Liver Transplantation for Unresectable Disease

Abstract

Surgical resection is the only curative modality for colorectal liver metastases (CLM), and 5-year overall survival after resection is about 40%. Nonresectable CLM is not curable and 5-year overall survival is currently about 10%. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%). Consequently, CLMs were considered a contraindication to liver transplantation. Since then, the survival rate after liver transplantation in general has improved by almost 30%. In a prospective pilot study of liver transplantation for nonresectable CLM, a 5-year overall survival rate of 60% was demonstrated; however, 19 of 21 patients experienced recurrence of disease. Patient selection and selection criteria is of critical importance to achieve good results. The access to liver grafts is the main limiting factor, and novel developments are needed if liver transplantation for selected cases of CLM is going to be a clinical reality. By review of the current and ongoing research in this field, the potential role for liver transplantation as one of several treatment modalities for CLM is discussed.