Liver Transplantation for Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of Survival Outcomes
In brief
Selected patients with colorectal liver metastases reach 83% five-year survival after transplant
In highly selected patients with liver-confined, unresectable colorectal metastases, reported five-year survival after liver transplant reached 83%. A pooled comparison favored transplant, but the estimate depended heavily on one randomized trial and varied across different comparison treatments; recurrence was frequent, though often treated with curative intent. How much benefit transplant offers beyond strict patient selection remains uncertain.
- Journal
- Clinical colorectal cancer (Q1)
- Published
- 25 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Gabriel Valagni, Rafael Alvim Pereira, Gabriel Lenz, Gabriel Barcellos, Tiago Biachi de Castria
- PMID
- 42881061
- DOI
- 10.1016/j.clcc.2026.09.002
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 17 October 2026): Systematic review/meta‑analysis of liver transplantation for unresectable colorectal liver metastases
Abstract
Palliative chemotherapy for unresectable colorectal liver metastases (uCRLM) yields poor long-term survival. Liver transplantation (LT) is an emerging curative option for highly selected patients with liver-only disease. We performed a systematic review and meta-analysis following PRISMA guidelines. Electronic databases were searched for studies evaluating LT for uCRLM. Overall survival (OS) from comparative studies was pooled using random-effects models. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I V2. Potential patient overlap between cohorts from the same transplant programs was assessed and, where present, only 1 report per cohort contributed to pooling. Seventeen studies were included, with 3 comparative studies providing data for meta-analysis. Pooled analysis favored LT over best alternative therapies (HR 0.45, 95% CI 0.28-0.72; P = .0009; I² = 3%). This estimate was not robust: the TransMet randomized trial contributed 63% of the pooled weight, and its exclusion rendered the effect nonsignificant (HR 0.64, 95% CI 0.30-1.35). Comparators were clinically heterogeneous, spanning chemotherapy alone, mixed best alternative therapy, and ALPPS, so the pooled hazard ratio should not be read as a single transferable estimate of transplant benefit. Narrative synthesis indicated 5-year OS rates reached 83% following strict biological selection. Post-transplant recurrence was frequent (72%-81.5%) but often amenable to curative-intent management. Referral data, available only from a conference abstract, suggest that approximately 10% of evaluated patients ultimately undergo LT. In highly selected patients with permanently unresectable, liver-confined CRLM, LT is associated with a survival advantage, although the pooled estimate rests principally on a single randomized trial and should not be generalized across the clinically distinct comparators from which it was derived. The benefit appears to be driven by identifying a ``biological elite'' through stringent selection and aggressive multidisciplinary management of recurrences. PROSPERO registration: CRD42025124542.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.