Selection criteria related to long‐term survival following liver transplantation for colorectal liver metastasis

Patients with nonresectable colorectal cancer receiving palliative chemotherapy have a 5‐year overall survival rate of about 10%. Liver transplant provided a Kaplan‐Meier–estimated 5‐year overall survival of up to 83%. The objective of the study was to evaluate the ability of different scoring systems to predict long‐term overall survival after liver transplant. Patients with colorectal cancer with nonresectable liver‐only metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography (PET)‐CT scans from 2 prospective studies (SECA‐I and ‐II) were included. All included patients had previously received chemotherapy. PET‐CT was performed within 90 days of the liver transplant. Overall survival, disease‐free survival, and survival after relapse based on the Fong Clinical Risk Score, total PET liver uptake (metabolic tumor volume), and Oslo Score were compared. At median follow‐up of 85 months for live patients, Kaplan‐Meier overall survival rates at 5 years were 100%, 78%, and 67% in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume–low group, and Oslo Score 0 to 2, respectively. Median overall survival was 101, 68, and 65 months in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume–low, and Oslo Score 0 to 2. These selection criteria may be used to obtain 5‐year overall survival rates comparable to other indications for liver transplant. Based on different scoring systems, colorectal cancer patients with nonresectable liver‐only metastases may obtain Kaplan‐ Meier calculated 5‐year overall survival of 67%‐100% after liver transplantation. See the editorial from Goto and Selzner on page 331.