Liver transplantation for colorectal metastasis – selection criteria, outcomes, and management recurrence: a systematic review and meta-analysis

BACKGROUND: Despite advances in systemic therapies, the prognosis for non-resectable colorectal liver metastases (nCRLMs) remains poor, with a 5-year survival rate of only 10%. Liver transplantation (LT) has emerged as a potential curative option for select patients. This study evaluated survival outcomes, recurrence rates, prognostic factors, and quality of life (QoL) following LT for nCRLM. METHODS: A comprehensive search was performed through PubMed, Scopus, and the Cochrane Library for studies available up to 4 October 2024. Eligible studies reported survival, recurrence, or QoL following LT for nCRLM. Risk of bias was evaluated using the Risk of Bias in Nonrandomized Studies of Interventions and the Risk of Bias Tool for Randomized Trials/the Cochrane Risk of Bias Assessment Tool 2. A random-effects model pooled overall survival (OS), disease-free survival (DFS), and recurrence rates. Heterogeneity and publication bias were examined using Cochran's Q and Egger tests. RESULT: Out of 549 patients, 20 studies with 377 unique patients were selected. OS at 1, 3, and 5 years were 91%, 67%, and 54%, respectively, and DFS at 65%, 38%, and 16%, respectively. Recurrence occurred in 52%. Favorable pretransplant factors were linked to better OS. QoL varied, with fatigue, pain, and dyspnea reported posttransplantation. CONCLUSION: LT offers strong survival benefits in nCRLM. However, high recurrence rates highlight the need for strict selection using Oslo score and metabolic tumor volume.