Liver Transplantation for Non-Resectable Liver Metastases from Colorectal Cancer

Abstract

Introduction: Colorectal liver metastases (CLM) are currently considered an absolute contraindication for liver transplantation (Lt). Before 1995 several Lts for CLM were performed, but the outcome was poor (18% 5 year survival) and Lt for CLM was abandoned. Since then, several advances have been achieved and survival following Lt has improved by almost 30%. Based on this, a 5 year survival of 50% following Lt for CLM could be anticipated. Less than 10% of patients with non-resectable CLM will survive beyond five years. Methods: In a prospective study, Lt for non-resectable CLM was performed (n=21). The objective was to investigate safety and the potential for long term overall survival (OS). Main inclusion criteria were non-resectable CLM, excised primary tumor, good general health status and minimum 6 weeks of chemotherapy. Results: OS at 1-, 3-, and 5 year post Lt were 95%, 68% and 60%, respectively. Recurrence of disease was common and appeared in 19 of 21 patients, mainly in the lungs. However, a significant proportion of the recurrences were accessible for surgery and at follow up (median 27 months (range 8 - 60)), 7 patients (33%) had no evidence of disease. Conclusions: All patients had advanced CLM at the time of Lt. Long term OS exceeds by far previously reported outcome for this patient group and is comparable or better than survival following repeat Lt for non-malignant diagnoses. Refinement of robust selection criteria may further improve the results.[Figure 1]