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Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer

Hagness, Morten MD*,†; Foss, Aksel MD, PhD*,†; Line, Pål-Dag MD, PhD*; Scholz, Tim MD, PhD*; Jørgensen, Pål Foyn MD, PhD*; Fosby, Bjarte MD*,†; Boberg, Kirsten Muri MD, PhD; Mathisen, Øystein MD, PhD§; Gladhaug, Ivar P. MD, PhD†,§; Egge, Tor Skatvedt MD; Solberg, Steinar MD, PhD; Hausken, John MD**; Dueland, Svein MD, PhD††

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182823957
Features
Abstract

Objective: The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs).

Background: Patients with nonresectable CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute contraindication for liver transplantation, although liver transplantation for primary and some secondary liver malignancies shows excellent outcome in selected patients. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%) and liver transplantation for CLMs was abandoned. Since then, the survival rate after liver transplantation in general has improved by almost 30%. On the basis of this, a 5-year survival rate of about 50% after liver transplantation for CLMs could be anticipated.

Methods: In a prospective pilot study, liver transplantation for nonresectable CLMs was performed (n = 21). Main inclusion criteria were liver-only CLMs, excised primary tumors, and at least 6 weeks of chemotherapy.

Results: Kaplan-Meier estimates of the OS rate at 1, 3, and 5 years were 95%, 68%, and 60%, respectively. Metastatic recurrence of disease was common (mainly pulmonary). However, a significant proportion of the recurrences were accessible for surgery, and at follow-up (after median of 27 months; range, 8–60), 33% had no evidence of disease. Hepatic tumor load before liver transplantation, time from primary surgery to liver transplantation, and progressive disease on chemotherapy were identified as significant prognostic factors.

Conclusions: OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453).

In Brief

Colorectal liver metastases are considered a contraindication for liver transplantation. In this study, liver transplantation for nonresectable colorectal liver metastases was performed (n = 21). Five-year survival rate post–liver transplantation was 60% (95% confidence interval, 34–85). Relapse was frequent, but many patients with recurrence were available for surgery. At follow-up, 33% had no evidence of disease.

Author Information

*Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital

Institute of Clinical Medicine, University of Oslo

Section for Gastroenterology, Department of Transplantation Medicine

§Section for Hepato-Pancreato-Biliary Surgery, Department of Gastrointestinal Surgery

Departments of Radiology and Nuclear Medicine

Cardiothoracic Surgery

**Anesthesiology

††Oncology, Oslo University Hospital, Oslo, Norway.

Reprints: Aksel Foss, MD, PhD, Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway. E-mail: afoss@ous-hf.no.

Disclosure: Supported by South-Eastern Norway Regional Health Authority (contract 39151, project 10920) and Oslo University Hospital (contract 38034, project 10920). Also financially supported by Oslo University Hospital and Helse Sor-Ost HF. The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.