*Purpose: Colorectal Cancer (CRC) represents the third most common malignancy worldwide. In the US, CRC lifetime risk is approximately 1 in 23 (4.4%) for men and 1 in 25 (4.1%) for women. For those with unresectable disease, survival rates are 10% for 5 years. Liver transplantation has been sought out as a treatment for such unresectable malignancies and has been explored with the SECA study from Oslo University Hospital in Norway. Their results showed overall survival at 1, 3 and 5 years were 95%, 68% and 60% respectively. Disease-free survival (DFS) was 35% at 1 year and 0% at 2 years. This case series reports the experience of living donor liver transplantation for unresectable colorectal metastasis in 5 patients.

*Methods: The medical records of five patients with CRC who underwent living donor liver transplant for unresectable colorectal metastasis to the liver from 2019 to 2020 were reviewed.

*Results: Our 5 patients are Caucasian males with ages ranging from 38 to 67. Mean age for 5 participants is 56. Rectal tumors were identified in 3 of the 5 patients and the remaining 2 had colonic tumors. All patients had resection of their primary tumor and completed chemotherapy regimens prior to evaluation for transplant. All patients had Liver resections for treatment of metastasis with recurrence of tumor and were deemed unresectable. Average time from initial diagnosis to transplant was 72 months with a range of 13-113 months. On day of transplant, an exploratory laparotomy was performed prior to the donor to evaluate for extrahepatic metastasis. Patients were transplanted with a right lobe allograft from a living donor. Blood transfusion were utilized intra-operatively in 2 of 5 patients, and received 1, and 3 units packed red blood cells respectively. Post operatively, all patients placed on immunosuppression regimen with IL-2R induction, and tacrolimus/mycophenolate mofetil for first 4. Post-operative complications included 1 biliary leak, 1 episode of rejection treated with appropriate steroid therapy and recovered. All patients are alive, none lost to follow up. One evidence of recurrence in the transplanted allograft occurred and is currently under treatment with RFA. Time to recurrence in this patient was 7 months. Follow-up duration ranged from 1 month to 19 months, with a mean of 10.6 months.

*Conclusions: Our case series describes 5 patients treated for CRC and presenting with, or later developed liver metastasis. After treatment with appropriate chemotherapeutic agents and recurrence after surgical intervention, they were all deemed further unresectable. Liver transplantation is a viable option to treat this group of patients and is currently being used in certain areas in Eastern countries. Long term follow-up will be needed to evaluate for recurrence in the allograft in our remaining patients.

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