A life-saving transplant trial
Drs. Gonzalo Sapisochin and Ian McGilvray

​Dr. Gonzalo Sapisochin performs living donor liver transplants in cancer patients. Dr. Ian McGilvray leads liver and pancreas surgery at Sprott Surgery.

Doctors are using living donor liver transplants to save patients with cancer

It’s late in the evening on Mother’s Day 2017, and Sandra Elhilali is sitting with a radiologist, counting the tumours on a scan of her liver. She should have been celebrating the day at the lake with her husband and kids, but the 42-year-old had been feeling unwell for several months, not eating and sleeping all hours. A trip to the ER that morning revealed the shocking cause: Stage 4 colorectal cancer with metastasis to the liver. “...16, 17, 18, 19...” The radiologist stops at 20, realizing it’s pointless to continue.

Elhilali is immediately admitted to her local hospital to begin chemotherapy in a palliative setting and is told she might never return home to her family. “It was the absolute worst possible scenario,” she recalls, her voice breaking.

What Elhilali didn’t know at the time, however, was that at Toronto General Hospital, Dr. Gonzalo Sapisochin, a transplant surgeon with the Sprott Department of Surgery who is also part of the Soham & Shaila Ajmera Family Transplant Centre, had just launched a clinical trial to perform living donor liver transplants on patients just like her – a groundbreaking procedure that would eventually save her life.

Leaders of living donor liver transplants

Sprott Surgery is home to a team of surgeons who are experts at living donor liver transplants. They perform about 70 a year, making it the largest such program in the western world. Unlike with other organs, someone can donate 70 per cent of their liver to another person, and then have it regrow to regular form in a few weeks or months. “The liver is the only organ in the body that regenerates,” explains Dr. Sapisochin. “You can donate most of a liver to a person, and both livers will quickly regenerate almost to normal size.”

These transplants are already routinely done on patients with inoperable primary liver cancer, but living donor liver transplants are not usually the standard of care for individuals like Elhilali, who have colorectal cancer that has spread to the liver.

It’s an unfortunately large cohort of patients, often with poor prognoses. Of the more than 25,000 Canadians diagnosed with colorectal cancer each year, about half will see the disease spread to their liver because blood drains directly from the colon to the sponge-like organ, which effectively soaks up the cancer cells. For 60 to 80 per cent of these patients, surgical removal of the liver tumours is impossible, because the size and number of tumours are too great, and it’s too difficult to leave an adequate amount of normal functioning liver. As a result, only five to 10 per cent of patients will be alive five years after their diagnosis.