A New Pathway to Liver Transplants for Patients With Stage 4 Colorectal Cancer

Colorectal cancer is the third most common cancer worldwide, and the liver is its most common site of spread. Yet, when colorectal cancer spreads to the liver, liver transplant options have historically been limited — in large part due to a shortage of donor organs and disadvantages within the allocation system.

As part of the effort to address this problem, surgeons at Northwestern Medicine successfully split a deceased donor liver into two parts, transplanting one portion into the intended recipient and the smaller segment into a patient with metastatic colorectal cancer who could not find a suitable living donor. “The smaller segment was allowed to grow inside of the patient for two weeks, after which we went back in and removed the rest of the cancer,” says Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “This marked a milestone in the United States.”

Continue reading below for the full patient story.

A CLEAR Option

This unique treatment option is known as resection and partial liver transplantation with delayed total hepatectomy (RAPID).

It is now available for select patients who have advanced colorectal cancer with liver metastasis through a clinical program at Northwestern Medicine called Colorectal Metastasis to Liver Extraction with Auxiliary Transplant and Delayed Resection (CLEAR).

“The CLEAR program is exciting and unique because it serves an unmet need in a particular patient population,” says Dr. Nadig. “Because liver transplantation for colorectal cancer is not done at many centers around the country, the current organ allocation system does not prioritize these patients, and they end up falling lower on the waitlist.”

By offering this procedure, the CLEAR program provides an innovative pathway to treatment for patients with cancer who might not survive the wait for a traditional transplant.

1 Donated Liver Split for 2 Patients

In December 2021, 50-year-old Barclay Missen of Chicago was experiencing some minor abdominal discomfort when he came to Northwestern Memorial Hospital for a colonoscopy. To his surprise, doctors found a large tumor in his colon and diagnosed him with stage 4 colorectal cancer — the disease had spread to his liver.

Barclay’s medical team was able to slow the progression of the disease by using chemotherapy, removing the cancerous part of the colon (known as a colon resection), and destroying cancer cells in the tumor through minimally invasive liver ablations. However, it was only a matter of time before the cancer became resistant to treatment.

By April 2024, the disease had severely damaged his liver and he learned he would need a transplant. Though friends and family volunteered as donors, none were a suitable match for Barclay.

In October 2024, Barclay matched with a deceased donor liver that had been assigned to another Northwestern Medicine patient, Kelli Podrez of Hanover Park, Illinois. Kelli, who was 57 at the time, was listed higher on the transplant waitlist due to severe liver scarring (cirrhosis). She agreed to share a piece of the liver that had been allocated to her.

“My medical team told me that the liver is like the skin; it regenerates and grows,” says Kelli. “If I could survive without the whole organ and help save someone’s life, why not share it?”

With Kelli’s consent, surgeons worked for eight hours to remove a graft from the deceased donor liver, roughly the size of a human hand. While surgeons split the organ, a machine pumped warm, oxygenated blood through the liver to keep it healthy. The larger portion was then transplanted into Kelli.

One operating room over, a separate team of surgeons removed half of Barclay’s cancerous liver to make space for the smaller graft. Since this piece was too small to support Barclay on its own, the surgeons left half of his cancerous liver in place to provide enough liver function for him to survive. Once they sewed in the new piece, they directed blood flow to the area to encourage it to grow as quickly as possible. Within two weeks, Barclay’s new liver had nearly doubled in size — large enough to sustain him on its own.

A RAPID Procedure

Barclay became the first patient at Northwestern Medicine to receive a liver transplant through the RAPID surgical technique. After receiving the donated liver, Barclay shows no signs of cancer in his body and does not require any further cancer therapy. Kelli’s new liver is also working well.

“We are excited to offer RAPID as an option through the CLEAR program,” says Zachary C. Dietch, MD, a transplant surgeon at Northwestern Medicine. “The entire goal of the program is to make it easier for patients with advanced colorectal cancer to get a liver transplant. We know that transplant is a life-saving option for these patients, especially if the cancer is otherwise confined to the liver. Without it, five-year survival with chemotherapy is just 10%, but that survival can reach 80% with a liver transplant.”

Learn more about how you can become a living organ donor.