Liver Transplantation for Colorectal Liver Metastasis

Abstract

Purpose of Review Accumulating evidence suggest that selected patients with nonresectable liver only metastases from colorectal cancer can be offered liver transplantation with acceptable outcome. This review provides an update on the scientific literature. Recent Findings The SECA-I study showed an estimated 5-year survival of 60% in a heterogenous patient population and guided the development of the first clinical selection criteria. In the sequel SECA-II trial, an estimated 5-year survival of 83% was obtained. A recent study shows that an Oslo score of 0–2, a metabolic tumor volume below 70 cm3 on PET-CT or Fong score of 0–2 at time of listing, can stratify patients with superior survival. Recurrence is common, but about 70% are slow-growing lung metastases, whereof the majority are resectable. Summary Liver transplantation for colorectal liver metastasis is an option in highly selected patients. Futile use of grafts can be avoided by applying stringent selection criteria.

Cost-effectiveness of liver transplantation versus last-resort systemic therapy for colorectal liver metastases

“…Given the scarcity of liver grafts, it is therefore unlikely that these patients will be listed for LT with standard donor grafts. These estimates, however, support the continued exploration of how LTs can be made possible in such patients through expansion of the donor pool, using techniques such as extended-criteria donation 17 , resection and partial liver segment II-III transplantation with delayed total hepatectomy (RAPID) 18 , or allowing living donation combined with the RAPID procedure 19 . Ongoing studies are evaluating both the expected clinical outcomes and ethical issues related to using these techniques (ClinicalTrials.gov, NCT02864485).…”

Expanding MELD exceptions for colorectal liver metastasis: data and policy

“…Many centers across the world are exploring the utilization of liver transplant for CRLM, and over the next decade, many trials will conclude and provide more data and recommendations regarding the use of this treatment [7,12 ▪▪ ] (Fig. 1).…”

Liver Transplantation for Unresectable Colorectal Liver Metastasis: Perspective and Review of Current Literature

“…Given the low number of patients who qualify for surgical resection of liver metastases and the high rate of cancer recurrence after resection, alternative strategies are needed to optimize outcomes in these patients. Liver transplant (LT) is one possible option that is garnering more attention [14][15][16][17][18][19] in treating unresectable CRLM.…”