Liver Transplantation for Colorectal Liver Metastases

Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related mortality worldwide. Over 50% of CRC patients develop liver metastases either at diagnosis or during follow-up. While hepatic resection offers 5-year survival rates of 25–60%, only 20–40% of patients have resectable disease, and recurrence rates remain high. The role of liver transplantation (LT) for non-resectable CRLM has re-emerged over the past two decades with promising results in selected patients.
To evaluate the evolving role of LT in non-resectable CRLM, summarizing key studies, patient selection strategies, and outcomes. We reviewed pivotal studies including SECA I/II, European Consortium, TRANSMET, and recent LDLT series from Toronto, Pittsburgh, and multicenter U.S. cohorts. Inclusion criteria, patient characteristics, surgical and oncological outcomes, and prognostic factors were analyzed.
Early European experiences in the 1980s–1990s showed poor outcomes (5-year overall survival (OS) 12–21%). However, the SECA studies demonstrated 5-year OS of 60–83% in carefully selected patients. The TRANSMET trial, the first randomized study, showed significantly improved 5-year OS in the LT+chemotherapy arm (73.2%) versus chemotherapy alone (9.3%). Living donor liver transplantation (LDLT) series reported comparable survival benefits without impacting organ-sharing systems. Key prognostic factors influencing outcomes include Fong and Oslo scores, tumor biology (KRAS, BRAF, SMAD4 mutations), metabolic tumor volume on PET, CEA levels, and tumor sidedness.
LT for non-resectable CRLM is no longer experimental but a promising option in selected patients with favorable tumor biology and controlled disease. Advances in systemic therapy, imaging, and genomic profiling are critical for refining patient selection. Multidisciplinary collaboration and expansion of LDLT programs may mitigate ethical concerns related to deceased donor organ allocation.

Keywords: Colorectal cancer, colorectal liver metastases, liver transplantation, living donor liver transplantation