*Purpose: Colorectal cancer is the third leading cause of cancer related death, unfortunately 50% of patients will develop colorectal liver metastases (CRLM), and a minority of these patients undergo resection. Unfortunately, best 5-year survival for liver-confined CRLM remains poor at ~10%. Here we present a North American experience in applying hepatectomy and orthotopic liver transplantation (LT) for CRLM.

*Methods: Multidisciplinary teams reviewed available international data and developed strict criteria for evaluating liver-confined unresectable CRLM for LT. Patient and donor clinicopathologic data was prospectively collected following informed consent for inclusion into institutional registries. Experiences from two high-volume LT centers were pooled for outcome analysis.

*Results: Independent protocols were established at two large volume transplant centers in the United States. Criteria between centers was similar in excluding established risk factors for recurrence including: failure to demonstrate response to chemotherapy, largest lesion exceeding 5 cm in diameter, oncogene activating mutations, and presence of extrahepatic disease during surveillance period of response. Between the two centers, 54 patients were evaluated and followed for consideration. Forty-four patients dropped out due to progression. The remaining 10 patients met criteria and underwent OLT, 8 receiving grafts from living donors, and two from donation after brain death. These patients were on average 46.3 years of age, and 40% female. Ninety-day mortality was 10%. With a median follow up of 400 days, the cohort exhibits a 388 day median disease free survival, and 80% of patients are alive after LT. The four patients who experienced disease recurrence underwent select metastasectomy or adjuvant chemotherapy. Kaplan Meier estimate for overall survival is shown in Figure 1.

*Conclusions: To date, our experience is rapidly evolving with LT for CRLM, however a clear finding is the high rate (81%) of drop out when utilizing strict selection criteria. Early followup data is encouraging with excellent overall survival and acceptable recurrence free survival. These results suggest that with strict selection criteria, good results are obtainable.

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