Episode 284: The Evolution of Liver Transplant for Cancer With Maen Abdelrahim

Maen Abdelrahim, MD, PhD, Section Chief of Gastrointestinal Medical Oncology at Houston Methodist Neal Cancer Center—home to the nation’s highest-volume liver transplant program—joins the show to discuss the expanding field of transplant oncology, including which patients with hepatocellular carcinoma, colorectal cancer metastatic to the liver, biliary cancers, and intrahepatic cholangiocarcinoma may benefit from liver transplantation. He explores the history of liver transplantation and the development of the Milan criteria, how those advances paved the way for transplant oncology as a multidisciplinary specialty, and the ongoing educational gaps surrounding transplant eligibility and referral. Dr. Abdelrahim also shares insights from his book, “Transplant Oncology: A Frontier in Multidisciplinary Cancer Care,” while discussing the evolving role and safety of immunotherapy and ctDNA in the peri-transplant setting and the future of cancer care for patients once considered untreatable.

Check out Chadi’s website for all Healthcare Unfiltered episodes and other content. https://www.chadinabhan.com/

Watch all Healthcare Unfiltered episodes on YouTube. https://www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA

Transcript

SPEAKER_01 0:13

It's Healthcare Unfiltered. It's your host, Shadi Nabhan. I'm a hematologist and a medical oncologist with interest in all aspects in healthcare delivery, treatment, leadership, mentorship, and policy. Today's podcast, we talk about transplant oncology. When do we do transplantation, liver transplantation for cancers? And no one is better than Dr. Man Abdurahim from Houston Methodist in Texas, in Houston, Texas, to discuss this topic with me. Apparently, Houston Methodist does the most transplants in the country for the liver. And I think a lot of you who are watching or listening, you know that we often, well not often, we there are some patients with hepatocellular carcinoma, this is primary liver cancer, that could undergo hepatic transplantation. But it turns out there are other indications where patients also undergo transplantation. And Dr. Abdurrahim is going to explain all of this for us. Furthermore, he wrote a book called Transplant Oncology. He's the editor of the book. He invited many co-authors to write many chapters in this textbook. The textbook came out in December 2024, and we're going to talk to Uman about his book, the process, and the reception of this textbook, and when he is planning on doing a second edition. So very grateful to Uman for coming on Healthcare Unfiltered. His first time on the show, and of course, it's not going to be his last time. Folks, check out my books, The Cancer Journey, Understanding Diagnosis, Treatments, Recovery and Prevention, and Toxic Exposure, The True Story Behind the Monsanto Trials and The Search for Justice. Two more books coming out in 2026: AI and Cancer Care, When Machines Meet, Modern Medicine. And my first fiction novel, Medical Thriller, Deception in the Ivory Tower. And before without further ado, Dr. Man Abdulrahim on Healthcare Unfiltered. Folks, we have a first timer on Healthcare Unfiltered podcast, Dr. Man Abdulrahim. Welcome to the show, my friend.

SPEAKER_00 2:18

Thank you, Shadi, for having me and looking forward for a great discussion and congratulations for all the success and uh for you.

SPEAKER_01 2:24

Oh no, that's only a fraction, a fraction of what you have done. Uh, but um uh it's actually the first time it's it's it's pretty funny that we've known each other for so long, but it's the first time you come on my podcast. But you do listen to it, you like this podcast, don't you?

SPEAKER_00 2:40

Always, always. You have a great speaker, you have like the topic you choose is always uh educational and always you know uh informative uh to what's going on around us. We are in a dynamic field and healthcare and general and oncology specifically. And uh thank you for your voice, for your program and your platform to keep us informed and to keep all audience are also uh up to date.

SPEAKER_01 3:03

Appreciate it. So tell me, tell us just tell listeners and viewers a bit about you. I mean, I know you're GI oncologist, but how did this all start and what got you into GI oncology and what do you do day in and day out right now?

SPEAKER_00 3:15

Well, Shadi, I uh my story is a little bit interesting. And I started as a pharmacist actually, and uh after the pharmacy school, I got interested in the science and I did a PhD in pharmacology and toxicology. And I had my lab actually after that, and where I work on a drug discovery in oncology in general and uh GI cancer later on. And I get started, you know, uh interesting in medicine um after having a patent application on a drug. This drug actually is a migraine medication uh used to treat uh migraine for many years in Europe and South America, and we found that it's actually interesting. Can treat cancer? And I get curious about it, and one thing led to another data and supporting animal models, and I put it in a clinical trial, phase one. And at that moment, I said, like, no, I've been interested in medicine, and really now I want to do take this drug to the next level in a clinical setting. I went back to medical school, Texas AM, I get my medical degree and baylor for my residency, then uh Duke, I get my fellowship and specifically for GI Oncology, and I came back to Methodist now to practice in GI Oncology. And there so the the journey been actually uh interesting and in effect, starting with the drug discovery, uh, pharmacy, then pharmacology, lab, scientists, and going to a clinical uh practice with heavy uh and a clinical research, phase one. I'm a medical director for phase one, and I do also phase two and three because I'm uh chief of GI Oncology Methodist. So I end up participating on all phase three clinical trials as well as working with my colleague and the lab to get translational research ongoing.

SPEAKER_01 4:52

I did not know that you had a patented uh drug for migraine. I I did not know that story. So, what happened to that drug? Tell us what happened there.

SPEAKER_00 5:00

It's an interesting story in the fact that this is like almost um it's a non-esteroidal anti-inflammatory drug. It's a migraine called typhanamic acid. And it's been used for many years, actually more than 20 years, and it's an older drug and for uh have a good safety profile. I was screening drugs for uh or family with drugs for their effect on bacteria cancer, and I found this actually this drug and a cousin drug, you know, related to the same structural amountes that actually inhibit or target the transcription factors called SP protein, which is important to turn on the genetic machinery for cancer and uh carcinogenesis. And with that drug being the lead compound, because it's been used by humans for many years, I took it to the clinical trials and we try to put it now in phase one uh program uh in our our uh hospital here with a patient uh for pancreatic cancer along with germaproxene. So this drug is gonna be used with germaproxene and the first line sitting to treat pancreatic cancer. And those patients with pancreatic cancer actually, uh they have SP protein elevation, basically, which is the transcription factor lead to cancerogenesis and turning on machinery. So uh long story short, this drug can target the transcription factors make the cell susceptible to chemotherapy. And this, uh little bit early about aspo protein, it is uh high in an infant and it goes down uh to minimum level in adults, but turn on again in cancer. So become a prognostic factor and therapeutic target, and become really like as an interesting target or try screen many drugs on this, and this drug is repurposed to be used in uh GI cancer, but specifically for pancreatic cancer. And hopefully, like no the clinical trials, you know, we're gonna start having some patients on it soon, and hopefully, like no end of next year we'll have some some data if everything went as planned.

SPEAKER_01 7:00

This is really a fascinating story. This is really a fascinating story.

SPEAKER_00 7:04

Yeah, yeah, yeah.

SPEAKER_01 7:06

And I know that you have also an MBA.

SPEAKER_00 7:10

Uh well, like no, it was a leadership uh program through uh Rice University, and uh after that leadership program start like working MBA, but you know, it's start like working progress.

SPEAKER_01 7:20

Did you finish the MBA or it's world work in progress?

SPEAKER_00 7:24

This is uh this is a plan.

SPEAKER_01 7:25

So uh yeah, we're gonna run, we're gonna run. We I don't think we're gonna have enough space for the number of letters after your name. So maybe just take your time a little bit.

SPEAKER_00 7:35

Well, you know, each each uh I'm still learning from uh each uh program I was participating in, and the story is not complete because a lot to learn, you know.

SPEAKER_01 7:45

So so um the uh right now are you mainly clinical or do you have a lab as well?

SPEAKER_00 7:52

You know, I collaborate with my colleague in the lab, and uh but uh most of the time um clinical and clinical research, and uh the lab is a translational component uh where I'm working in the phase one program, so I can bridge the gap between the lab and the clinic and work with my colleague. But some of the drug is my colleague actually in the lab work with us.

SPEAKER_01 8:13

And GI oncology, I mean, I mean, back in the day, uh people were doing just general oncology, then they became GI oncologists, and now you have to be sub-specialized in GI oncology. So I presume you're seeing a lot of pancreatobiliary liver, or are you actually seeing also upper-lower GI?

SPEAKER_00 8:31

I see upper lower GI, but most of my focus is uh hepatiopancetobiliary on a disease group where the pancreas, the liver cancer, and uh uh reside on the bile duct cancer. And I also see disease that has been treated by transplantation, you know, like for example, like a neuron consumer that we can treat by transplant. I see those patients because our transplant program is really heavy and we transplant for many indications uh for oncological need. So uh I see like, you know, and that way the transplant oncology becomes like an interest to me with this disease that we can treat not only by chemotherapy or immunotherapy or targeted therapy, we can treat cancer by transplantation.

SPEAKER_01 9:14

And that's really why I invited you on the podcast because we want to talk a little bit about transplant oncology for solid tumors, obviously, that's what we're talking about, and also you authored the book on this. So before we talk about the book, um, transplant oncology, are there specific diseases where transplantation could work for cancers? Uh I uh you know, we were taught about liver cancer, but are you are you focused outside of that or just you're talking liver cancer specifically?

SPEAKER_00 9:45

Yeah, Shadi, it's been uh interesting and evolving field, and it's beyond liver cancer. So back in the history, uh cancer uh diagnosis is a contraindication for transplantation, especially like we're talking about focusing on liver. So liver transplant for cirrhotic patients with liver disease, and that's the initial indication. And then there is uh the oncological indication back in the 1996-97 when Mazafaro started like no having uh the concept of treating liver cancer by transplantation, and that created what you called Milani criteria back then. And the Milani criteria was very conservative, you know, one less than five, on three less than three each, and to go for treatment for liver cancer, which was treated by Surafanin by transplantation, and the outcome actually turned to be good, but you know, it was very conservative criteria, and since then they expand the criteria, UCS Africa criteria and many criteria across the globe.

SPEAKER_01 10:43

Let's back back up a little bit. What's the what was the criteria that you're referring to? Because maybe there are folks who are listening to this who are not really familiar with what you're talking about.

SPEAKER_00 10:51

Yeah, initially when that uh liver transplantation offered for patients with liver cancer, uh the Milani criteria stating that is if you have one lesion that is less than five or three lesions and none of them is bigger than three, then you can offer the patient a transplantation for oncological indication to treat uh at CC of liver cancer. And the outcome was turned to be like really good. And uh, you know, the overall survival, five years can range from 70 to 80s, which is you know was very good compared to patients without transplantation, can be like a single digit. Since then, you know, the criteria um was uh expanded in different countries, including the USA and Europe and Asia and China and so and Toronto. There was multiple criteria placed, and they go through these criteria to loosen up your line criteria a little bit, allow it multifocality, beginning tumors using certain markers like alpha-fetoprotein. And the outcome continued to be good, five-year survival to be around in the 60 to 70. Then, with so much success in liver cancer, the question came about what about bile duct cancer, beyond liver cancer. The initial study for bile duct cancer, which is Billy Highlight, was really disappointing because the transplant and the outcome was poor, recurrence within one to two years. Then they start implementing certain chemotherapy and radiation therapy to stabilize the disease till the liver become available, or the transplantation after this bridging therapy, if you will. The outcome becomes good, and then the which is five-year survival, it's you know 50 to 60 on September 70, depending on the study. Later on, the question came about okay, well, if we treat primary liver cancer, which is HCC or coloniocarcinoma, can we treat metastasis from another cancer? Neuron to consumer metastasis from from the gut to the liver, uh, the outcome turned out to be good. And there is um, you know, uh Milan net was at least, and the outcome was good, so they become an indication actually for treating neuron to consumer metastasis to the liver by transplantation. The bigger question came about a few years uh back is that you know, what about colorectal cancer with stage four metastasis to the liver? Can we treat this by liver uh transplantation? A few studies you know came in from Europe, uh one of them called Sika 1, and the second one is called SICA2, and then later on the last one is transmit. All these studies support the fact that is the five-year survival for liver-only metastasis from correct cancer is only 15 years. But for selected patient population, if you treat them with liver transplantation after restricting the primary, there's no evidence of cancer extrahepatic, the outcome actually, the five-year survival can be 60 to 70. From 15 to 60 to 70. The initial studies once you can do even if there's a recurrence in the lung, those patients can be treated with oligometastasis treatment, uh, restriction, radiation, or section, the outcome is still good. So that the that created the field of um transplant oncology. Uh I mentioned alial bile duct cancer, very highlight, but intrahepatic colondrocarcinoma also become an indication and become a utility. So much into that, more than just oncological indication, certain diseases or certain technologies, CTDNE, immunotherapy, transplant, become an evolving field.

SPEAKER_01 14:34

Sure. So let's try to uh dissect this because I want to get uh to what led you to decide to write a book in a very evolving field. But what I heard you say for transplant, liver transplant, uh, for oncological diseases, what we're gonna focus on is hepatocillary carcinoma, there is biliary duct cancers, there is possibility for certain scenarios where there's metastasis to the liver from neuroendocrine disease, or even adenocarcinoma of the colon that's just metastasized to the liver if there's like you know one. So let's try to spend maybe a couple of minutes on each one. Let's start from the latter because that's seems pretty um unique. What patients with colon cancer that metastased to the liver you think should be referred for an evaluation at least uh of for transplant?

SPEAKER_00 15:32

Yeah, that's a great question, and the criteria is evolving. And uh, you know, the the SICA one study uh have some you know markers for uh for reveal, which is the initial, but uh what some the outcome of treating cororectal cancer with livometastasis. SICA 2 added a little bit more restriction and transmit have also more patients involved with more restriction. So the criteria as a guideline is not uh solid yet because there is into it there's more evolving factor. But the general theme is that somebody who have uh liver-only metastasis, proven to be liver-only, uh somebody have been uh treatment and have been a response to treatment. The synchronous and metasynchronous, the time of metastasis, this has been a question mark, but we they said like no, they have to be at least more than a year from the time of the diagnosis to know the biology of the cancer and the stability of a disease on the treatment. In addition, there is a component of what we call it, um uh molecular profiling, start playing a role on those patient selection. For example, the BRAF, which is we know it's a bad player and usually an aggressive cancer. The question is do we transplant those patients or not? Because the recurrence might be high and maybe the outcome might not be as good initially. So there is a component of stability of a disease, uh fit of the patient, you know, usually like somebody who is appropriate for transplanting or young fit and somebody who has molecular profiling supportive of this uh initiative or this uh model, if you will. So there is molecular component, there's patient factors, there is cancer factors and cancer biology as well. How about the number of metastases? Yes, number one criteria that patient should be unresectable.

SPEAKER_01 17:24

So we have No, no, but the number, like could I have does it matter if I have diffuse liver, like 10, 20 metastases versus one or two isolated lesions, still not resectable, but only a couple. Like the number of metastases matter, or no, you could still have transplants?

SPEAKER_00 17:40

Yeah, it doesn't matter. As like the disease burden and the number of myths are lower, or you know, it doesn't matter as long we have a good biology control and then intrahepatic uh disease, uh, no extrahepatic control and treatment, and there's also no disease progression at the time of transplant. That is also like no uh Kirchhood.

SPEAKER_01 17:59

And what should we before we move on to the next indication, what should we expect if a patient undergoes transplant? You did mention pretty good uh percentages. I mean, so these are um sustainable, it seems like, you know, over half of patients stay alive at five years or less.

SPEAKER_00 18:16

So the the good news is that you know, those patients who have uh the transplantation and uh the outcome is being good. Uh, we we indicate that is the liver can be utilized in a good way if we have a five-year survival that is above 50 or 60 percent. So those patients we've been with the transplanted with uh with uh colorectal liver metastasis a protocol, you know, the five-year survival is in this 50 to 60, which is a good utilization of the liver, better than 15 percent liver transplantation. Yeah, so the outcome has been good. Even there is a situation when there is cancer coming back, most likely likely if they're gonna come back or recur, it occurs in the lung. And those patients, even with the oligometric metastasis treatment, the outcome is still good.

SPEAKER_01 19:05

Yeah, yeah. Okay. Now, how about neuroendocrine? Any it's about the same or something unique about neuroendocrine?

SPEAKER_00 19:12

Neuroendocrine actually the outcome is uh even better. And actually, we've been following those patients in more than five years, and there's some data about 10 years from those patients. Wow because the the disease you don't have to be like no, um, not the high grade, the intermediate grade, grade one, grade two, and the disease, the outcome has been also been very good. Uh, 70 to 80 percent five year survival, and the uh utilization of liver in this scenario is been good. And we indication also to have to take the primary out. You know, you have the source of the primary, take it out, and you know that liver only and the milan met, or other, it's been a good outcome. So it's been five year survival, 60 to 70.

SPEAKER_01 19:54

Now, the other two indications mentioned biliary and hepatocellary. When should somebody with biliary cancer, which is extremely aggressive, um, should be referred to see a transplant oncologist?

SPEAKER_00 20:07

Yeah, so the for biliary cancer initially what was uh bilialer, and uh the data was supporting like a small uh uh disease, a small uh disease burden. Initially, there was some criteria was blessed about the intrahepatic, which has become the new indication after the berihalar. So the size matter in uh intrahepatic londrocarcinoma, the indication say like no, some societies see like less than three centimeters uh lesion that should be indicated for transplantation, and definitely also uh no extrahepatic and to be controlled on the treatment. So the the intrahepatic is the new uh the new indication uh for bile duct cancer to be transplanted uh for uh oncological indication, if you will.

SPEAKER_01 20:53

Amazing. And then we you shorted us as the hepatocellular, which is um man, how I mean you you travel a lot, you talk to a lot, community oncologists, academic oncologists, uh in the US, outside the US as well. Do you think people know about all of this? Like, how do you feel there's an educational gap um about specifically liver transplant for all of these indications?

SPEAKER_00 21:20

I agree with you, Sharia. Like there is a lot uh to learn and a lot to uh educate as well. You know, uh the liver transplant oncology is evolving field. And uh I presented uh like uh the data, I presented the concept along with our colleagues uh nationally, internationally, uh to different countries, different institutions in the US as well. And there was a lot of interest, and some of the programs actually they are uh having increased interest to want to share uh protocols and uh patients you know to be eligible to be transplanted for such indication. So that's why the book came in on a good time. This is the first and the only book transplant oncology. Uh, uh uh and and globally actually and I have many colleagues across the globe US, uh North America, South America, Middle East, Asia, and we have from Africa and actually my colleague is a from across the globe participating in chapters on this book. We're excited about this because actually it put a lot of concepts together in one place. This is a reference book, the first and with good publisher, Alce Beer, a very respected publisher. And my colleague who write on these uh these chapters actually are pioneers in their field. So when we select and we distributed the topic uh for the book, we carefully selected uh colleagues and to participate according to their expertise. We covered different topics, we covered the concept, the evolving concept, the history of it and where we stand, uh AI in transplant ecology, the future of transplant oncology, what we live in the era of immunotherapy. I mean the question came about is what about immunotherapy for oncological indication and you are treating with transplantation. Can we use immunotherapy for transplant? Can we use immunotherapy after transplant? Because after transplant there's a ton of immunosuppressant patients will have second primary cancers like a skin and visceral or recurse of a disease. Immunotherapy is indicated can we use it before transplant can we use immunotherapy to bridge to transplant and this has become an evolving field and there was a lot of unanswered questions. I participated on the consensus conference for International Liver Transplant Society um in Spain and we sat with our colleague to put some guidelines on on how to approach this field and how to approach the new indication for transplantation for cancer. And so this book became the reference point for many of the trainees many of the faculty uh faculty who have a transplant center not as as as big but they try to expand faculty who have no transplant center but they like to refer patient for transplantation and actually this book um we uh interesting enough actually one of my patients actually came into the clinic uh from out state and he have the holding the book he bought it from Amazon and came in and I look he read through the book he said like hey I don't understand the specific details but I read most of the chapters I have a big idea of what it is and just from looking the book he was more than halfway reading it.

SPEAKER_01 24:35

So so that I mean that takes you to my next question.

SPEAKER_00 24:37

So really the target audience for your book is medical professionals medical students oncology fellows transplant fellows and so on this is not for the general public yes uh the the technicality of the book uh is in in um is high and it's intended for uh healthcare professionals uh surgeons um hepatologists uh oncologist uh student uh resident fellows and uh also healthcare uh administrative sometimes you know with the indication of of this transplantation and expanding their programs where there's a lot of programs they talk to us about you know uh and actually they end up like no having the book and we discuss certain topics based on the book chapters is uh living donor disease donors uh what indication is the program feasible how is your experience for in your correct cancer does your oncologist refer when they can refer so actually it's uh it's interesting and um the field is dynamic uh so many topics were covered but I think there's more can be done as well. How long did it take you to uh write write the book I know that obviously you have contributing authors across the chapters but that's no easy feat to get everybody to write and chase the uh the the writers and make sure like how long did this process take you and how much research did you spend until you you you you were able to actually uh come the book like what's the what's the how long it took an average a year you know that's nothing just one year but a lot it's a teamwork there was a lot of people contributing and we've been as you said we've been like you know zoom meeting uh meeting with colleagues with meeting with authors and uh sometimes the authors like no you find them you know they're busy everybody's busy schedule they have you know all our time they have surgery they have you know a patient and research and uh within a year we're able to accomplish um the the the book on on one place and definitely a few months later on to publish and get it out but you know within a year uh we had 99 of the material was actually only place in in its final format uh with it was figure chapters uh you know and there is uh tables to be placed and there was some communication back and forth about editing uh of this but it's it's a team offered I have to say like you know without um contribution of all all my co-authors yeah yeah this book will not make it uh to to life uh and when did it come out officially uh December 2025 okay and what's have you December 2024 yeah how how was the reception it's been over a year have you gotten any feedback have you gotten any aside from your patient story that you mentioned I mean do you have any feedback from people who read it i i get a good feedback and actually uh some of my colleagues they uh who are participating as uh as uh co-authors they ask you know hey we have more information for data so we're ready for the next uh version of the of the edition of the book uh the big feedback from colleagues actually in the feed who bought the book actually they asked me hey i can use can I use this figure uh as a reprint and and my uh presentation or my uh review articles or we're talking about this topic can I reprint and definitely see the form to do that and we've been sending forms that means they are into depth on the report and there was a lot of interest there are certain uh chapters they said could be uh expanded even farther to cover certain topics even in a bigger uh range but we try to make sure that this is the first book and this is the inaugural you know uh book for the for the for the concept we try to make sure that is the data uh written in this book is based on level one evidence or the data that is evolving a strong science behind it we lift out anything that is not yet uh strong enough to support the book and Shadi interesting enough you know the book came about when we had our first inaugural GI Oncology uh summit at Methodist so that book was actually given as a gift uh token to all speakers who participate in the GI Summit uh in 2024 it was December and the book was came about in December and we had this as a gift and for appreciation I can only imagine the I mean you should be proud of this I mean the sense of pride when you have something like this I mean takes a long time until it comes out and then the feedback and so on.

SPEAKER_01 29:24

But but whenever it comes to medical books the field moves so fast.

SPEAKER_00 29:30

I mean it's 2026 so there's no way I mean it seems like you're gonna have to update this every couple of years no yeah that's absolutely like you know uh we uh publish and ourselves and our colleague in the front part of the world in the war been the author actually in these chapters they published multiple research articles they some of the clinical trials actually conducted and concluded actually and there are some data become available so this is just we are ready for uh the second edition uh some of the topic for example I can give an example shadi is a ct dene in uh era for transplant oncology so we actually published uh the largest study on HCC and utility of CTDNE for uh liver cancer transplant and restriction and other papers coming about you know for CTDNE and colangiocarcinoma and this was a chapter actually in the C T DNA utility and the transplant oncology so the data initially was retrospective and now we have like like some data that is retrospective and we are ready to incorporate this data uh in the new uh edition of the book so this is only from our group imagine the bigger group across the globe yeah there's more data coming up how many transplants how many liver transplants do you guys do a year at Houston Methodism what are we talking about this is a good year actually and a good we we now officially number one uh in the United States uh with a number of transplant and outcome so 300 plus uh transplant done last year so we like one one once a day so like certain days you know our transplant surgeon is super busy and uh we work together and on uh a lot of patients and we created what you call transplant oncology clinic where we work together around in around the patient the patient coming in surgeon hepatologist oncologist we all see on the same day and that clinic is evolving and getting busier uh but you know the the news was we've been celebrating and we've been exciting about is you know uh Methodist in a transplant center become number one in your state uh what was number two for a couple of years and now it's number one volume and outcome and it's exciting news for us and for our patient uh we have a lot of patients coming from off state out of the country and we've been you know honored to serve our patient and to have this outcome who did you displace from number one uh we have it was like you know uh Mayo and UCSF so they've been like up and down the the list you know it seems like the premier league of uh the you know in uh in the UK okay so I mean I think we we um any other books on the horizon for you I mean did you enjoy the price of writing I mean this medical writing it's not really non-medical writing target audience and so on but writing a book is different than writing a scientific paper so um how was what's your can you reflect on that and uh the good bad and the ugly well you're right scientific book is really uh the writing there is kind of um uh more evolving it's uh the the the the opinion of of the writers and their discussion is is so important in the topic especially that is evolving uh it's it's been a journey and I have to say uh from the time when we become an idea and when become as as a need uh there is a lot of uh thought that plays on this book uh the the journey is you know there is uh hiccup in the road and you talked about the the deadline and you know something a little bit and uh from the choosing even the cover and choosing the topic and maybe uh some feedback while we're writing it like this topic might doesn't overlap with other topic. So it's been like a great uh uh journey and a great experience and uh the success of this is actually come from the need and uh from the patient that is we treat and from the expert who are really participating in this book and the motivation we got you know from family support from uh you know that's that's also like you know hey like this is a book that you're writing the book and we're spending after the hours spending the weekends on the the book so um you you wrote uh books and you know you you know how it takes and also uh the the pleasure finally to see it out yeah the pleasure to get like as a piece of uh you know uh of art or educational piece where other can benefit and uh I know you are like just before we come in here that you're uh you was talking about your new book looking forward to uh yeah we'll see no but I mean like you said really congrats this is really amazing and um I I believe you're gonna do a second edition very soon I mean there's no question about it uh in doing so um so man I mean are there any other things pertaining to the book writing or what's going on in transplant oncology I didn't ask you and I think in answering this I guess I would say what are the top one or two questions that you think in the next calendar year uh or in the next 12 months or 18 months that we should be on the lookout for uh in the transplant oncology world are there specific studies that we need to be on lookout for anything that the field is anticipating I guess um soon the two most important uh topic or uh field I would say uh immunotherapy um then the topic for the last 10 years plus on oncology and now we're introducing uh a treatment modality for cancer by transplantation immunotherapy made it to every single type of cancer and including the cancer that we treat by transplantation the question what about the safety of immunotherapy uh around transplantation can we use immunotherapy before transplant to break patient to transplant and keep them on the list for longer time so they can receive the curative treatment of transplantation what if we have a secondary cancer coming after the transplantation or the cancer came back after transplant can we use immunotherapy which has uh been so much success to treat certain diseases can we use it safely after transplantation or are we worried about rejection yeah so these are uh uh a topic of interest uh what about marker for transplantation can we select certain blood markers to say like this patient is gonna fit better for transplantation versus yeah this patient is high risk for transplantation what about marker of recurrence like a ct dNA before transplant is going up or going down is the marker for response uh ct dena after transplant you have a residual disease we have a recurrence uh ct dena is ready for the prime time as a bio markers for recurrence surveillance given the lead time for cdNE is is uh is shorter than imaging that can help us you know we detect earlier recurrence so the immunotherapy buried transplantation uh ct dNE uh around the transplantation before and after is the two hot topics uh that we look for to have uh more data and hopefully in the second edition of the book we're gonna have more uh data to support that and uh data to uh give us an idea and a clue how we gonna treat our patient with transplantation and what's the guideline. So then it's gonna be a need for a certain guideline to cover this topic down the road and this is the consensus conferences being conducted and the last conference was actually in Houston um just last week about uh colorectal level metastasis and part of it was transplantation so there is the field is dynamic and we these topics you know we'll learn more as we go fascinating stuff uh I've learned so much by the way I mean I've learned so much about this and I look forward to having you back.

SPEAKER_01 37:26

Any final thoughts before we let you go back to your busy day?

SPEAKER_00 37:29

Well I thank you sorry I thank you for having me Shadi and I thank you for all that you do uh this um topic that you select uh carefully I always uh follow uh your uh platform and I learn from it always uh well the field is dynamic as we said and we're gonna continue to learn.

unknown 37:49

Dr.

SPEAKER_01 37:49

Man Abduraheem from Houston Methodist thank you so much for coming on Healthcare Unfiltered.

SPEAKER_00 37:54

Thank you so much for having me.

SPEAKER_01 37:55

Have a good day okay folks thank you so much for listening thank you Man for coming on the show thank you for everything you're doing and continue to do it's amazing to see the progress that you have been part of I appreciate you giving us a glimpse of that on Healthcare Unfiltered. Before I let you go folks I want to make sure that you can join the conversation you can follow me on Twitter Facebook Instagram TikTok and really message me with any suggestions or ideas that you may have pertaining to this podcast or the other podcasts I have Healthcare Unfiltered Express. The express version of my podcast usually discusses clinical topics in oncology that cannot wait to the weekly edition of Healthcare Unfiltered and before I let you go I'm gonna leave you with the saying by Winston Churchill if you're going through hell keep going. Until next time take care