As part of a ground-breaking pilot, clinicians at Queen Elizabeth Hospital Birmingham (QEHB), King’s College London and The Royal Free Hospital London have successfully performed the first three liver transplants to be used as a treatment for patients with a rare type of cancer.
Neuroendocrine tumours (NET) are a complex group of cancers that are difficult to diagnose and manage. They often spread to the liver by the time they are discovered and the only chance of a cure, is if they can be removed entirely.
Currently, transplants are not a routine intervention for patients with NETs that has spread to the liver, with a key challenge being the availability of donated livers, which have fallen in the past two years.
In some patients, it is possible to remove the origin of the cancer, usually from the bowel or the pancreas, and then consider replacing the liver if no other site of cancer is present.
Dr Tahir Shah, Liver Transplant Physician at QEHB, has collaborated with UK’s Liver Advisory Group (LAG), NHS Blood and Transplant, and experts from across Europe to set up the pilot programme that is initially serving NET patients in UK and the Republic of Ireland.
Dr Shah said: “The pilot aims to address a critical gap in treatment options for patients with this rare cancer that has spread to the liver.
“Liver transplantation was not a routine intervention for patients with NETs, with key challenges being the availability of donated livers, which has worsened in the past two years, and lack of expertise in identifying and treating patients likely to benefit from this procedure.
“This pilot is testament to the power of collaboration; I must emphasise the joint efforts of colleagues from across UK successfully initiating a complex and challenging programme.
“Together we have demonstrated the possibility of hope in to action, for a further curative strategy in the treatment of these life limiting cancers.
“This is the culmination of four years of planning that involved the UK and Europe’s top experts leading to the development of international guidance, protocols and infrastructure for delivering the large pilot programme that is initially planned to perform 50 liver transplants for patients with NETs.”
The pilot programme aims to become a routine part of the arsenal in the treatment of NET, with the goal to expand the number of liver transplants to approximately 100 per year across the country.
Vitally, the expansion of this treatment relies on more people opting to become organ donors after their death.
A spokesperson from NHS Blood and Transplant said: “This pilot stands as a beacon of hope for patients who, under normal circumstances, might not have had the chance for a transplant. But a renewed chance at life requires a greater number of organ donors within the UK.
“At the end of our lives, we can save or change the lives of up to 13 people by becoming organ donors, make your wishes clear by signing the organ donor register today.”
The first patient successfully transplanted was Neil Morris, 50, from Stourbridge, who received a donated liver after a gruelling treatment for the rare NET cancer that had spread to his old liver.
Without a transplant, survival would be limited.
Neil said: “I was diagnosed with neuroendocrine cancer in September 2019, after having tests for the symptoms of inflammatory bowel disease. I was advised that the primary tumour had been found in my bowel and sadly the cancer had already spread to my liver.
“The only treatment available to me was a monthly lanreotide injection, that would help to prevent the tumours growing for an unknown period of time.
“After two years of treatment, I was called unexpectedly by one of the NET nurses who advised me of the pilot programme. It was explained that should I meet the extensive criteria, bowel surgery and liver transplantation could be a possibility and cure me of my cancer.”
“I had successful bowel surgery in October 2022, to remove the primary tumour, then, after being assessed for liver transplantation, received ‘the call’ to inform me of a donor almost exactly 12 months later.”
“I have recovered well and my future is positive. My wife Tina and I cannot thank Dr Shah and everyone involved in my treatment and the pilot programme.”