LIVING DONOR LIVER TRANSPLANT FOR COLORECTAL LIVER METASTASIS: THE FIRST CASE IN LATIN AMERICA

INTRODUCTION

Colorectal adenocarcinoma is a common malignancy around the world and synchronous or metachronous liver metastases will be observed in about 50% of these patients. Hepatic resection is a potentially curative treatment for metastases from colorectal cancer^1,2. However, only about 20% of the patients are suitable for resection, and recurrence occur in the majority of these patients and they are candidates for palliative chemotherapy. Liver transplant has been performed for liver tumors in well selected patients, mainly hepatocellular carcinoma, liver metastases from neuroendocrine tumors and peri-hilar cholangiocarcinoma emerging the concept of transplant oncology. Complete surgical resection is the treatment of choice for patients with liver metastases, but in a large proportion it is not possible to obtain a complete R0 resection. In 2006 the Oslo group started the first trial on liver transplant for patients with colorectal liver metastases (SECA I study). The inclusion criteria were R0 primary colorectal resection, unresectable liver metastases, no extrahepatic disease, at least six weeks of chemotherapy and an Eastern Cooperative Oncology Group (ECOG) performance status 0-1^2,3. Twenty-one patients with unresectable colorectal liver metastases (u-CRLM) were included. The overall survival rate at five years was 60% with a median survival time of 27 months. Notwithstanding the disease free survival rate was 35% at one year and all patients got relapse if observed up to three years, mainly in the form of lung metastases which were slow growing and most often resectable. Some factors were identified as related to worse prognosis (the Oslo Criteria) and include: 1) time from primary cancer surgery <2 years; 2) progressive disease on chemotherapy; 3) maximum tumor diameter >5.5 cm; and 4) CEA levels >80 μg/l. Beside Norway, liver transplant for colorectal liver metastasis have been performed in Japan, France, Canada, Portugal, Turkey, and Germany^2,4,5. Very recently the Oslo group reported the preliminary results of SECA II trial, indicating that a five year overall survival of about 80% may be obtained if stricter selection criteria for liver transplant in this patient cohort are used⁶. Nowadays, the majority of liver transplant reported for u-CRLM utilize deceased donor liver transplant (DDLT). In Brazil DDLT is not possible due to organ shortage problem and living donor liver transplant (LDLT) seems to be the only available alternative.