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Liver transplantation for non-resectable colorectal liver metastasis: where we are and where we are going

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Abstract

Purpose

Almost 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastasis (LM). Although their only long-term curative treatment is surgery, less than half of these patients can be eventually resected. Therefore, palliative chemotherapy is offered as a definitive option, though with poor results. Recently, the University of Oslo group has published encouraging results in the treatment of these patients with liver transplantation (LT), whereby worldwide interest in this option has been renewed.

Methods

A literature review of LT for patients with unresectable colorectal metastasis was performed. This included information regarding patient selection, complications, overall survival (OS) and disease-free survival (DFS), immunosuppression, chemotherapy, and description of the ongoing trials.

Results

Improvements in OS and DFS have been observed in consecutive published prospective trials, as patient selection has been refined. Papers reporting OS of patients who randomly presented similar selection criteria also exhibited good results.

Conclusion

LT within the available therapeutic options in patients with CRC-LM seems to be a compelling alternative in carefully selected patients. The ongoing trials will provide valuable information regarding selection criteria, immunosuppressive therapy and different modalities of adjuvant chemotherapy, which are, to our knowledge, the vital platform of LT in CRC-LM. Although some of the developing techniques involve living donors, graft availability for these patients remains a matter of major concern.

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The funding involved in this work has been provided by our institution.

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Authors and Affiliations

  1. Department of Surgery, Division of HPB Surgery, Liver& Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina

    Juan Glinka, Victoria Ardiles, Juan Pekolj, Juan Mattera, Rodrigo Sanchez Clariá, Eduardo de Santibañes & Martin de Santibañes

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  1. Juan Glinka
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  2. Victoria Ardiles
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  3. Juan Pekolj
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Contributions

J.G. and M.d.S participated in the study conception and design, data analysis, drafting of the article, and critical revision; V.A, R.S.C, J.M., J.P., and E.d.S. participated in the research design, drafting of the article, and critical revision.

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Correspondence to Juan Glinka.

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Glinka, J., Ardiles, V., Pekolj, J. et al. Liver transplantation for non-resectable colorectal liver metastasis: where we are and where we are going. Langenbecks Arch Surg 405, 255–264 (2020). https://doi.org/10.1007/s00423-020-01883-2

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