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This research aims to evaluate the impact of multimodality neoadjuvant therapy on outcomes for patients undergoing liver transplantation for colorectal liver metastasis.

May 29, 2026

Multimodality neoadjuvant downstaging therapy before liver transplantation for colorectal liver metastasis: Real-world data from the Cleveland Clinic.

Key Points

This research aims to evaluate the impact of multimodality neoadjuvant therapy on outcomes for patients undergoing liver transplantation for colorectal liver metastasis.
23 patients entered the protocol; 22 underwent liver transplantation following the Cleveland Clinic down-staging protocol.
Interventions included intensive locoregional therapy and systemic chemotherapy, assessed using FDG PET-CT, ctDNA, and CEA.
Follow-up included evaluation of metabolic activity pre- and post-liver transplantation.
At a median follow-up of 1.6 years, 20 (91%) of patients remain alive and 18 (82%) are recurrence-free.
Median recurrence-free survival was 5.4 years (95% CI=3.52-7.36) and overall survival was 6.72 years (95% CI=5.34-8.00).
Pre-LT ctDNA negativity correlated with non-viable tumors on explant (p=0.028).

Abstract

3594 Background: Liver transplantation (LT) has a clear survival benefit in advanced, unresectable, liver-confined colorectal cancer liver metastasis (CRLM). However, pre-transplant management and optimal selection criteria remain understudied and previously reported data indicate recurrence-free survival 70cm 3 correlated with histologically viable tumor (p=0.031). Pre-LT HAIP demonstrated a trend towards non-viable tumor on explant (n=5/7 non-viable, 71%). Conclusions: LT for CRLM shows clear survival benefit in randomized trials. Aggressive pre-LT locoregional and systemic therapies aimed at minimizing disease burden assessed by PET scan and ctDNA may demonstrate improved outcomes, as may HAIP. A clinical trial testing these hypotheses has been designed with expected enrollment in 2026 at three sites.

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Multimodality neoadjuvant downstaging therapy before liver transplantation for colorectal liver metastasis: Real-world data from the Cleveland Clinic.

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Abstract

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