From Terminal Diagnosis to 'No Evidence of Disease': How a Liver Transplant Is Rewriting the Playbook on Stage 4 Colorectal Cancer

When Amy Piccioli walked into a Los Angeles emergency room in May 2024 expecting treatment for dehydration, she had no idea she was about to receive the most devastating diagnosis of her life. A CT scan revealed a mass in her colon and multiple lesions in her liver. At 39 years old, a mother of three with no family history and no symptoms, Piccioli had stage 4 colorectal cancer [1][2].

Ten months later, she would undergo a groundbreaking liver transplant at Northwestern Medicine in Chicago. Three months after that — in March 2026 — her doctors confirmed what once seemed impossible: no evidence of disease [1].

Her story is not just a tale of personal survival. It sits at the intersection of several converging medical crises and breakthroughs — a sharp rise in colorectal cancer among younger adults, a transformative clinical trial that has upended decades of oncological orthodoxy, and an innovative surgical program that could expand access to lifesaving transplants for thousands of patients currently facing a death sentence.

A 'Silent' Cancer That Strikes the Young

Piccioli's case embodies a troubling epidemiological trend. Colorectal cancer, long considered a disease of older adults, is surging among younger generations at an alarming rate. According to the American Cancer Society's 2026 statistics report, colorectal cancer diagnoses are rising by nearly 3% per year in adults under 50 and by 0.4% per year among those aged 50 to 64, even as rates continue to decline among adults 65 and older [3][4].

The numbers are stark. In 2026, the ACS projects approximately 108,860 new cases of colon cancer and 49,990 new cases of rectal cancer in the United States, with about 55,230 deaths [5]. Nearly one in five people diagnosed with colorectal cancer is now under age 55, and the disease has become the leading cause of cancer death in that age group [3]. Nearly half — 45% — of all new diagnoses are in individuals younger than 65, up from 27% in 1995 [4].

Source: American Cancer Society / CA: A Cancer Journal for Clinicians, 2026

Data as of Mar 1, 2026CSV

"I had zero signs of colorectal cancer. No pain, no changes in bowel habits, and no family history," Piccioli told Northwestern Medicine's press team [2]. Her experience underscores a pattern that oncologists find deeply concerning: younger patients often present with advanced disease because they fall outside traditional screening guidelines and their symptoms — when they exist at all — are frequently dismissed.

In 2021, the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45, a change driven by the rising incidence in younger populations [6]. But screening uptake in the 45-49 age group remains low, and patients like Piccioli, diagnosed at 39, still fall below even the revised threshold.

The Transplant Revolution: TRANSMET Changes Everything

For decades, liver transplantation for colorectal cancer that had spread to the liver was considered a dead end. Early attempts in the 1990s produced dismal results, with five-year survival rates as low as 18% and high rates of recurrence, leading the transplant community to largely abandon the approach [7].

The turning point came in 2013, when the Norwegian SECA-I pilot study reported a 60% five-year overall survival rate after liver transplant in patients with unresectable colorectal liver metastases — a result that stunned the oncology world and reignited interest in the field [7].

But the definitive evidence arrived in 2024 with the publication of the TRANSMET trial, a multicenter, randomized controlled trial conducted across 20 centers in Europe. The results, published in The Lancet, were nothing short of remarkable [8][9].

Among 94 patients randomized to either liver transplantation plus chemotherapy or chemotherapy alone, the per-protocol analysis showed a five-year overall survival of 73% in the transplant group compared to just 9% in the chemotherapy-only group — an 84% reduction in the risk of death [8][9]. The intent-to-treat analysis, which includes patients who were assigned to transplant but did not receive one, still showed a striking 57% five-year survival versus 13% [9].

Source: TRANSMET Trial / The Lancet, 2024

Data as of Sep 22, 2024CSV

"It's safe to say this works," said Dr. Kenneth Lee, commenting on the trial results at the 2024 ASCO Gastrointestinal Cancers Symposium [9].

Even with a 72% recurrence rate among transplant recipients, nearly half of those who relapsed underwent successful rescue surgery or ablation. At more than 50 months of follow-up, 42% of transplant recipients had no evidence of disease — a figure that would have been unthinkable a decade ago [9].

Amy's Journey: From California to Chicago

After her diagnosis, Piccioli's California medical team began chemotherapy, which succeeded in shrinking her tumors. They then encouraged her to explore transplant programs — a relatively new option that few centers in the country offer [1][2].

She was referred to Northwestern Medicine, which had launched one of the nation's most innovative programs for liver transplantation in colorectal cancer patients. In September 2025, Piccioli traveled to Chicago, where a multidisciplinary team evaluated her and determined she was a strong candidate for a living-donor liver transplant [2].

The question of finding a donor resolved itself in an unexpected way. Lauren Prior, a 37-year-old mother of three from Glenview, Illinois — the daughter of longtime family friends who had known Piccioli since childhood — volunteered to be tested. She was a match [1][2].

"It's such a small sacrifice to make that could potentially save someone's life," Prior said [1].

On December 17, 2025, surgeons at Northwestern Memorial Hospital removed a portion of Prior's liver and transplanted it into Piccioli, whose diseased liver was removed. Both women recovered, and by March 2026, Piccioli's blood tests showed no residual cancer [2].

"I feel completely back to normal," Piccioli said, though she continues to take anti-rejection medication, a lifelong requirement after organ transplantation [1].

Dr. Zachary Dietch, the transplant surgeon who led the operation, emphasized the significance of the outcome. "Transplant is a lifesaving option for these patients," he said. "Five-year survival with chemotherapy is just 10%, but that survival can reach 80% with a liver transplant" [10].

The CLEAR Program: Expanding Access Through Innovation

Piccioli's transplant was a living-donor procedure, but Northwestern Medicine has also developed a program designed to expand access for patients who cannot find a living donor. The CLEAR program (Colorectal Metastasis to Liver Extraction with Auxiliary Transplant and Delayed Resection), officially announced in March 2025, employs an innovative two-stage surgical technique called RAPID [10][11].

The RAPID procedure (Resection And Partial Liver Transplantation with Delayed Total Hepatectomy) works by using a portion of a deceased donor liver — specifically, a smaller segment that would otherwise go unused — and transplanting it alongside the patient's existing liver. Here is how it works in practice [10][11]:

1. When a deceased donor liver is allocated to a patient on the waitlist, surgeons split the organ.
2. The larger portion goes to the original designated recipient.
3. Simultaneously, half of the cancer patient's liver is removed.
4. The smaller donor graft is implanted into the cancer patient.
5. A machine perfusion pump maintains organ viability during the process.
6. Within approximately two weeks, the transplanted graft doubles in size through natural liver regeneration.
7. Once the graft has grown sufficiently, the remaining cancerous liver is removed in a second surgery.

This approach is significant for two reasons. First, it does not divert organs away from patients already on the transplant waitlist, since the primary recipient still receives the larger portion of the liver. Second, it leverages the liver's remarkable regenerative capacity to create a viable organ from a smaller graft [10][11].

The CLEAR program, led by Dr. Satish Nadig and Dr. Dietch, plans to track outcomes in its first 80 patients as part of a clinical research registry. Participation in the registry is voluntary and not required to receive treatment [10].

The Donor Question: Ethics, Risks, and the Organ Shortage

Any expansion of liver transplantation for cancer patients raises critical questions about organ allocation. The United States faces a persistent organ shortage: as of late 2024, approximately 9,424 patients were waiting for a liver transplant, and 13 people die each day waiting for an organ [12]. Only 3 in 1,000 people die in circumstances that allow for deceased organ donation [12].

Living donation, as in Piccioli's case, sidesteps the waitlist entirely but introduces risks for the donor. Donor mortality is less than 1%, though complication rates range from 15% to 25%, including wound-related problems, respiratory issues, and psychological complications [13]. Long-term studies have found that some donors face elevated rates of depression and other health issues compared to matched healthy controls, though the vast majority do not regret their decision [13].

The RAPID procedure's split-liver approach attempts to thread a difficult ethical needle — offering transplants to cancer patients without reducing the supply available to other waitlisted patients. Whether this model can scale nationwide remains to be seen.

What This Means for Patients

The implications of the TRANSMET trial results and programs like CLEAR extend far beyond individual cases. Colorectal cancer is the third most common cancer in the United States and the second leading cause of cancer death [5]. Approximately 50% of patients with colorectal cancer will develop liver metastases at some point during their disease, and for many, the tumors in the liver are unresectable — meaning they cannot be surgically removed [7][8].

For these patients, chemotherapy has long been the only option, offering a median survival of around two years and a five-year survival rate of roughly 10% [8]. The TRANSMET trial has demonstrated that, in carefully selected patients, liver transplantation can transform a terminal diagnosis into a potentially curable one.

The challenge now is access. Only a handful of centers in the United States currently offer liver transplantation for colorectal liver metastases. Patient selection criteria remain stringent — candidates must demonstrate that their cancer responds to chemotherapy, that the disease is confined primarily to the liver, and that they are fit enough to withstand major surgery and lifelong immunosuppression.

But the trajectory is clear. Programs like CLEAR are designed to make the procedure more widely available, and the strength of the TRANSMET data is likely to accelerate adoption at transplant centers across the country. For Amy Piccioli, the math was simple. "Without the transplant," she said, her options were "very poor chances at long-term survival" [1]. With it, she is cancer-free, raising her three children, and advocating for broader access to the treatment that saved her life.