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Published on: March 3, 2023
451
Transplantation for colorectal liver metastasis
Pål-Dag Line1,2, Svein Dueland1
1Department of Transplantation Medicine, Oslo University Hospital.
Current Opinion in Organ Transplantation
|November 23, 2023
Summary
Liver transplantation may benefit selected patients with colorectal liver metastasis. Favorable factors include specific Oslo and tumor burden scores, guiding better patient selection for improved survival outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Liver transplantation is a potential treatment for unresectable colorectal liver metastasis (CRLM).
- Optimal selection criteria and outcomes for this patient group remain debated.
- Early multidisciplinary evaluation is crucial, not solely after conventional therapy failure.
Approach:
- Analysis of large cohorts to identify prognostic factors for overall survival.
- Review of recent trials challenging traditional exclusion criteria.
- Consideration of emerging technologies like circulating DNA and liquid biopsy for patient selection and monitoring.
Key Points:
- Metachronous disease, Oslo score 0-1, metabolic tumor volume (MTV) < 70 cm³, and tumor burden score < 9 are positive predictors of survival.
- Technical resectability may not be an absolute exclusion criterion for selected high-tumor-load patients.
- Liquid biopsy and circulating DNA offer future potential for patient selection and monitoring.
Conclusions:
- Refining selection criteria for liver transplantation in CRLM requires larger datasets.
- Multidisciplinary evaluation should be initiated early in the treatment pathway.
- Emerging biomarkers and reassessment of exclusion criteria are key to optimizing outcomes.
