Salvage Living Donor Liver Transplantation for Colorectal Cancer Liver Metastasis: A Case Report

Abstract

Introduction: Approximately half of the patients with Colorectal cancer (CRC) develop metastases to the liver. Surgical treatment of liver metastases (LM) is the only curative treatment option; however, only 20-40% of patients are candidates for liver resection. In CRC LM cases with unresectable disease, liver transplantation could be a solution with promising results from Norway. Method: Here we present a case with unresectable CRC-LM who developed jaundice and cholangitis and underwent living donor liver transplantation (LDLT) Result: A 42 yo male was referred to our center with cholangitis and jaundice who had multiple percutaneous biliary drainage and endoscopic drainage attempts. The patient was diagnosed with sigmoid colon adeno cancer with multiple liver metastasis 3 years ago and underwent low anterior resection and segment 5 wedge tumor resection (T3N2M1) followed with chemotheraphy (CHT). His LM responded to CHT however recurred after 14 months. He underwent liver resection (18months after initial surgery) followed CHT with capecitabine. He had recurrent liver metastasis for which he underwent portal vein embolization for anatomical resection which was not performed and consecutively transarterial radioembolization. The patient developed jaundice and cholangitis due to biliary compression which required multiple drainage attempts. He went on to have several bouts of cholangitis and severe biliary obstruction requiring multiple admissions and numerous drainage attempts. At referral to our center, his MELD score was 20 (Bil:9.8, INR1.54) and CEA 2737 ng/ml. He had PET scan which showed liver only disease. He had staging laparotomy where 3 hepatoduodenal lymphnodes were negative. After ethical commitee approval, our institutional transplant board decided LDLT. He underwent right lobe living donor liver transplantation and recovered uneventfully and discharged 4 weeks after LDLT. At discharge, his CEA level normalised gradually (53ng/ml) and PET scan was negative. Conclusion: LDLT could be a life saving option for patients with unresectable CRC-LM patients with liver failure.