Liver transplantation in well-selected patients with unresectable colorectal liver metastases

Background: Liver transplantation may be a curative treatment option in patients with otherwise unresectable liver metastases. We sought to evaluate the long-term outcomes of transplantation candidates by comparing two groups: one treated with living-donor liver transplantation and the other, due to the absence of available living donors, receiving the current gold standard of chemotherapy only. Methods: Eligibility for inclusion of patients with unresectable liver metastases required either stable disease or tumor regression after systemic chemotherapy with no extrahepatic tumor burden. Patients were divided into two cohorts according to the availability of a suitable living donor. The fundamental technical principle is a two-stage transplantation procedure, also referred to as the RAPID technique (Resection and Partial Liver Transplantation with Delayed Hepatectomy). In the first operation, a left hemihepatectomy is carried out in the recipient, followed by orthotopic transplantation of the left lateral liver lobe (segments II and III) from a living donor. To promote graft hypertrophy, portal vein ligation is undertaken. In the second step of the operation, the remaining right lobe of the liver will be removed. Results: The 3-year and 5-year survival rates for the transplantation group were 71.3% and 57%, respectively, compared to 33.3% and 11.1%, respectively, for 15 patients with a negative donor evaluation. The recurrence rate among transplanted patients was 58%. The median disease-free survival time between liver transplantation and recurrence or death was 17.4 months. For those who experienced a recurrence, the median survival time from recurrence was 25.6 months. Conclusions: Liver transplantation for patients with unresectable colorectal liver metastases leads to a significant survival advantage compared to chemotherapy alone. Living-donor liver transplantation is a suitable and safe method to expand organ availability for selected patients.