease on second-line/third-line chemotherapy at time of Ltx, had a median OS of 39 months and a 5 year OS of 30%. Conclusions: Patients with non-resectable CLMonly, has a dramatic improved OS after Ltx compared to chemotherapy. The difference could not be explained by patient selection. Selected patients with CRC obtain OS similar to Ltx patients transplanted for primary liver malignancies. Selected CRC patients should therefore be considered for Ltx. Clinical trial information: NCT01311453.
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Affiliation(s)
- Svein Dueland
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Pål-Dag Line
- Department of Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Hagness M, Foss A, Egge TS, Dueland S. Patterns of recurrence after liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg Oncol 2013; 21:1323-9. [PMID: 24370906 PMCID: PMC3942624 DOI: 10.1245/s10434-013-3449-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Indexed: 12/11/2022]
Abstract
Background Surgical resection is the only curative modality for colorectal liver metastases (CLM), and the pattern of recurrences after resection affects survival. In a prospective study of liver transplantation (Lt) for nonresectable CLM we have shown a 5-year overall survival rate of 60 %, but 19 of 21 experienced recurrence. This study reports the pattern of recurrences after Lt for CLM and the effect on survival. Methods Characterization of metastatic lesions in a prospective study for Lt for nonresectable CLM was performed (n = 21). The study included reexamination of chest computed tomographic scans taken before Lt. Results At the time of first recurrence, 16 were a single site, and three were multiple sites. Thirteen of the single sites were pulmonary recurrences. The pulmonary recurrences appeared early and were slow growing, and several were accessible to surgical treatment. When chest computed tomographic scans were reexamined, seven patients had pulmonary nodules at the time of Lt without an effect on survival. There was no first single-site hepatic recurrence. Six of the seven patients who developed metastases to the transplanted liver died from metastatic disease. Conclusions The pulmonary recurrences after Lt for CLM were of an indolent character, even those that were present at the time of Lt. This contrasts with the finding of metastases to the transplanted liver, which was prognostically adverse. The lack of single hepatic first-site recurrences and hepatic metastases only as part of disseminated disease is different from the pattern of recurrence after liver resection. This suggests two distinct mechanisms for hepatic recurrences after resection for CLM.
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Affiliation(s)
- Morten Hagness
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Hagness M, Henjum K, Landskron J, Brudvik KW, Bjørnbeth BA, Foss A, Taskén K, Aandahl EM. Kinetics and Activation Requirements of Contact-Dependent Immune Suppression by Human Regulatory T Cells. J I 2012; 188:5459-66. [DOI: 10.4049/jimmunol.1101367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Andersen MH, Dueland S, Hagness M, Vidnes T, Finstad ED, Wahl AK, Foss A. Quality of life following liver transplantation in patients with liver metastases from colorectal carcinoma. Scand J Caring Sci 2012; 26:713-9. [PMID: 22452269 DOI: 10.1111/j.1471-6712.2012.00984.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To study quality of life (QoL) in patients with liver metastases from colorectal carcinoma (CRC) following liver transplantation (Ltx). METHODS Ten patients participated in a prospective explorative pilot study. Inclusion criteria were nonresectable liver-only metastases determined by CT/MRI-, PET/CT- scans and colonoscopy, and ECOG 0-1. Primary outcome was QoL assessed by the EORTC-C30 questionnaires at baseline, and at 3, 6 and 12 months after Ltx. RESULTS The patients' age ranged from 50 to 63 years. Nine of 10 patients were observed for 12 months. One patient did not return the form at 6 months and died shortly after because of recurrence of the malignant disease. Compared to baseline, Ltx resulted in sustained excellent global health status scale (score of 100) in one patient, improved scores in 4 and unchanged scores in 3 patients at 12 months. The majority of the patients also reported good functional scores at follow-ups. Although two patients had marked symptoms both before and after Ltx, the patients in general reported low levels of pain and fatigue before and after surgery. CONCLUSION The present study indicates that CRC patients with liver-only metastases who receive Ltx have good QoL and have mostly minor symptoms the first year after Ltx.
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Affiliation(s)
- Marit Helen Andersen
- Division of Cancer Medicine, Surgery and Transplant, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Dueland S, Hagness M, Line PD, Scholz T, Jorgensen P, Fosby B, Mathisen O, Gladhaug I, Foss A. Liver transplantation (Ltx) in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
577 Background: Liver resection is considered the only curative treatment of liver metastases (mets) from colo-rectal (CRC) tumors. Ltx is standard of care in selected patients with hepatocellular carcinoma, cholangiocarcinoma and neuroendocrine tumors. Patients with non-resectable liver metastases (mets) from colo-rectal cancer (CRC) receiving palliative chemotherapy have a median survival of about 2 and 1 year from start of 1. and 2. line chemotherapy, respectively. Overall 5 years survival in CRC patients after start of palliative chemotherapy is about 5-10%. In this study we examined overall survival after Ltx in selected CRC patients. The primary endpoint of the study was overall survival at 2 years after Ltx Methods: Major inclusion criteria were: non-resectable liver mets, no extra hepatic disease or local relapse determined by PET/CT scan, CT- or MRI scan and colonoscopy. No mets. on frozen section biopsies at time of surgery, ECOG 0-1, at least one line of chemotherapy for metastatic disease. Postoperative immunosuppresion: mTOR inhibitor (Rapamune), mycofpenolmofetil and tapering doses of prednisolon. Quality of life questionnaire (EORTC-C30) pre Ltx, 3, 6 and 12 months post Ltx. Results: Thirteen men and 8 women with non-resectable liver only CRC liver mets received Ltx in the period of Nov 2006 to March 2011. Median age was 56 years (range 45-65 years). Thirteen patients had colon cancer and 8 patients had rectal cancer. The T-stage of the primary tumor was T2,T3 and T4 in 2, 16 and 3 patients, respectively. N status of the primary tumor was: pN0, pN1 and pN2 all 7 patients. Nine patients had received 1.line chemotherapy and 12 patients had received 2. or 3.line therapy. The median number of liver mets was 8 (range 2-40) and the median size of the largest lesion was 4.5cm (range 2.8-13cm). The patients had good, stabile or increased Global Health Score and Physical Function at all time points after Ltx. Fifteen patients with follow-up of 2 years or more or death within 2 years of Ltx had 2 years overall survival of 87%. Conclusions: Long term survival is obtained after Ltx in selected patients with non-resectable liver mets from CRC. The patients reported good quality of life and physical function after Ltx.
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Affiliation(s)
- Svein Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Pal-Dag Line
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Tim Scholz
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - P. Jorgensen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Bjarte Fosby
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Ostein Mathisen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Ivar Gladhaug
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Aksel Foss
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Oslo University Hospital, Oslo, Norway
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Midtvedt K, Namtvedt T, Scott H, Abedini S, Rocke JC, Dørje C, Foss S, Christen U, Hagness M, Hartmann A. Single transplanted kidneys from a 90-year-old deceased donor perform acceptably at 1 year. Transplant Proc 2011; 43:2107-9. [PMID: 21693337 DOI: 10.1016/j.transproceed.2011.01.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/19/2011] [Indexed: 11/29/2022]
Abstract
Most centers are reluctant to accept expanded criteria donors above 70 to 75 years of age. We accepted kidneys from a 90-year-old male and report the 1-year outcome. The kidneys were used as single transplants and both had immediate graft function. Recipient A was a 71-year-old male, with cold ischemia time of 4 hours 49 minutes. One rejection was successfully treated with intravenous methylprednisolone. At 1 year, serum creatinine was 146 μmol/L with estimated glomerular filtration rate (eGFR) 41 mL/min. Recipient B was a 79-year-old male with known panel-reactive antibody positivity prior to transplantation. Cold ischemia time was 10 hours 4 minutes. He experienced no rejections. At 1 year serum-creatinine was 99 μmol/L with eGFR 63 mL/min. Both recipients performed a surveillance biopsy at 1 year with identical findings: interstitial fibrosis and tubular atrophy grade 1 with moderate to severe arteriolosclerosis. We conclude that both kidneys performed acceptably 1 year after engraftment. The use of old kidneys in old recipients gives them a properly functioning kidney and improves quality of life. Longer observation is needed.
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Affiliation(s)
- K Midtvedt
- Department of Specialized Medicine and Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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