Where Are We Now With Liver Transplant for Colorectal Metastasis?

• Published in: Current transplantation reports 2022-12, Vol.9 (4), p.257-266
• Main Authors: Chávez-Villa, Mariana, Ruffolo, Luis I., Tomiyama, Koji, Hernandez-Alejandro, Roberto
• Format: Article
• Language: English
• Subjects: Immunology; Liver Transplantation (D C Mulligan and R Batra; Medicine; Medicine & Public Health; Section Editors; Surgery; Topical Collection on Liver Transplantation; Transplant Surgery
• ISSN: 2196-3029; 2196-3029
• DOI: 10.1007/s40472-022-00373-2

Purpose of Review To summarize the current state of liver transplant (LT) for unresectable colorectal liver metastases (CRLM) and share our institutional experience. Recent Findings SECA I and II trials showed a 5-year overall survival (OS) after LT for unresectable CRLM of 60% and 83%, respectively. The recurrence was high, with a 3-year disease-free survival (DFS) in the latter, of 35%. However, the 4-year OS after recurrence remained at 73%. Similarly, the first 10 living donor LT for this indication in North America showed a 1.5-year OS of 100% and DFS of 62%. Additionally, in selected patients with high tumor burden, 5-year OS after LT is 45.3% compared to 12.5% after liver resection. Summary The benefit of total hepatectomy and LT for selected patients with unresectable CRLM has been recently demonstrated. This may also be suitable for resectable disease in patients with high tumor burden and favorable biology. Despite almost universal recurrence, the survival is good due to the indolent pattern of recurrence. The clinical trials currently underway reflect the international interest in this field and are oriented towards evidence-based practice in the future.