MCALLEN, RGV – The Centers for Disease Control and Prevention has issued a “red flag” warning for the Rio Grande Valley because the region has the highest rates of liver cancer in the nation.

In response, the new DHR Health Transplant Institute has already started to study the issue.

Its transplant director and surgeon, Dr. Jose Luis Almeda, says the high ranking cannot be explained away by the fact that the Valley is heavily Hispanic because other regions with a similar demographic profile do not have such alarming numbers.

He explained that southern California, parts of Arizona, parts of Chicago, parts of Florida, are also heavily Hispanic regions. But, their rates of liver cancer are not as high.

“There is something about here that makes it a little bit higher than any place else,” Almeda said.

A grand opening and ribbon-cutting ceremony was held on July 25, 2018, for the new DHR Health Transplant Institute.

The Rio Grande Guardian interviewed Dr. Almeda at the launch of the DHR Health Transplant Institute late last month.

“The Centers for Disease Control and Prevention has labeled the Rio Grande Valley as the population with the highest rate of liver cancer and we want to find out why,” Almeda said.

“Liver cancer comes as a result of a few different reasons. Some are genetic, some are from the environment, some are because of our diet. We find that no matter what, the Valley has lot more than in other places.”

Almeda said the new institute, working with the UT Rio Grande Valley School of Medicine, has “active research” going on right now to find out why. 

“We have identified a toxin that sort of correlates with it, but that is not 100 percent the cause. We have nothing to really hang our hat on just yet. We think it is going to be a combination of genetics and diet, in the end. But, we have a little ways to go to prove that,” Almeda said.

“Other places in the United States have a lot of alcohol, other places have a lot of Hepatitis C. These are my words, we will probably find a combination of diet and genetics.”

Asked how long the research will take, Almeda said: “Within the next year or two.”

Asked what the prevalence of liver cancer is in Mexico, Almeda said: “We don’t know. We started some international collaborations just recently to figure that out. We don’t know. We want to figure that out, too. Hopefully, in the next couple of years we will be able to compare their population and our population.”

Almeda pointed out that a liver transplant is one of the options for patients that have liver cancer. 

“So, if it comes to the point where that is your only option, we are here to help.”

Dr. Philip G. Thomas, a transplant surgeon at DHR and associate professor at UTRGV School of Medicine, acknowledged the Valley has a “concentration” of liver diseases and Metabolic Syndrome, which combines obesity, diabetes, hyper-tension. 

“They (the Centers for Disease Control and Prevention) have studied Hispanic populations in other parts of the U.S. and in other countries and they do not seem to have this cluster of illnesses related to Metabolic Syndrome, or what is commonly referred to as fatty liver,” Thomas said.

“Fatty liver disease is recognized as having a tremendous cluster in the Rio Grande Valley. There are lots of people who are putting money into studying this. There are at least four drugs that are in the pipeline to treat fatty liver and none of them are yet FDA (U.S. Food & Drug Administration) approved. But, we have the people here that might be good candidates to evaluate those drugs and use those drugs down the road.”

Asked about the work of the DHR Health Transplant Institute, Thomas said:

“We evaluate people who have chronic liver disease, or fatty liver disease. We fix those who are fixable but those who have gone on to end-stage liver disease or who have developed cancers and are candidates for transplants, we can manage them for transplant elsewhere and down the road will be providing transplant as well. At this point we have started the kidney transplant. But down the road we will be adding liver transplants as well.”

The Concept of Healing

Dr. Philip G. Thomas

In an exclusive interview with the Rio Grande Guardian, Dr. Thomas said “the concept of healing is nebulous” and that the community a transplant recipient comes from can be more important that the surgeon who conducts the transplant operation.

“The ultimate cure is to do a transplant. You replace the diseased organ. But, that does not always heal the person. Healing is often provided by the community. Like they say, it takes a village to raise a child. Healing comes to the community and it comes from the community.”

Thomas said he and other transplant surgeons are sometimes questioned about the value of an individual transplant.

“So, when you do a transplant, sometimes people criticize us, ‘oh, you are spending a million bucks on doing a transplant. How will you ever get a return on that investment?’ It is not the person who is receiving the transplant who has to pay back society. It is not possible. 

“But, what I have seen over the years is that when a community gets together to help this kind of an individual, who has such enormous medical needs, to help him survive, it strengthens that community. It makes them stronger in ways which… the return on investment comes back in many different ways.”

Thomas illustrated his theory about a community helping to heal a transplant patient.

“A very simple example: a father needs a liver transplant. He has fatty liver, he has got a liver cancer. Now, the whole community has to come together to get him transplanted. You have a son, a daughter, a cousin fighting among themselves, they do not really see eye to eye. Just when they come together to get their father to survive this, it builds that bond and they become stronger than they ever were. The father may not be the one who makes the return on investment, but that family unity has suddenly become so much stronger, that that return on investment will come to society through that group.”

Before arriving at the DHR Health Transplant Institute, Thomas spent a few years helping heal patients in Kerela, a very underserved region in southwest India. It is his ancestral home.

“My folks come from there. Many people there are called Thomas because we believe St. Thomas came to Kerela and started Christianity there. It is a strange place because although it is not financially very well off, they have some of the best health statistics in the world. And the reason, they have found, is the high level of education, and it is not necessarily the level of education, it is the female education. Women are educated, almost 100 percent of the population of women are educated. So, in spite of having poverty… developing transplant in that area is what I went back for.”

Thomas added: “Healing comes from the community, not the person who does the transplant. I tell people, the donor heals the recipient, I just have to get the plumbing right. That is really the way it is. This field of medicine is so strange that it is really the donor who is healing the recipient.

“Everybody runs out of a burning building but the firefighter runs into it. These are crazy people but they are our heroes. We can’t have a society without its heroes. And these donors are our heroes, they heal the patient. They heal society.”

Editor’s Note: The main photo accompanying the above story was taken at a recent ribbon-cutting ceremony for the new DHR Health Transplant Institute. Pictured from left to right are: Dr. Philip G. Thomas, primary transplant surgeon, Mercedes Rivas of McAllen, a kidney transplant recipient, Dr. Mourad Alsabbagh, transplant nephrologist, and Dr. Jose Luis Almeda, transplant director.