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Meta-Analysis
. 2021 Nov;45(11):3404-3413.
doi: 10.1007/s00268-021-06248-4. Epub 2021 Jul 28.

Liver Transplantation for Non-Resectable Liver Metastases from Colorectal Cancer: A Systematic Review and Meta-Analysis

Rebecca Varley #  1 , Munir Tarazi #  2 , Madhav Davé  1 , Shahd Mobarak  1 , Martyn C Stott  1 , Minas Baltatzis  3 , Thomas Satyadas  1
Affiliations
Meta-Analysis

Liver Transplantation for Non-Resectable Liver Metastases from Colorectal Cancer: A Systematic Review and Meta-Analysis

Rebecca Varley et al. World J Surg. 2021 Nov.

Abstract

Backgrounds: Colorectal liver metastases were historically considered a contraindication to liver transplantation, but dismal outcomes for those with metastatic colorectal cancer and advancements in liver transplantation (LT) have led to a renewed interest in the topic. We aim to compare the current evidence for liver transplantation for non-resectable colorectal liver metastases (NRCLM) with the current standard treatment of palliative chemotherapy.

Methods: A systematic review and meta-analysis of proportions was conducted following screening of MEDLINE, EMBASE, SCOPUS and CENTRAL for studies reporting liver transplantation for colorectal liver metastases. Post-operative outcomes measured included one-, three- and five-year survival, overall survival, disease-free survival and complication rate.

Results: Three non-randomised studies met the inclusion criteria, reporting a total of 48 patients receiving LT for NRCLM. Survival at one-, three- and five-years was 83.3-100%, 58.3-80% and 50-80%, respectively, with no significant difference detected (p = 0.22, p = 0.48, p = 0.26). Disease-free survival was 35-56% with the most common site of recurrence being lung. Thirteen out of fourteen deaths were due to disease recurrence.

Conclusion: Although current evidence suggests a survival benefit conferred by LT in NRCLM compared to palliative chemotherapy, the ethical implications of organ availability and allocation demand rigorous justification. Concomitant improvements in the management of patients following liver resection and of palliative chemotherapy regimens is paramount.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias summary and graph showing authors’ judements about each risk of bias domain for observational studies using the ROBINS-I tool
Fig. 3
Fig. 3
Survival outcomes: A 30-day mortality, B 1-year survival, C 3-year survival, D 5-year survival. Kaplan–Meier survival curves: E overall survival, F disease-free survival
See this image and copyright information in PMC

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