Recurrence of Colorectal Cancer After Liver Transplant for Isolated Colorectal Liver Metastases: A Narrative Review

Liver transplant can significantly improve survival in patients with isolated colorectal liver metastases (CRLMs) not amenable to surgical resection. The use of evolving strict selection criteria to identify patients with CRLM best suited for transplant has greatly prolonged disease-free survival and resulted in a post-transplant overall survival similar to that of other established indications for transplant such as advanced cirrhosis or hepatocellular carcinoma. While recurrence of colorectal cancer is still seen in the majority of patients after transplant, lesions are typically slow-growing and treatable without significant mortality. Further profiling of patients' tumor molecular and biologic activity before transplant can help risk-stratify them for aggressive recurrence. Our current understanding of recurrence after liver transplant for CRLM is based on only a small number of prospective studies but further trials are underway. Novel surgical approaches which could expand the pool of patients eligible for transplant are also being evaluated. We summarize and discuss the current state of the literature describing the patterns, risk factors, and treatment of recurrence after liver transplant for isolated CRLM.