Transplantation for Nonresectable Colorectal Liver Metastases - Long Term follow- up of the First Prospective Pilot Study

Ann Surg. 2022 Sep 9. doi: 10.1097/SLA.0000000000005703. Online ahead of print.

Abstract

Objective: To determine whether liver transplantation (LT) can provide long term overall survival (OS) in selected patients with nonresectable liver-only colorectal liver metastases (nrCRLM).

Summary background data: In 2005 the first prospective pilot study on LT for nrCRLM was initiated in Norway. We here report long-term data from this study.

Methods: Main inclusion criteria were nrCRLM, excised primary tumors, and 6 weeks of chemotherapy. Carcinoembryonic antigen >80µg/L, progressive disease on chemotherapy, size of largest lesion >5.5 cm, and less than 2 years from primary tumor resection to LT were previously found to be associated with survival. The sum of these factors constitutes the Oslo Score.

Results: From 2006 to 2012, 23 patients underwent LT in the study. In February 2022, the actual 5- and 10-year OS after LT were 43.5% and 26.1% respectively. All patients alive were observed for more than 10 years (range, 133-168 mo) . Four patients were alive without signs of cancer and with no evidence for disease (NED) of median of 102 months (53-133 mo). A fifth patient died of non-cancer cause after 164 months with NED for 31 months. For patients with Oslo Score of 0 or 1, the 5- and 10-year actual OS was 75 and 50% respectively (n=6). For patients with Oslo Score of 2, the 5- and 10- year actual OS 50% was 33% (n=6). All patients with Oslo score 3 or 4 were deceased 86 months post LT (n=9).

Conclusion: LT for nrCRLM can provide long term survival and perhaps cure for selected patients. The OS is excellent compared to oncological treatment options and in line with results from studies on resectable CRLM.