Surgery and Transplant

To follow up on devoncat’s thorough information: the transplant option is one that is only available to a select few. You should certainly explore this course with your health care team, as no one on this board could tell you whether or not your mom would be a candidate. That being said, devoncat is spot-on regarding the cherry-picking of patients for the procedure. It’s actually pretty difficult to meet the requirements – tumor size OR number of tumors; vascular involvement; lymph node involvement; what type of biliary cancer (intrahepatic vs. extrahepatic, vs. klatskin); overall health. While extremely frustrating, the US has a tremendous organ shortage, and the doctors end up being extremely selective to ensure the few available organs go to the most positive cases. I think at the end of the day that this drives home the point every healthy individual in the US should sign up to be a donor so that we can move towards loosening the requirements. Even if it is only a few people that are missed, you have to wonder how many people were just outside the eligibility criteria for the transplant, and may have been cured…So frustrating.

I have just read this article in The Scotman newspaper about a girl in Australia who received a liver tranplant. The difference here is that her blood type change to the same type as the donor meaning that she does not require drugs to stop rejection. Doctors do not know why it happened but are now trying to find answers. As they say – it is a long shot, but it is a positive step.

http://news.scotsman.com/latestnews/Transplant-girl-who–has.3710635.jp

I was told that the numbers are skewed. That if one can have a liver resection, than that is just as good as a transplant given that the transplant group is so heavily cherry picked that those who have a transplant would be likely to have good statistics anyway. To be considered for a transplant, you have to have no spread.

I have bee on and off the transplant list and now might be back on. The three doctors I have discussed with this have said the following:
1) Go for resection, if that is not possible consider transplant.
2) The immunosuppresents needed for the transplant do cause problems iif the cancer returns. Almost a guaranteed death sentence.
3) Only consider transplant if you meet VERY, VERY strict criteria.
4) The number 1 cause of death after transplant is cancer reoccurance
5) The statistics are good, but that apparently the Mayo clinic did something like evaluate over 1000 people for the protocol and then only did surgery on less than 40 so the statistics cant be compared like for like with other treatments

I am unsure about a transplant for me, as is my doctor. I want to be in the 80% survival group, but what does that statistic really mean? I have more tests at the beginning of February which will determine if I get on the list or not, then I need to make my mind up if it is something I really want. If I think of anything else from my conversations with the doctors I will let you know.

Kris