Liver Transplantation for Non‐Resectable Liver Metastases from Colorectal Cancer: A Systematic Review and Meta‐Analysis

Abstract

Backgrounds Colorectal liver metastases were historically considered a contraindication to liver transplantation, but dismal outcomes for those with metastatic colorectal cancer and advancements in liver transplantation (LT) have led to a renewed interest in the topic. We aim to compare the current evidence for liver transplantation for non-resectable colorectal liver metastases (NRCLM) with the current standard treatment of palliative chemotherapy. Methods A systematic review and meta-analysis of proportions was conducted following screening of MEDLINE, EMBASE, SCOPUS and CENTRAL for studies reporting liver transplantation for colorectal liver metastases. Post-operative outcomes measured included one-, three- and five-year survival, overall survival, disease-free survival and complication rate. Results Three non-randomised studies met the inclusion criteria, reporting a total of 48 patients receiving LT for NRCLM. Survival at one-, three- and five-years was 83.3–100%, 58.3–80% and 50–80%, respectively, with no significant difference detected (p = 0.22, p = 0.48, p = 0.26). Disease-free survival was 35–56% with the most common site of recurrence being lung. Thirteen out of fourteen deaths were due to disease recurrence. Conclusion Although current evidence suggests a survival benefit conferred by LT in NRCLM compared to palliative chemotherapy, the ethical implications of organ availability and allocation demand rigorous justification. Concomitant improvements in the management of patients following liver resection and of palliative chemotherapy regimens is paramount.

PET-Uptake in Liver Metastases as Method to Predict Tumor Biological Behavior in Patients Transplanted for Colorectal Liver Metastases Developing Lung Recurrence

“…Due to the scarcity of donor grafts LT can only be a treatment option in a minority of patients with CRLM. Several studies with LT in CRC patients are ongoing in Europa and Canada, and several US-transplant centers have now transplant programs considering selected CRC patients for LT [ 29 ]. It is therefore important that the international medical community is aware of LT as a possible treatment option for highly selected CRLM patients.…”

“…The International Hepatico-Panreatico-Billiary Association (IHPBA) has recently published consensus guidelines for LT in CRC patients [ 28 ], and several transplant centers in the United States are now offering LT to highly selected patients with CRLM, including patients with liver failure after chemotherapy and without evidence of malignant disease. In addition, several ongoing clinical trials are investigating LT in non-resectable CRLM both in Europe and North America [ 29 ].…”

Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study

“…Liver transplantation might be an additional therapeutic option for patients responding to induction ST but not achieving eligibility for resection, with a great advantage in terms of survival outcome compared to chemotherapy alone. Patient selection based on a combination of clinical and patho-radiological criteria (i.e., metabolic tumor volume and total lesion glycolysis on PET), molecular prognostic markers, and dynamic evaluation of biological behavior (assessment of response to bridging therapy during an extended period of observation time) guarantees 5-year OS ranging from 50% to 100% for unresectable liver disease [ 46 , 47 , 48 ]. Notably, the inclusion criteria for liver transplantation in ongoing trials enrolling unresectable CRLM are, like those described in our study, to identify patients that are eligible for successful conversion therapy.…”

Liver transplantation for unresectable colorectal liver metastasis

“…The slight decrease in 5-year OS may be explained by the heterogeneity in the selection criteria of the patients included; however, this increased to 66% after 2005 [8]. The second showed a 1-, 3-, and 5-year OS of 83–100%, 58–80%, and 50–80%, respectively, with a 1-year DFS of 53–56% [9]. Although most of this information stems from single-center retrospective studies, there are a growing number of clinical trials being conducted prospectively [10 ▪ ].…”