Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer

Abstract

OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453).

Overview of the Indications and Contraindications for Liver Transplantation

“…Extrahepatic malignancies as well as hepatic metastases from non-neuroendocrine tumors so far remain absolute contraindications for liver transplantation. However, a recent Norwegian pilot study evaluating liver transplantation for unresectable colorectal liver metastases showed that overall survival exceeds by far the reported outcome for chemotherapy, is comparable with overall survival after liver resection for resectable colorectal liver metastases, and is comparable with overall survival after repeat liver transplantation for nonmalignant diseases (Hagness et al 2013). Thus, ongoing improvements in multimodality cancer therapy may in the future widen indications for liver transplantation in malignant disease.…”

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

“…86,87 By using a mammalian target of rapamycin inhibitor for primary immunosuppression, a Norwegian pilot study of 21 patients achieved 60% overall survival at 5 y, far exceeding the reported outcomes of chemotherapy in this subset of patients. 87 Although 19 of 21 (90%) patients had recurrent disease, a significant proportion of them were accessible to further local treatments and 7 (33%) had no evidence of disease at the last follow-up. 87 However, this study was conducted because of the exceptional situation in Norway where a surplus of organs exists and an ethical dilemma needs to be solved.…”

“…87 However, this study was conducted because of the exceptional situation in Norway where a surplus of organs exists and an ethical dilemma needs to be solved. 87,88 Meanwhile, an Austrian group has suggested a novel technology to detect micrometastases in histologically negative lymph nodes to select patients who may benefit from LT. 89 Tremendous progress in LT over the last several decades as well as new tools developed for patient selection and the notably improved efficacy of chemotherapy may evoke a paradigm shift in the treatment of colorectal cancer.…”

“…On the contrary, in rare circumstances such as Norway where organ supply surpasses demand, clinical trials challenging the current consensus are permissive. 87 (2) Immunological distress: Induction of immune tolerance after transplantation and the crosstalk between transplant and tumor immunity, 145,146 both organ-and disease-specific, has yet to be elucidated. How to determine an adequate level of immunosuppression to prevent rejection and tumor progression at the same time remains the key question.…”

Does center-specific reporting limit innovation

“…For example, in Norway, a trial was performed looking at the outcome of liver transplantation in patients with liver metastases from colorectal carcinoma. 15 One of the cited factors allowing for this trial to proceed was the "fortunate donor situation" in Norway, which allows for transplantation within 1 month. The overall survival at 1 year was acceptable and probably would not have led to center flagging, and the 5-year survival was comparable to that seen in retransplantation.…”