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Liver transplantation for colorectal metastases

Recent clinical evidence, including the landmark TransMet trial and the SECA study series, has shifted liver transplantation (LT) from an absolute contraindication to a viable, life-saving option for highly selected patients with unresectable colorectal liver metastases (uCLM). Current standards (as of 2026) emphasize that success depends on stringent selection criteria focusing on tumor biology and response to therapy rather than just the number of lesions. Core Indications for Transplantation The following criteria are generally required across most transplant protocols: Disease Confined to the Liver: No evidence of extrahepatic disease on high-resolution imaging (CT/MRI) and PET/CT. Some protocols now permit stable, resectable lung metastases. Controlled Primary Tumor: Radical R0 resection of the primary colorectal adenocarcinoma is mandatory. Chemotherapy Response: A minimum of 6 months of systemic chemotherapy demonstrating stable disease or a partial response (typically ...
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Staged resection for small liver remnants (PVE vs. ALPPS) Liver has a remarkable ability to regenerate to meet the metabolic needs of the human body. The growth factors needed for regeneration travel to the liver via the portal vein. If the portal flow is reduced or stopped the liver will atrophy. This knowledge has been used successfully in the treatment of patients who require an extensive liver resection but would not have enough remaining liver to survive. The threat of liver failure is real. Two options are available for to increase the safety: 1. portal vein embolization/ligation 2. ALPPS procedure.  Both procedures have pros and cons. Portal vein ligation can be done in the operating room at the same time as removing tumors from the future liver remnant. If the future liver remnant is free of tumors but is just too small, then portal vein ligation can be performed percutaneously in interventional radiology. The liver remnant will grow approximately 1-2%/week. Th...
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