The Current State of Liver Transplantation for Colorectal Liver Metastases in the United States: A Call for Standardized Reporting

Abstract

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.

Liver transplantation for unresectable colorectal liver metastasis

“…This multicenter study, including ten patients from three centers in the US and Canada, demonstrated a 1.5-year OS of 100% and DFS of 62% [12 ▪▪ ]. Interestingly, although this publication showed the outcomes of three high-volume referral centers, the activity has been considerably wider in the US, as shown by Sasaki et al after analyzing the United Network Organ Sharing (UNOS) database [13 ▪▪ ]. This work showed that between 2017 to 2022, 64 patients were listed for this indication, of which, 46 received a LT at 15 centers, showing a 1- and 3-year OS of 89% and 60%; with a DFS of 75% and 54%, respectively.…”

Expanding MELD exceptions for colorectal liver metastasis: data and policy

“…Due to the success of transplantation in the treatment of other types of liver tumors such as hepatocellular carcinoma and metastatic neuroendocrine tumors, liver transplantation has been explored as a treatment option for unresectable colorectal liver metastases (CRLM) in select patients [1 ▪▪ ]. While several trials have shown promising results in the last decade, patients who require a transplant for treatment of their CRLM are not given exception points for their diagnosis [2 ▪▪ ].…”

Emerging Role of Liver Transplantation for Unresectable Colorectal Liver Metastases

“…As such, the first prospective cohort study of LDLT for patients with uCRLM in North America (N = 10) demonstrated a 1.5-year OS and DFS of 100% and 62%, respectively. 19 Subsequently, Sasaki et al 20 reported trends from the United Network Organ Sharing (UNOS) database, showing that between 2017 and 2022, 46 patients received a LT at 15 centers. Slightly more than half (56%) used LDLT, and the rest received deceased donor grafts because of liver failure.…”