Deceased Donor Liver Transplantation and Postoperative Survival in Patients with Unresectable Colorectal Liver Metastases: A Retrospective Multicenter Study.
Academic Article
Overview
abstract
BACKGROUND: Previously, colorectal liver metastases (CLM) was a highly morbid condition, for which standard palliative chemoradiation conferred dismal survival. Liver transplant has emerged as a promising treatment for CLM; however, access has been limited to patients without a history of hepatic artery infusion pump (HAIP) therapy and those with access to living donors. STUDY DESIGN: Six centers participated in a retrospective cohort study evaluating patients undergoing deceased donor liver transplant (DDLT) for CLM. Our primary endpoints were overall and disease-free survival. A subanalysis was performed based on HAIP therapy. RESULTS: 35 patients with CLM were transplanted using DDLT, of whom 15 experienced recurrence (42.9%). Patients underwent primary resection a median of 146 days from diagnosis. 19 patients underwent HAIP therapy (54.3%). KRAS mutation was statistically significantly associated with recurrence (p=0.01). Transplant was performed a median of 1079 days (35.5 months) from diagnosis, at a median MELD score of 7. Of those who recurred, median time to recurrence was 218 days and most metastasized to the lung (n=11) followed by the liver (n=5). Overall DFS was 62.7% at one year and 53.2% at two years. Most patients who recurred remain alive: overall, OS was 96.9% at one year and 84.8% at two years. HAIP therapy was not associated with differences in disease-free or overall survival. CONCLUSION: DDLT confers favorable long-term overall survival to patients with CLM. Although HAIP did not confer improved survival in this cohort, larger studies assessing its impact are necessary.
