Living Donor APOLT-ALPPS : Paradigm shift in the management of irresectable colorectal liver metastases

Abstract

Background: Recently, the Norwegian SECA trial suggested deceased donor liver transplantation (DDLT) as promising palliative therapy for patients with irresectable CRLM (i-CRLM)with 5 year OS > 60% notwithstanding early tumor recurrence.The Oslo group reported on one patient with i-CRLM, who underwent Resection And Partial Liver segment 2-3 transplantation from DD with Delayed total hepatectomy ("RAPID" procedure). AIM: To report the first case worldwide of Living Donor RAPID procedure(LD-RAPID). Methods: A 49-year-old woman with i-CRLM and no extra-hepatic disease underwent first a left hepatectomy followed by implantation of her son’s left lateral segments 2-3 according to the APOLT technique plus transection of the right portal vein (ALPPS concept). At POD 10, completion of right hepatectomy was performed. Results: Donor’s postoperative course and the long term FUP (POM 12) were uneventful. The recipient had no complications after Stage 1. After stage 2 she developed a slight SFSS and a late bile leak from BDA which spontaneously resolved. At POM 5 extra hepatic tumor recurrence was observed (positive liquid biopsy , bone and small bilateral lung metastases < 5 mm).Systemic chemotherapy and local radiation therapy were started. At POM 12 she is asymptomatic,in good general condition, with stable disease and negative liquid biopsy. Conclusion: Living Donor APOLT-ALPPS procedure (i.e. LD-RAPID) is feasible and safe for both donor and recipient and may represent a paradigm shift in the management of i-CRLM.