The TransMet trial and Norwegian studies have shown excellent outcomes in highly selected patients undergoing liver transplant (LT) for unresectable colorectal liver metastases (uCRLM). Our aim is to provide an updated analysis of the current state of LT for uCRLM in the US. Adult patients with diagnosis of uCRLM listed for LT between December 2017 and March 2025 were identified from the United Network for Organ Sharing database and analyzed. An analysis between living donor LT (LDLT) and deceased donor LT (DDLT) was performed. During this period, 222 patients were listed, and 158 received a LT across 33 centers. Of these, 76 (48.1%) underwent LDLT, and 82 patients (51.9%) DDLT. Of the 82 deceased donors, 56 (68.2%) were out-of-sequence offers. Overall, the 3-year survival and disease-free survival rates were 66.7%, and 44.0%, respectively. The 3-year survival for LDLT and DDLT was 74.1% and 57.3% ( P =0.04), respectively. While these results have not yet reached the acceptable threshold established for other LT indications, these have improved and are expected to continue improving after the implementation of prioritization points. Given the potential variability of oncologic selection criteria and graft quality, we call for the standardization of nationally accepted selection criteria for listing patients for LT with uCRLM and for providing early access with high-quality organs. To achieve this it is imperative to create, or update and maintain national databases that allow for the collection of more granular oncological variables.
Chávez‐Villa et al. (Tue,) studied this question.
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