United Kingdom Criteria for Liver Transplantation in the Setting of Isolated Unresectable Colorectal Liver Metastases.

AIM
Studies have demonstrated that liver transplantation may be an effective treatment for isolated unresectable colorectal cancer liver metastases (CRCLM). Published data suggest 5-year survival may be as high as 80%; however, recurrent disease is commonplace. Consequently, the Liver Transplantation for Un-resectable Colorectal Liver Metastases Fixed Term Working Unit (FTWU) recommended to NHS Blood and Transplant Liver Advisory Group that while CRCLM is an appropriate indication for transplantation, selection criteria should be conservative, and that it should be undertaken within a clinical service evaluation programme. This document outlines the proposed UK selection criteria and follow up process for CRCLM transplantation.


METHOD
Consensus statement by colorectal cancer / liver transplantation patient representatives, experts in colorectal cancer surgery / oncology, liver transplantation surgery, hepatology, hepatobiliary radiology, hepatobiliary pathology, and nuclear medicine.


RESULTS
This study provides a comprehensive outline of the inclusion / exclusion criteria for referral in the UK. Furthermore, the referral framework is also explained. Pre-transplant assessment criteria for listing / delisting are outlined. Finally, the oncology specific outcome measures post-transplant are described.


CONCLUSION
It is anticipated this service will begin in December 2022. A series of educational events for the referrers and transplant units will be arranged throughout 2023 to highlight CRCLM as a newly accepted UK indication for transplantation. A national audit will be undertaken to identify patients currently on treatment who meet criteria for transplant. Data will be collected in a national registry and reviewed on an ongoing basis to confirm the safety of this treatment and to determine if inclusion criteria require revision.