Liver transplantation for colorectal metastasis –selection criteria, outcomes, and management recurrence: a systematic review and meta-analysis

Background: Despite advances in systemic therapies, the prognosis for non-resectable colorectal liver metastases (nCRLM) remains poor, with a 5-year survival rate of only 10%. Liver transplantation (LT) has emerged as a potential curative option for select patients. This study evaluated survival outcomes, recurrence rates, prognostic factors, and quality of life (QoL) following LT for nCRLM. Methods: A comprehensive search was performed through PubMed, Scopus, and the Cochrane Library for studies available up to 4 October 2024. Eligible studies reported survival, recurrence, or QoL following LT for nCRLM. Risk of bias was evaluated using ROBINS-I and RoB 2. A random-effects model pooled overall survival (OS), disease-free survival (DFS), and recurrence rates. Heterogeneity and publication bias were examined using Cochran’s Q and Egger tests. Result: Out of 549 patients, 20 studies with 377 unique patients were selected. OS at 1, 3, and 5 years were 91%, 67%, and 54%. DFS: 65%, 38%, and 16%. Recurrence occurred in 52%. Favorable pre-transplant factors were linked to better OS. QoL varied, with fatigue, pain, and dyspnea reported post-transplantation. Conclusion: LT offers strong survival benefits in nCRLM. However, high recurrence rates highlight the need for strict selection using Oslo score and Metabolic Tumor Volume (MTV).