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Dr. Roberto Hernandez-Alejandro is the Surgical Director of Liver Transplantation at LHSC and Associate Professor of Surgery & Oncology at Western University. He joined LHSC seven years ago and has rapidly gained a reputation for leadership and collaboration, both within LHSC and in the broader surgical community nationally and internationally.
Dr. Hernandez-Alejandro has brought an innovative surgical technique known as ALPPS (Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy) to London for patients with metastatic colorectal cancer to the liver. This patient population can only be successfully treated if their liver metastases can be safely removed surgically, but often the tumours are in multiple segments of the liver. A complete resection wouldn’t leave enough liver behind, but the ALPPS technique allows for this resection to occur in two stages, giving an option for patients who would have otherwise only had palliative therapy as an option. In the first operation, cancerous tissue is removed from the smaller left portion of the liver, and blood flow is directed to that fragment which then quickly grows to a much larger life-sustaining size in 1-2 weeks. The patient then has a second operation and the remaining cancer-containing right side of the liver is removed.
After hearing a European report of this approach, despite many in the medical community remaining skeptical, Dr. Hernandez-Alejandro developed the approach at LHSC. ALPPS offers real hope of extending survival for a patient population that would otherwise live for less than one year. To-date, Dr. Hernandez-Alejandro has been able to implement this technique for 32 patients at LHSC with no mortality and morbidity, and he has published more than 10 peer-reviewed manuscripts related to ALPPS.
Dr. Hernandez-Alejandro is a pioneer in North America for this technique and has talked widely through North America on the surgical innovation. Dr. Hernandez-Alejandro has enrolled all of his cases in a pilot study in an International Registry that is gathering data on the global experience with ALPPS. As one of the five members of the international scientific committee analyzing data from the registry, Dr. Hernandez-Alejandro is helping to judge the effectiveness of the surgical approach.
In addition to his innovative work with ALPPS, under the direction of Dr. Hernandez-Alejandro LHSC has become one of the leading Canadian hospitals for organ transplantation from donors after cardiac death (DCD), and liver transplants from DCD donors now account for 15 per cent of LHSC’s annual totals—more than any other Canadian centre. He is also spearheading machine perfusion of donated livers at LHSC in collaboration with two other Canadian centres in order to maximize the use of organs that might otherwise be discarded.
Dr. Hernandez-Alejandro inspires colleagues, fellows, and residents through his own work ethic, resourcefulness and desire to help patients with life-threatening problems. He is truly pushing the envelope for patients facing a life-threatening illness.