CHICAGO – March 12, 2026 – In May 2024, 39-year-old Amy Piccioli walked into an emergency department in Los Angeles expecting treatment for dehydration after a stomach bug swept through her family. Instead, a CT scan revealed a mass in her colon and multiple lesions in her liver. When a biopsy confirmed stage 4 colorectal cancer, Piccioli was shocked. She had no symptoms at all.

“I had zero signs of colorectal cancer. No pain, no changes in bowel habits and no family history,” said Piccioli, now 41. “When a doctor tells you it’s stage 4, you think, ‘My life is over.’ Learning that a transplant could be an option for me changed everything.”

As Piccioli began to process her diagnosis, she learned that her experience reflects a troubling trend: colorectal cancer is increasingly affecting adults under 50, often at more advanced stages and with few or no warning signs. For patients like Piccioli, whose cancer had spread to the liver alone, advances in transplant oncology are opening options that didn’t exist a decade ago.

“Because transplant for colorectal liver metastases is still so new and offered at only a handful of centers, it’s not yet on the radar for every clinician and patient,” said Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “Amy was fortunate because her team in California recognized that possibility and sent her our way. Patients who meet the criteria should hear about transplant early enough in their journey to benefit from it.”

At the time of her diagnosis, Piccioli was a busy mom raising three young children in the South Bay region of Los Angeles. She worked as a CPA and spent weekends biking to the beach and attending Dodgers games with her family. Her medical team in California started chemotherapy, shrinking her disease to the point where liver transplantation could be considered and encouraged Piccioli to explore programs in the U.S. that were offering transplantation for colorectal liver metastases.

After learning about Northwestern Medicine’s innovative oncologic approach to liver and lung transplantation, Piccioli traveled to Chicago in September 2025, where a multidisciplinary team at Northwestern Memorial Hospital evaluated her and determined she was a strong candidate for a living‑donor liver transplant.

“Amy had disease confined to the liver and had responded very well to treatment,” said Zachary Dietch, MD, transplant surgeon at Northwestern Medicine. “For patients with unresectable colorectal liver metastases, chemotherapy alone historically results in a 10% five‑year survival. But in carefully selected patients who undergo liver transplantation, five‑year survival can reach 60% to 80%, and some patients achieve long‑term cure.”

A donor steps forward

When Piccioli shared the living‑donor screening link with friends and family, an unexpected match emerged: Lauren Prior, the daughter of longtime family friends who live in Chicago and have known Piccioli since she was a toddler.

“It felt like fate,” Piccioli said. “Lauren and her family had already told us we could stay with them in Chicago while I recover from the surgery. And then she turned out to be my perfect match. At that point, I had so much faith in my surgical team that I was more scared of a Chicago winter than a liver transplant.”

On Dec. 17, 2025, surgeons at Northwestern Medicine performed Piccioli’s transplant, removing the last of her cancer. Three months later, both Piccioli and Prior are recovering well. A blood test that detects residual cancer cells came back negative, confirming she has no evidence of disease.

Coordinating cancer‑related liver transplants

Successful transplantation for metastatic colorectal cancer requires meticulous coordination between oncology, hepatology and transplant surgery, said Andres Duarte‑Rojo, MD, section chief of hepatology and director of liver transplant at the Northwestern Medicine Comprehensive Transplant Center.

“We only enroll patients in whom we believe we can completely eradicate the cancer,” said Dr. Duarte‑Rojo. “That means patients with disease confined to the liver, and no invasion of nearby structures. The timing of chemotherapy, imaging, liver‑directed therapy and transplant must be planned precisely. That orchestration is the strength of our program.”

Unlike standard liver transplants, patients transplanted for colorectal cancer undergo more frequent and intensive imaging, including CT or MRI scans of the chest, abdomen and pelvis every three months to detect recurrence as early as possible.

Healing far from home

Piccioli will remain in Chicago through the end of March for close monitoring as she continues to recover from her transplant. She said she felt compelled to share her story during Colorectal Cancer Awareness Month, especially as new data shows colorectal cancer has become the leading cause of cancer-related deaths in people under 50.

“I’m more committed to the cause than anything,” she said. “If your cancer has spread to your liver, ask your doctor about a transplant. It might be an option you didn’t know existed. That information could save someone’s life. I can’t express how grateful I am for my donor and the Northwestern Medicine transplant team for saving mine.”

Advancing the field of transplant oncology

Northwestern Medicine is among a small number of health systems in the United States pioneering transplantation for select patients with metastatic cancers of the colon or lung. In 2025, the Northwestern Medicine Comprehensive Transplant Center launched a clinical program called CLEAR to increase liver transplant opportunities for patients with colorectal cancer. The center now evaluates patients from across the country and has received international inquiries.

“Liver transplantation for colorectal cancer is still in its infancy, but the impact is undeniable,” said Dr. Nadig. “Our goal is to expand awareness so patients and physicians know this option exists, and to continue advancing transplant innovation so we can offer hope in situations where historically only hospice was offered.”

For more information about Northwestern Medicine’s transplant programs, visit nm.org.

CHICAGO – June 15, 2025 – Fifteen years ago, Andrew Wagner received a life-saving liver transplant. A relatively common autoimmune disease known as primary sclerosing cholangitis (PSC) had damaged the bile ducts in his liver, causing it to fail.

After six weeks in a medically induced coma, Wagner received his new liver at a Florida hospital in October 2010. Despite facing major blood loss, post-surgical complications and multiple follow-up surgeries, he went on to work as a recruitment manager at a local blood bank in Orlando, where he shared his personal story of how organ and blood donation had saved his life. However, in 2022, a routine abdominal and chest CT scan revealed new cause for concern: stage 1 lung cancer.

“I was completely shocked. I had no symptoms at all and this was found incidentally,” said Wagner, a 55-year-old non-smoker from Winter Garden, Florida. “Little did I know that even with a positive outcome, this cancer diagnosis was going to lead to one of the biggest roadblocks of my life.”

A year after surgeons in Florida removed his cancerous lung nodule and declared him cancer-free, Wagner began experiencing a build-up of fluid around his lungs. To his surprise, the symptom wasn’t his cancer returning – his transplanted liver was starting to fail.  

“When you get cancer after a transplant, you’re really between a rock and a hard place,” said Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “When Andrew was diagnosed with lung cancer in Florida, some of his anti-rejection medications likely had to be reduced to give his immune system a chance to fight the disease, which may have contributed to rejection of his transplanted liver.”

The search for a second opinion

As Wagner’s condition worsened, his wife, Nicole Wagner, sprang into action. In the spring of 2024, she reached out to transplant centers across the country hoping that someone would agree to a second transplant. However, because Wagner had not been cancer-free for three to five years, they were told repeatedly that a retransplant wasn’t an option.

While searching for answers online, Wagner’s wife came across the story of Gary Gibbon, MD – a California physician who traveled to Northwestern Medicine to receive the first double-lung and liver transplant for advanced lung cancer in the U.S.

Since Dr. Gibbon had been transplanted with active lung cancer, the Wagners figured the transplant team at Northwestern Medicine might be willing to take on Wagner’s case. In October 2024, the couple traveled to Chicago to get Wagner evaluated for a second liver transplant at Northwestern Memorial Hospital. There, they received the ‘yes’ they had been searching for.

“Andrew was really on the brink when he first got to Chicago. He likely had months to live,” said Northwestern Medicine hepatologist Andres Duarte-Rojo, MD. “After presenting his case to our multidisciplinary selection committee, we determined that even with immunosuppression, the risk of his lung cancer relapsing was very low. Though we knew the surgery would be difficult, as retransplants tend to be, we were excited to offer him this critical chance for survival.”

On Dec. 16, 2024, surgeons at Northwestern Medicine began the complex process of retransplanting Wagner’s liver. Previous surgeries left him with a significant amount of scar tissue, making his old liver difficult to remove. To minimize blood loss during the extraction, surgeons placed Wagner on bypass to ensure he’d have adequate blood flow to his heart. While surgeons removed his old liver, his new liver was kept functioning outside the body in a device called “liver in a box,” which pumps warm, oxygenated blood through the organ to keep it healthy.

“Having access to this wide range of techniques allowed us to navigate Andrew’s transplant effectively,” said Northwestern Medicine transplant surgeon Zachary Dietch, MD. “It was an interesting blend of old and new – traditional methods like bypass used alongside the latest advancements in transplant such as ‘liver in a box.’”

A father heads home

Five months after surgery, Wagner’s new liver is functioning well and he remains cancer-free. Since returning home to Winter Garden, he has been focused on staying active with walking, weightlifting, swimming and biking around his neighborhood. He is looking forward to spending Father’s Day with his blended family including his wife and two biological daughters, Estella Wagner (16) and Ava Wagner (19), two step-daughters, Riley Swartz (20) and Taylor Castillo (23) and the family’s newest addition, granddaughter Isla Castillo, who was born in April 2025.

“This particular Father’s Day will be so incredibly joyous,” said Wagner. “Receiving the greatest gift of life from the most generous organ donor has given me the opportunity to witness all the future milestones in our daughters’ and granddaughter’s lives. Thanks to my donor and my incredible transplant team at Northwestern Medicine, I still get to be a dad and grandfather.”

“Andrew not only connected with me as a daddy, but as a daughter-daddy,” said Dr. Nadig. “A few days after his transplant, I was talking to Nicole about a trip to Disney World my wife and I had planned for our daughter’s eighth birthday. Living close to the theme park, the Wagners were able to gift me with ‘Mickey ears’ for us to surprise her with. It’s families like that who remind you why you got into medicine in the first place, and why we are willing to take on the most complicated cases at Northwestern Medicine.”

Advancements in transplant oncology

Northwestern Medicine is one of the few known health systems in the country focused on redefining the criteria for transplant eligibility, especially for patients with lung or colorectal cancer. To date, the Northwestern Medicine Canning Thoracic Institute has performed more than 50 lung transplants for patients with advanced lung cancers through a first-of-it’s-kind clinical program called DREAM (Double Lung Transplant Registry Aimed for Lung-Limited Malignancies).

In March 2025, the Northwestern Medicine Comprehensive Transplant Center launched a clinical program called CLEAR (Colorectal Metastasis to Liver Extraction with Auxiliary Transplant and Delayed Resection) to expand liver transplant access for patients with stage 4 colorectal cancer.

“It’s a very exciting time for the field of transplantation,” said Dr. Nadig. “What we’ve learned in the past is not necessarily what we’re taking with us into the future. I think it’s time to re-examine what we think we know about the indications for transplant, and become more inclusive of those who have recently faced or who are facing cancer. Northwestern Medicine should not be a stop along a patient’s journey – it should the destination.”

For more information about Northwestern Medicine’s transplant programs, visit nm.org.

CHICAGO – March 18, 2025 – The scarcity of donor organs and disadvantages within the allocation system can create a difficult pathway to transplant for patients with stage 4 colorectal cancer whose disease has spread to the liver. For the first time at Northwestern Medicine, surgeons have successfully split a deceased donor liver into two parts, transplanting one portion into the intended recipient and the other, smaller segment, into a patient with terminal colorectal cancer who could not find a suitable living donor. The treatment option is now available for select patients with advanced colorectal cancer with liver metastasis in a new 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,” said Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “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. As a result, patients with colorectal cancer with liver metastasis often rely on living donors. Unfortunately, not everyone is walking around with a living donor. For many of these patients, the only alternative is palliative treatment, which we refuse to accept.” 

In the fall of 2024, after failing to find a living liver donor to treat his stage 4 colorectal cancer, 53-year-old Barclay Missen of Chicago became the first patient at Northwestern Medicine to receive a liver transplant via a surgical technique known as resection and partial liver transplantation with delayed total hepatectomy (RAPID). The two-stage procedure is for patients with cancer who might not survive the wait for a traditional transplant.

First, surgeons remove a graft from a deceased donor liver that is allocated to a patient higher on the transplant waitlist. The larger portion is transplanted in the initially designated recipient, while the smaller portion is transplanted into the patient with cancer, who has half of their cancerous liver removed simultaneously. Weeks later, once the small piece has grown in size, the remaining cancerous liver is removed.

Four months after receiving his new liver via the RAPID technique, Missen has no signs of cancer in his body and doesn’t require any further cancer therapy.

“We are excited to offer RAPID as an option through the CLEAR program,” said Northwestern Medicine transplant surgeon Zachary Dietch, MD. “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 lifesaving 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."

A surprising diagnosis 

Colorectal cancer is the third most common cancer in both men and women worldwide, and the liver is the most common site of spread, with up to 60% of colorectal cancer patients developing liver metastasis. 

In Dec. 2021, Missen was experiencing some minor abdominal discomfort when he came to Northwestern Memorial Hospital for a colonoscopy following his fiftieth birthday. 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.

Missen’s medical team was able to slow the progression of the disease with chemotherapy, a colon resection, and liver ablations, but it was only a matter of time before the cancer grew 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 Missen. The husband and father of two was facing few options for survival when his Northwestern Medicine transplant team approached him with their innovative solution. 

“When I learned that RAPID was an option for me, I was elated,” said Missen. “To go from having little hope to learning that I could become the beneficiary of so much skill, so much bravery, and so much generosity was unbelievable. Not only was I hopeful and grateful to have a chance for a cure, when I learned that this could open doors for other patients, I was all for it.”

Sharing hope

In October 2024, Missen matched with a donor after cardiac death (DCD) liver that had been assigned to another Northwestern Medicine patient – then 57-year-old Kelli Podrez of Hanover Park, Illinois. Podrez, who was listed higher on the transplant waitlist due to severe liver scarring (cirrhosis), 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,” said Podrez. “If I could survive without the whole organ and help save someone’s life, why not share it?”

On Oct. 23, 2024, with Podrez’s consent, surgeons worked for eight hours to remove a graft roughly the size of a human hand from the donor liver. 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 Podrez.

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

On Nov. 7, 2024, Missen went back to the operating room to have the rest of his cancerous liver removed. Four months after surgery, Podrez and Missen’s new livers are working well. Missen has no evidence of cancer left in his body and is looking forward to getting back to his favorite activities: woodworking, camping, painting, building guitars, and spending time with his wife and two teenage children.

“I get emotional when I think about all the things that had to happen,” said Missen. “This donor and their family had to go through what they went through to make this possible. And on top of that, to have another person whose life is on the line be willing to share their hope with me – I can’t put into words how grateful I am for their generosity. I’m sitting here today because of that decision and my incredible Northwestern Medicine transplant team who made it happen.” 

“This procedure is incredibly rare and involves many moving parts,” said Dr. Nadig. “RAPID has been sparingly utilized outside of America, but by splitting a DCD liver on a machine perfusion pump, we’ve chosen to apply it in a unique way at Northwestern Medicine. On top of the skills, expertise, and technology a procedure like this requires, we have to have the collaborative culture to be able to simultaneously transplant these livers, working closely with oncologists and radiologists to make sure the cancer isn’t spreading while the new liver grows. Most importantly, we need a patient who is willing to share the gift of a new liver with another, and a patient who trusts us enough to participate in a first for the health system.”

About the CLEAR Research Registry

The outcomes of the CLEAR program’s first 80 patients will be tracked in a research registry also called CLEAR (Colorectal Metastasis to Liver Extraction with Auxiliary Transplant and Delayed Resection), available on ClinicalTrials.gov The research registry is focused on the outcomes of the treatment intervention. Participation in the research registry is voluntary. A patient may receive a RAPID transplant as part of the CLEAR program without enrolling in the CLEAR research registry. 

“There is still early, but accumulated evidence that shows that certain patients with cancer who receive transplants will derive equivalent or better outcomes than patients who receive transplants for more traditional indications,” said Dr. Dietch. “Transplant oncology is a new frontier in the field of transplant, and Northwestern Medicine is at the forefront. We look forward to providing hope to more patients who are being told the alternative is palliation and death.”

For more information about Northwestern Medicine’s transplant programs, visit nm.org.