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Invited Commentary
March 31, 2021

Liver Transplant for Extensive Colorectal Liver Cancer Metastases: Another Tool in the Arsenal?

Author Affiliations
  • 1Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Surg. Published online March 31, 2021. doi:10.1001/jamasurg.2021.0269

Liver transplant is now an alternative in selected patients with extensive isolated colorectal liver metastases (CRLM). One need only to go to a tumor board to hear critics of the concept of liver transplant for isolated CRLM, who implicitate hyperextreme patient selection for the impressive reported outcomes, noting these patients would have done just as well if they underwent chemotherapy alone. Proponents of liver transplant could not agree more and liken finding the ideal recipient to discovering the proverbial needle in the haystack. This elegant experience by Dueland et al1 continues to build on their experience of using liver transplant and compares it with portal vein embolization (PVE) and resection in a retrospective fashion. In this highly selected group with heavy tumor burden, Dueland et al1 found a 5-year survival of 33.4% with liver transplant compared with only 6.7% with PVE/resection. Half of the patients who received liver transplant had 16 lesions or more at time of liver transplant. These impressive results build on the authors’ previous work advocating the use of liver transplant for isolated colorectal metastases in a strict biology-driven protocol.2 We have added one more tool to our complex arsenal of treatment options for CRLM.

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