Liver Transplantation for Unresectable Colorectal Liver Metastases

Colorectal cancer (CRC) is the third most common malignancy worldwide and a leading cause of cancer-related death. Nearly half of CRC patients develop metastatic disease, with the liver being the most frequent site of metastases. While curative-intent surgical resection remains the gold standard for colorectal liver metastases (CRLM), most patients are initially ineligible for surgery, and recurrence rates remain high. Systemic chemotherapy is the primary treatment for unresectable CRLM, with some patients achieving downstaging to surgical eligibility. Alternative approaches, including immune checkpoint inhibitors for MSI-H/dMMR cancers, hepatic artery infusion pumps, and locoregional therapies, have been explored to improve survival. Liver transplantation (LT) was initially abandoned for CRLM due to poor outcomes, but advancements in surgical techniques, immunosuppression, and donor availability have reignited interest in this approach. With LT becoming an established option for hepatocellular carcinoma and cholangiocarcinoma, its potential role in treating unresectable CRLM is being reconsidered. This review provides the latest evidence on LT for CRLM, including patient selection, outcomes, and future research directions.