Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases

Roberto Hernandez-Alejandro, Luis I Ruffolo, Kazunari Sasaki, Koji Tomiyama, Mark S Orloff, Karen Pineda-Solis, Amit Nair, Jennie Errigo, M Katherine Dokus, Mark Cattral, Ian D McGilvray, Anand Ghanekar, Steven Gallinger, Nazia Selzner, Marco P A W Claasen, Ron Burkes, Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Bassam N Estfan, Choon Hyuck David Kwon, K V Narayanan Menon, Federico Aucejo, Gonzalo Sapisochin, Roberto Hernandez-Alejandro, Luis I Ruffolo, Kazunari Sasaki, Koji Tomiyama, Mark S Orloff, Karen Pineda-Solis, Amit Nair, Jennie Errigo, M Katherine Dokus, Mark Cattral, Ian D McGilvray, Anand Ghanekar, Steven Gallinger, Nazia Selzner, Marco P A W Claasen, Ron Burkes, Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Bassam N Estfan, Choon Hyuck David Kwon, K V Narayanan Menon, Federico Aucejo, Gonzalo Sapisochin

Abstract

Importance: Colorectal cancer is a leading cause of cancer-related death, and nearly 70% of patients with this cancer have unresectable colorectal cancer liver metastases (CRLMs). Compared with chemotherapy, liver transplant has been reported to improve survival in patients with CRLMs, but in North America, liver allograft shortages make the use of deceased-donor allografts for this indication problematic.

Objective: To examine survival outcomes of living-donor liver transplant (LDLT) for unresectable, liver-confined CRLMs.

Design, setting, and participants: This prospective cohort study included patients at 3 North American liver transplant centers with established LDLT programs, 2 in the US and 1 in Canada. Patients with liver-confined, unresectable CRLMs who had demonstrated sustained disease control on oncologic therapy met the inclusion criteria for LDLT. Patients included in this study underwent an LDLT between July 2017 and October 2020 and were followed up until May 1, 2021.

Exposures: Living-donor liver transplant.

Main outcomes and measures: Perioperative morbidity and mortality of treated patients and donors, assessed by univariate statistics, and 1.5-year Kaplan-Meier estimates of recurrence-free and overall survival for transplant recipients.

Results: Of 91 evaluated patients, 10 (11%) underwent LDLT (6 [60%] male; median age, 45 years [range, 35-58 years]). Among the 10 living donors, 7 (70%) were male, and the median age was 40.5 years (range, 27-50 years). Kaplan-Meier estimates for recurrence-free and overall survival at 1.5 years after LDLT were 62% and 100%, respectively. Perioperative morbidity for both donors and recipients was consistent with established standards (Clavien-Dindo complications among recipients: 3 [10%] had none, 3 [30%] had grade II, and 4 [40%] had grade III; donors: 5 [50%] had none, 4 [40%] had grade I, and 1 had grade III).

Conclusions and relevance: This study's findings of recurrence-free and overall survival rates suggest that select patients with unresectable, liver-confined CRLMs may benefit from total hepatectomy and LDLT.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Kwon reported receiving grants from Medtronic, Integra LifeSciences, Olympus, Fujifilm, and Ethicon outside the submitted work. Dr Sapisochin reported receiving grants from Roche and Bayer and personal fees from Integra, Roche, AstraZeneca, and Novartis outside the submitted work. No other disclosures were reported.

Figures

Figure.. Kaplan-Meier Estimates of Overall and Recurrence-Free…
Figure.. Kaplan-Meier Estimates of Overall and Recurrence-Free Survival in Patients Who Underwent Total Hepatectomy and Living-Donor Liver Transplant

References

    1. Steele G Jr, Ravikumar TS. Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg. 1989;210(2):127-138. doi:10.1097/00000658-198908000-00001
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492
    1. Bismuth H, Adam R, Lévi F, et al. . Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224(4):509-520. doi:10.1097/00000658-199610000-00009
    1. Garden OJ, Rees M, Poston GJ, et al. . Guidelines for resection of colorectal cancer liver metastases. Gut. 2006;55(suppl 3):iii1-iii8. doi:10.1136/gut.2006.098053
    1. Cremolini C, Casagrande M, Loupakis F, et al. . Efficacy of FOLFOXIRI plus bevacizumab in liver-limited metastatic colorectal cancer: a pooled analysis of clinical studies by Gruppo Oncologico del Nord Ovest. Eur J Cancer. 2017;73:74-84. doi:10.1016/j.ejca.2016.10.028
    1. Dueland S, Guren TK, Hagness M, et al. . Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer? Ann Surg. 2015;261(5):956-960. doi:10.1097/SLA.0000000000000786
    1. Scientific Registry of Transplant Recipients. OPTN/SRTR 2019 annual data report: liver. Health Resources and Services Administration. Accessed July 15, 2021.
    1. Kwong AJ, Kim WR, Lake JR, et al. . OPTN/SRTR 2019 Annual Data Report: Liver. Am J Transplant. 2021;21(suppl 2):208-315. doi:10.1111/ajt.16494
    1. Ishaque T, Massie AB, Bowring MG, et al. . Liver transplantation and waitlist mortality for HCC and non-HCC candidates following the 2015 HCC exception policy change. Am J Transplant. 2019;19(2):564-572. doi:10.1111/ajt.15144
    1. Reichman TW, Katchman H, Tanaka T, et al. . Living donor versus deceased donor liver transplantation: a surgeon-matched comparison of recipient morbidity and outcomes. Transpl Int. 2013;26(8):780-787. doi:10.1111/tri.12127
    1. Lai Q, Sapisochin G, Gorgen A, et al. . Evaluation of the intention-to-treat benefit of living donation in patients with hepatocellular carcinoma awaiting a liver transplant. JAMA Surg. 2021;156(9):e213112. Published online September 8, 2021. doi:10.1001/jamasurg.2021.3112
    1. Bonney GK, Chew CA, Lodge P, et al. . Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol. 2021;6(11):933-946. doi:10.1016/S2468-1253(21)00219-3
    1. Dueland S, Syversveen T, Solheim JM, et al. . Survival following liver transplantation for patients with nonresectable liver-only colorectal metastases. Ann Surg. 2020;271(2):212-218. doi:10.1097/SLA.0000000000003404
    1. Hagness M, Foss A, Line PD, et al. . Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257(5):800-806. doi:10.1097/SLA.0b013e3182823957
    1. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309-318. doi:10.1097/00000658-199909000-00004
    1. Line P-D, Dueland S. Liver transplantation for secondary liver tumours: The difficult balance between survival and recurrence. J Hepatol. 2020;73(6):1557-1562. doi:10.1016/j.jhep.2020.08.015
    1. Dueland S, Grut H, Syversveen T, Hagness M, Line P-D. Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis. Am J Transplant. 2020;20(2):530-537. doi:10.1111/ajt.15682
    1. Dankner M. Targeted therapy for colorectal cancers with non-V600 BRAF mutations: perspectives for precision oncology. JCO Precis Oncol. 2018;2(2):1-12. doi:10.1200/PO.18.00195
    1. Amaki-Takao M, Yamaguchi T, Natsume S, et al. . Colorectal cancer with BRAF D594G mutation is not associated with microsatellite instability or poor prognosis. Oncology. 2016;91(3):162-170. doi:10.1159/000447402
    1. Pomfret EA, Lodge JPA, Villamil FG, Siegler M. Should we use living donor grafts for patients with hepatocellular carcinoma? ethical considerations. Liver Transpl. 2011;17(suppl 2):S128-S132. doi:10.1002/lt.22356
    1. Sapisochin G, Hibi T, Toso C, et al. . Transplant oncology in primary and metastatic liver tumors: principles, evidence, and opportunities. Ann Surg. 2021;273(3):483-493. doi:10.1097/SLA.0000000000004071

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren