Deceased Donor Liver Transplantation and Postoperative Survival in Patients with Unresectable Colorectal Liver Metastases: A Retrospective Multicenter Study.

Previously, colorectal liver metastases (CLMs) were a highly morbid condition, for which standard palliative chemoradiation conferred dismal survival. Liver transplantation has emerged as a promising treatment for CLM; however, access has been limited to patients without a history of hepatic artery infusion pump (HAIP) therapy and those with access to living donors. Six centers participated in a retrospective cohort study evaluating patients undergoing deceased donor liver transplantation (DDLT) for CLM. Our primary endpoints were overall (OS) and disease-free survival (DFS).

A subanalysis was performed based on HAIP therapy. Thirty-five patients with CLM were transplanted using DDLT, of whom 15 experienced recurrence (42.9%). Patients underwent primary resection a median of 146 days from diagnosis. Nineteen patients underwent HAIP therapy (54.3%).

KRAS mutation was statistically significantly associated with recurrence (p = 0.01). Transplant was performed a median of 1,079 days (35.5 months) from diagnosis, at a median model for end-stage liver disease score of 7. Of those who recurred, median time to recurrence was 218 days and most metastasized to the lung (11) followed by the liver (5). Overall DFS was 62.7% at 1 year and 53.2% at 2 years.

Most patients who recurred remain alive: overall, OS was 96.9% at 1 year and 84.8% at 2 years. HAIP therapy was not associated with differences in DFS or OS. DDLT confers favorable long-term OS to patients with CLM. Although HAIP did not confer improved survival in this cohort, larger studies assessing its impact are necessary.