CRC patients with unresectable liver metastases may benefit from living-donor LT
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Living-donor liver transplantation may be a viable option for patients with unresectable, liver-confined colorectal cancer liver metastases, according to a study published in JAMA Surgery.
“This study proves for the first time in North America the feasibility and efficacy of living-donor liver transplant in patients with colorectal liver metastases,” senior study author Gonzalo Sapisochin, MD, PhD, MSc, a transplant surgeon at Ajmera Transplant Center and associate professor of surgery at the University of Toronto, told Healio. “To date, all the information that we had was on deceased donation and mainly out of Oslo, Norway. This gives hopes to patients that currently only receive palliative chemotherapy and no chance of cure.”
Sapisochin and colleagues identified 91 patients, all with liver-confined, unresectable CRC liver metastases and sustained disease control with oncologic therapy, from three North American LT centers with established living-donor LT programs. From July 2017 to October 2020, 10 patients (60% men, median age 45 years) underwent living-donor LT and were monitored until May 1, 2021. Ten living donors (70%) were men with a median age of 40.5 years.
Perioperative morbidity and mortality served as the primary outcome of the study; other outcomes included 1.5-year Kaplan-Meier estimates of recurrence-free and overall survival among transplant recipients.
According to study results, Kaplan-Meier estimates were 62% and 100% for recurrence-free and overall survival, respectively, 1.5 years after living-donor LT. Postoperatively, three recipients had no complications, three had grade II Clavien-Dindo complications and four had grade III. Among donors, five had no complications, four had grade I Clavien-Dindo complications and one had grade III.
“This study helps to open this option of living-donor liver transplantation to more patients, who currently only receive palliative care,” Sapisochin said. “It also helps to start to transition from what has been purely research to a new standard of care for Canadian patients.”
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