*Purpose: LT is a novel therapy for patients with unresectable CRLM. 5 year survival using LT appears to be significantly better than systemic chemotherapy in selected patients. The aim of this study is to characterize the clinical course of patients with unresectable CRLM that were referred for LT evaluation at a single institution and identify factors influencing progress to LT listing.

*Methods: Patients with CRLM referred to our institution have been prospectively studied under a clinical registry trial protocol since 2018. Demographic, clinical and tumor specific data at the time of presentation and LT evaluation were collected and analyzed.

*Results: 19 patients were referred for CRLM evaluation for potential LT evaluation from 2018 to 2021. Demographics and transplant evaluation data collected during visits for all patients are presented in Table 1. Of the 19 patients that presented for evaluation, 4 received a liver transplant (3 at home site), 1 is currently in liver transplant evaluation, 4 are in CRLM evaluation for transplant, and 10 are no longer eligible for transplant. For the 10 patients who are no longer eligible, the reasons evaluation was ended are identified in Table 2.

*Conclusions: Among patients referred for LT for CRLM, there is a high rate of drop-out prior to listing and progression to transplant. A significant portion of patients developed extra-hepatic disease or decompensated during the evaluation. While selection of appropriate candidates for excellent post-transplant outcomes is important, characterizing the candidates for transplant who present for evaluation and understanding why many do not progress to transplant is critical to refining referral criteria and improving access to transplant for appropriate patients with unresectable CRLM.

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