Liver transplantation (LT) for patients with colorectal liver metastases (CLM)

Curative-intent resection is the end point of the treatment of colorectal liver metastases (CLM). While R0-R1 resection offer the best outcome (40-50% 5-year survival), it is not always feasible. For initially non resectable patients, conversion chemotherapy may allow 15-20% of them to be downsized and further submitted to a secondary resection with a 30-40 % 5-year survival. However, still a majority of patients remain with extensive non resectable disease and the standard of care in these cases – chemotherapy- offers a little chance of long-term survival.
In the randomized Transmet trial, liver transplantation (LT) has recently demonstrated a much better survival compared to chemotherapy alone (73% vs 9%, at 5 years). Despite a 72% recurrence rate, 42 % of patients were disease-free after a 50-month follow up, with a real hope of cure.
Therefore, in select patients with definitively unresectable colorectal liver metastases, liver transplantation significantly improves survival compared to chemotherapy alone. These results argue for validating liver transplantation as a new standard option that may change the treatment strategy for liver-only definetively unresectable metastatic patients responding well to chemotherapy.
René Adam, Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Université Paris-Saclay, Villejuif