Background Current success in transplant oncology for select liver tumors, such as hepatocellular carcinoma, has ignited international interest in liver transplantation (LT) as a therapeutic option for nonresectable colorectal liver metastases (CRLM). In the United States, the CRLM LT experience is limited to reports from a handful of centers. This study was designed to summarize donor, recipient, and transplant center characteristics and posttransplant outcomes for the indication of CRLM. Methods Adult, primary LT patients listed between December 2017 and March 2022 were identified by using United Network Organ Sharing database. LT for CRLM was identified from variables: “DIAG_OSTXT”; “DGN_OSTXT_TCR”; “DGN2_OSTXT_TCR”; and “MALIG_TY_OSTXT.” Results During this study period, 64 patients were listed, and 46 received LT for CRLM in 15 centers. Of 46 patients who underwent LT for CRLM, 26 patients (56.5%) received LTs using living donor LT (LDLT), and 20 patients received LT using deceased donor (DDLT) (43.5%). The median laboratory MELD-Na score at the time of listing was statistically similar between the LDLT and DDLT groups (8 vs. 9, P = 0.14). This persisted at the time of LT (8 vs. 12, P = 0.06). The 1-, 2-, and 3-year, disease-free, survival rates were 75.1, 53.7, and 53.7%. Overall survival rates were 89.0, 60.4, and 60.4%, respectively. Conclusions This first comprehensive U.S. analysis of LT for CRLM suggests a burgeoning interest in high-volume U.S. transplant centers. Strategies to optimize patient selection are limited by the scarce oncologic history provided in UNOS data, warranting a separate registry to study LT in CRLM.

The current liver allocation system may be disadvantaging younger adult recipients as it does not incorporate the donor-recipient age difference. Given the longer life expectancy of younger recipients, the influences of older donor grafts on their long-term prognosis should be elucidated. This study sought to reveal the long-term prognostic influence of the donor-recipient age difference in young adult recipients. Adult patients who received initial liver transplants from deceased donors between 2002 and 2021 were identified from the UNOS database. Young recipients (patients 45 years old or below) were categorized into 4 groups: donor age younger than the recipient, 0-9 years older, 10-19 years older, or 20 years older or above. Older recipients were defined as patients 65 years old or above.To examine the influence of the age difference in long-term survivors, conditional graft survival analysis was conducted on both younger and older recipients.Among 91,952 transplant recipients, 15,170 patients were 45 years old or below (16.5%); these were categorized into 6,114 (40.3%), 3,315 (21.9%), 2,970 (19.6%), and 2,771 (18.3%) for groups 1-4, respectively. Group 1 demonstrated the highest probability of survival, followed by groups 2, 3, and 4 for the actual graft survival and conditional graft survival analyses. In younger recipients who survived at least 5 years post-transplant, inferior long-term survival was observed when there was an age difference of 10 years or above (86.9% vs. 80.6%, logrank p < 0.01), whereas there was no difference in older recipients (72.6% vs. 74.2%, log-rank p = 0.89). In younger patients who are not in emergent need of a transplant, preferential allocation of younger aged donor offers would optimize organ utility by increasing postoperative graft survival time.

Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic cholangiocarcinoma (iCCA) who are not amenable to curative resection. Recent studies have challenged the traditional notion that liver transplantation is contraindicated for iCCA, leading to a paradigm shift in its management. This review provides a comprehensive synthesis of the evidence regarding the role of liver transplantation in the treatment of very early or advanced iCCA and discusses the key challenges and future directions in this rapidly evolving field. For patients with cirrhosis and very early iCCA, liver transplantation has demonstrated excellent long-term survival rates, rivaling those of patients with hepatocellular carcinoma. However, the current transplantation criteria based on tumor size and number may be overly restrictive, excluding potential candidates who could benefit from this treatment. The incorporation of tumor markers into selection criteria may improve prognostic prediction and patient outcomes. In advanced iCCA, liver transplantation remains controversial but holds promise, especially when combined with neoadjuvant and adjuvant therapies. Donor organ scarcity necessitates the consideration of living donor liver transplantation as an alternative, while strategies such as utilizing marginal donors and exploring xenotransplantation offer potential solutions to address the shortage of donor livers. Overall, the evolving understanding of iCCA and the development of novel treatment strategies promise to refine and enhance the role of liver transplantation in the management of this challenging malignancy.

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