Living donor liver transplantation with two-stage hepatectomy for patients with isolated, irresectable colorectal liver\u2014the LIVER-T(W)O-HEAL study

Falk Rauchfuß,Alfred Königsrainer,Silvio Nadalin,Utz Settmacher

doi:10.1186/s12957-018-1549-5

Abstract

BackgroundColorectal cancer is the third most common malignancy worldwide. The occurrence of liver metastases worsens the prognosis of the patient significantly if the tumor burden is not resectable.Liver transplantation might be an option for otherwise irresectable colorectal liver metastases. In this study, we evaluate the role of two-stage hepatectomy in combination with a left-lateral living donor liver transplantation.MethodsPatients with irresectable liver metastases having a stable disease or tumor regression after at least 8 weeks of systemic chemotherapy without an extrahepatic tumor burden (except resectable lung metastases) are suitable for study inclusion. A randomization is not planned since the control arm (systemic chemotherapy) is well established and the superiority of the transplantation procedure has to be expected.The surgical treatment consists of two steps: in a first operation, a left hemihepatectomy in the recipient will be performed. At this place, the left lateral liver lobe (segments II and III) of a living donor will be transplanted. To induce a growth of the graft, a portal vein ligation will be performed. Approximately after 2 weeks, the removal of the right hemiliver will be conducted if the control imaging shows a sufficient growth of the graft.ResultsThe patient recruitment is ongoing. In total, three patients have been already transplanted with this protocol. Up to now, they are tumor-free and in good clinical health.DiscussionWith the design of the LIVER-T(W)O-HEAL study, it might be possible to offer patients with otherwise irresectable colorectal liver metastases a curative treatment option. The key point of this study will be, most probably, the patient’s selection.Trial registrationRegistered at Clinical Trials; NCT03488953; registered on April 5, 2018

Highlights

Recipient Donor Operation, Days Days Discharge Day Operation, Days Days Discharge 336 months transplantation evaluation evaluation step 11–7 8, 10, from the prior step 21–7 8, 10, from the months months months months months months months after step clinic after 14, hospital, step after 14, hospital, after after after after after after after 2 —close step 21 donor 2 step 21 recipient step 2 step 2 step 2 step 2 step 2 step 2 step 2 out- visit 1 after2 after step step Anamnesis XWritten consent donor and recipientIn- and exclusion X criteriaPhysical examination X
50% of patients suffering from colorectal cancer have developed or will develop liver metastases (CRLM) [2]
The purpose of the present study is to evaluate a two-stage hepatectomy with a left lateral living donor liver transplantation and right portal vein ligation for treatment of otherwise irresectable liver metastases of colorectal carcinoma in curative intent

Summary

Introduction

Recipient Donor Operation, Days Days Discharge Day Operation, Days Days Discharge 336 months transplantation evaluation evaluation step 11–7 8, 10, from the prior step 21–7 8, 10, from the months months months months months months months after step clinic after 14, hospital, step after 14, hospital, after after after after after after after 2 —close step 21 donor 2 step 21 recipient step 2 step 2 step 2 step 2 step 2 step 2 step 2 out- visit 1 after2 after step step Anamnesis XWritten consent donor and recipientIn- and exclusion X criteriaPhysical examination X. Liver transplantation might be an option for otherwise irresectable colorectal liver metastases. We evaluate the role of two-stage hepatectomy in combination with a left-lateral living donor liver transplantation. 50% of patients suffering from colorectal cancer have developed or will develop liver metastases (CRLM) [2]. The achievement of a R0 situation significantly improves the outcome since the 5-year survival rate in patients who had a curative liver resection is > 50% [4, 5]. Especially Gorgen et al, and Moris et al, proposed a subdivision in two different eras: one having performed liver transplantation for CRLM prior the year 2000 (having bad results) and the other after 2000 (with much better results, most probably due to an improved patient’s selection) [11, 12]

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