Transplantation for colorectal metastases: on the edge of a revolution

Abstract

Liver transplantation (LT) has become the standard of care for selected primary and secondary malignancies. Considered a contra-indication to transplantation until recently, unresectable colorectal liver metastases (CRLM) have gained interest since the publication of the SECA trial by the University of Oslo. It showed a 5-year overall survival of 60%, comparable to the one of standard transplant indication. This report generated multiple questions about the place of LT for CRLM and gave raise to several trials aiming at answering them. The present review is exploring this topic, defining the current state of the field, and extrapolating the future milestones.

Keywords: Liver transplantation (LT); colorectal liver metastases (CRLM).

Figure 1

Overall survival after liver transplantation for metastases from nonresectable CRC in the SECA 1 trial. The KM plot shows overall survival from the time of liver transplantation (red line). Stapled lines shows 95% CI for the KM plot. Blue line shows DFS. All deaths were due to the underlying cancer disease. No patients were lost to follow-up. Reprinted from Hagness et al. (34). OS, overall survival; DFS, disease-free survival; CRC, colorectal cancer.

Figure 2

Preoperative factors affecting survival in the SECA 1 trial. The 16 first patients in the study who had observational time of more than 2 years or who died within this period were analyzed. A, KM plots for patients with maximum tumor diameter above and below the median diameter of 5.5 cm. B, KM plots with CEA levels before transplantation above and below 80 µg/L. C, KM plots for patients with time from primary surgery to liver transplantation more than 2 years and less than 2 years. D, the number of patients who had progressive disease (PD) on chemotherapy at the time of liver transplantation was plotted against the number of patients with stable disease (SD) or had partial response to chemotherapy (PR). The factors displayed in panels A to D present in each patient was summed up, giving factors from 0 to 4. E, KM plots for 3 groups of patients, those having 0 to 1 factors, those having 2 to 3 factors, or those having all 4 factors. Log-rank method is used for the calculation of P values in all panels. Reprinted from Hagness et al. (34).