Is there a place for deceased donor liver transplantation for colorectal metastases in the united states? Feasibility of a protocol utilizing machine perfusion

Introduction: Despite European CRLM transplant trials having been performed entirely using deceased donor liver transplant(DDLT), there has been speculation whether similar results can be achieved in the USA given the lack of MELD score prioritization. Materials: A formal transplant protocol for unresectable CRLM was implemented in our center at the start of 2022 with the plan to utilize DDLT. Results: Between 2022-2025, 86 patients with CRLM were referred to our program and 19 patients underwent a formal transplant evaluation. Median time from listing until transplant was 31 days (range 3-115 d). Median allocation MELD was 8 (range 6-15). The donor livers were from DCDs, older donors, or National Share livers declined by all other centers. All but two of the cases underwent advanced perfusion. There were no cases of PNF, PRS, AKI, HAT, or IC. Median post transplant length of stay was 5 days. Graft and patient survival was 100% at the time of maximal follow-up. Recurrence developed in 3 recipients(25.0%), one of which was treated and has no evidence of disease. Conclusion: These findings support the viability of DDLT for CRLM using advanced perfusion, contingent on strict protocol adherence. Center-specific waitlist dynamics must inform the choice between DDLT and living donor liver transplant(LDLT). Keywords: