Novel Protocol: Living-Donor Liver Transplant to Treat Unresectable Metastatic Colorectal Cancer

With more than 40 years of pioneering experience in liver transplantation, UPMC is at the forefront of research and innovation in the field. We lead the nation in overall liver transplants performed from both deceased and living donors. Our team’s extensive experience allows us to manage some of the most complicated cases, including living-donor liver transplant to treat complex liver cancers. We’re also available to provide a second opinion for patients who have been declined for liver transplant at another center. 

Our experts have developed innovative protocols to treat several types of liver cancer, including unresectable metastatic colorectal cancer. The protocol details inclusion criteria, exclusion criteria, and operative details.

Inclusion Criteria:

• Age: 18 through 65 years
• Histologically confirmed adenoca of the colon/rectum, resected with adequate margins (at least
• 2 cm for rectal ca)
• Histologically confirmed colorectal liver metastasis non amenable to curative hepatic resection
• Primary Colorectal cancer tumor stage is MT4a or =N1LT to be considered at least 6 months after diagnosis/resection of primary tumor
• Time from primary CRC resection to transplant is at least U6 months
• Received at least 6 to 12 weeks of chemotherapy with no evidence of disease progression
• No signs of local recurrence on colonoscopy, within the past 6 to 12 months before LT
• Evaluation
• No signs of local or extra hepatic metastases on CT CAP/MRI/ PET CT, Bone scan at time of LT
• evaluation
• Bilateral and non-resectable Liver metastases
• No major vascular invasion by Liver metastases; metastases isolated to liver
• Carcinoembryonic Antigen (CEA) < 100 ng/dL at time of LT evaluation
• No limit in terms of number or size of lesions
• Good ECOG performance status: 0-1
• Available living donor

Exclusion Criteria:

• Poor performance status
• Diagnosis of other malignancy within the past 2 years (excluding superficial skin and cervical
• cancers)
• Previous or current extra hepatic metastases or local recurrence
• Any general contraindication for LT
• BRAF mutant tumors
• Previous or concurrent cancer (with some exceptions)
• Progression of Liver mets at any time point prior to transplant surgery

Operative details:

• Exploratory laparotomy first in recipient before donor operation started, with sampling of hilar lymph nodes to rule out spread.
• Postop immunosuppression regimen with IL-2R induction and FK/MMF for first 4 weeks and then subsequently converted to everolimus/MMF.
• Postop need for ongoing and adjuvant chemotherapy to be decided upon in conjunction with medical oncology based on final explant and clinical course of patient.

UPMC offers patients from across the United States and beyond with a single point of care for the full scope of liver disease. Our hepatology, liver cancer, and transplantation experts work in concert to provide comprehensive, seamless care for every patient referred to us.

Visit our website for more information or to refer a patient.