Living donor liver transplantation for colorectal liver metastasis: a narrative review

Abstract

: Colorectal cancer (CRC) is a spread disease worldwide. Most of the patients with CRC will develop liver metastases along the time and more than 75% of them are unresectable (uCRLM). In this case, despite the actual modern chemotherapy, the 5-year overall survival (OS) is lower than 10%. In the recent ten years liver transplantation (LT) for uCRLM experienced a “comeback” with excellent results in terms of OS at 5 years ranging from 60% to 100% according to different selection criteria, notwithstanding high recurrence rates (mainly extrahepatic). These promising results are based on a global population of almost 50 patients who underwent a DDLT. In times of organ paucity and still critical indication, standard DDLT will not find any place outside of studies. Additionally, the use of extended criteria donors (ECD) showed recently poor results in this context. Therefore, one way out of this dilemma may be represented by the use of Living-Donor liver transplantation (LDLT). In this review, we report about LDLT for uCRLM. In addition to a report of initial experience (i.e., global amount of 25 cases), we mainly focused on ethical, technical and oncological aspects of the procedure and proposed future applications as well. In summary, in times of scarcity of organs, LDLT for uCRLM may represent a valid alternative to DDLT with minimal donor risk and maximal recipient benefit in selected cases.