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Liver Transplantation for Unresectable Colorectal Liver Metastases: Evidence, Patient Selection, and Clinical
Tor Magnus Smedman1,2, Åsmund Avdem Fretland3,4, Svein Dueland1
1Transplant Oncology Research Group, Division of Surgery and Specialized Medicine, Oslo University Hospital, 0424 Oslo, Norway.
Cancers
|July 28, 2026
Summary
Liver transplantation (LT) offers a potential cure for select patients with liver-only colorectal metastases (CRLM). Rigorous selection criteria and molecular profiling are key to achieving high survival rates with LT.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Transplant Surgery
Background:
- Liver transplantation (LT) is re-emerging as a curative option for unresectable colorectal liver metastases (CRLM).
- Previous trials (SECA-I/II) showed 5-year overall survival (OS) of 60-83% in selected CRLM patients.
- The TransMet trial confirmed superior OS with LT versus chemotherapy alone.
Purpose of the Study:
- To review the evolving evidence supporting LT for CRLM.
- To discuss current patient selection strategies, including risk stratification and molecular profiling.
- To explore oncological outcomes and practical considerations for implementing LT in HPB and transplant practice.
Main Methods:
- Narrative review of prospective trials and randomized controlled trials.
- Analysis of patient selection criteria: Oslo Score, metabolic tumor volume (FDG-PET-CT), and molecular profiling.
- Inclusion of data on high-risk molecular features (BRAF V600E, RAS/TP53 co-mutations).
Main Results:
- Selected patients with CRLM can achieve 5-year OS rates of 60-83% with LT.
- LT demonstrates superior OS compared to chemotherapy alone in randomized trials.
- Exclusion of high-risk molecular features is crucial for favorable outcomes.
Conclusions:
- LT is a viable curative treatment for carefully selected CRLM patients.
- Rigorous patient selection, incorporating clinical and molecular factors, is essential for successful LT outcomes.
- Ethical considerations and alternative strategies like living-donor LT are important for broader implementation.
