Deceased Donor Livers Have Survival Benefit in Patients with Unresectable Colorectal Liver Metastases

Hill AL, Cullinan DR, Ahmed O, et al. Deceased Donor Liver Transplantation and Postoperative Survival in Patients with Unresectable Colorectal Liver Metastases: A Retrospective Multicenter Study. J Am Coll Surg. March 2026.

Previously, colorectal liver metastases (CLM) were a highly morbid condition for which standard palliative chemoradiation conferred dismal survival. Liver transplant has emerged as a promising treatment for CLM; however, access has been limited to patients without a history of hepatic artery infusion pump (HAIP) therapy and those with access to living donors.

Six centers participated in a retrospective cohort study evaluating patients undergoing deceased donor liver transplant (DDLT) for CLM. The primary endpoints were overall and disease-free survival. A subanalysis was performed based on HAIP therapy.

35 patients with CLM were transplanted using DDLT, of whom 15 experienced recurrence (42.9%). Patients underwent primary resection a median of 146 days from diagnosis. 19 patients underwent HAIP therapy (54.3%). KRAS mutation was statistically significantly associated with recurrence (p=0.01).

Transplant was performed a median of 1,079 days (35.5 months) from diagnosis, at a median MELD score of 7. Of those who recurred, median time to recurrence was 218 days and most metastasized to the lung (n = 11) followed by the liver (n = 5). 

Overall, disease-free survival was 62.7% at 1 year and 53.2% at 2 years. Most patients who recurred remain alive: overall, overall survival was 96.9% at 1 year and 84.8% at 2 years. HAIP therapy was not associated with differences in disease-free or overall survival.

For surgeons, DDLT confers favorable long-term overall survival to patients with CLM. Although HAIP did not confer improved survival in this cohort, larger studies assessing its impact are necessary.