Abstract
Introduction: Colorectal cancer remains a prevalent disease worldwide, with over 50% of patients developing liver metastases. Despite advances in improving resectability, most patients present with non-resectable colorectal liver metastases (NRCLM) only amenable to palliative systemic therapy. There is a growing interest in using liver transplantation (LT) to treat NRCLM in well-selected patients. To address the urgent need for a consensus approach, the International Hepato-pancreato-biliary Association (IHPBA) commissioned the Liver Transplantation for Colorectal Liver Metastases 2021 (LT-CoMet) working group. The aim was to standardise nomenclature and define management principles in five key domains: patient selection, evaluation of biological behaviour, graft selection, recipient considerations and outcomes. Method: A systematic review was performed and a three-step modified Delphi consensus process was undertaken between November 2020 and January 2021. Results: A final consensus of 44 statements, standardised nomenclature and a management algorithm are presented. Specific criteria for clinico-patho-radiological assessment and molecular profiling followed by an evaluation of biological behaviour via bridging therapy to transplantation is required. Sequencing of treatment in synchronous metastatic disease requires special consideration. Certain ethical dilemmas regarding organ allocation for malignant indications are discussed and the role for extended criteria grafts, living donor transplantation and machine perfusion technologies in NRCLM is reviewed. Immunosuppressive regimens and management of recurrent disease are proposed. Conclusions: This consensus guideline provides a framework by which LT for NRCLM may be safely instituted and is a meaningful step towards future evidenced-based practice for better patient selection and organ allocation to improve survival for patients with this disease.
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