Liver transplantation for intestinal malignancies

Area of Science:

• Oncology
• Hepatology
• Transplantation Surgery

Background:

• Liver transplantation (LT) is expanding beyond primary liver tumors to include metastatic intestinal cancers like colorectal liver metastases (CRLM) and neuroendocrine liver metastases (NELM).
• A reassessment of indications, patient selection, and outcomes is needed for transplant oncology.
• Distinguishing prognostic factors from selection criteria is vital for accurate patient stratification.

Purpose of the Study:

• To review the evolving role of LT in managing metastatic intestinal cancers.
• To explore patient selection criteria and clinical outcomes for LT in CRLM and NELM.
• To propose a framework for ethical allocation and outcome assessment in transplant oncology.

Main Methods:

• Review of current literature and prospective studies (e.g., SECA I-II, TransMet trial).
• Analysis of prognostic factors versus selection criteria for LT candidates.
• Evaluation of overall survival as the primary endpoint, contrasting with recurrence-free survival.

Main Results:

• LT demonstrates significant survival benefits in selected CRLM and NELM patients.
• Estimated transplant benefit varies, with ~22.5 months for per-protocol CRLM and ~12 months for NELM.
• Overall survival is a more reliable endpoint than recurrence-free survival due to biases.

Conclusions:

• Careful patient selection and ethical considerations are paramount for LT in intestinal malignancies.
• "Transplant benefit" offers a fair measure for resource allocation.
• Future directions include expanding LT criteria and enhancing collaborative oncologic governance.