Liver transplantation for isolated unresectable colorectal liver metastases - Protocol for a service evaluation in the United Kingdom - UKCoMET study

Krishna Menon; Aarathi Vijayashanker; Jamie Murphy; Pål-Dag Line; John Isaac; Anya Adair; Raj Prasad; Douglas Thorburn; NHS Blood and Transplant Liver Transplantation for Colorectal Liver Metastases Fixed Term Working Group

doi:10.1016/j.hpb.2023.02.011

Liver transplantation for isolated unresectable colorectal liver metastases - Protocol for a service evaluation in the United Kingdom - UKCoMET study

HPB (Oxford). 2023 Jun;25(6):684-692. doi: 10.1016/j.hpb.2023.02.011. Epub 2023 Feb 21.

Authors

Krishna Menon¹, Aarathi Vijayashanker², Jamie Murphy³, Pål-Dag Line⁴, John Isaac⁵, Anya Adair⁶, Raj Prasad⁷, Douglas Thorburn⁸; NHS Blood and Transplant Liver Transplantation for Colorectal Liver Metastases Fixed Term Working Group

Collaborators

NHS Blood and Transplant Liver Transplantation for Colorectal Liver Metastases Fixed Term Working Group:
Anya Adair⁹, Ian Parker¹⁰, Lindy Berkman¹¹, William Gelson¹², Rebecca Jones¹³, Derek Manas¹⁴, Gary Middleton¹⁵, Jamie Murphy¹⁶, Praveen Peddu¹⁷, John Isaac¹⁸, Thamara Perera¹⁸, Raj Prasad¹⁹, Joerg Pollok²⁰, Andrew Scarsbrook²¹, Yoh Zen²²

Affiliations

¹ Institute of Liver Studies, King's College Hospital, London, UK; Digestive Diseases and Surgery Institute, Cleveland Clinic London, UK. Electronic address: krishna.menon@nhs.net.
² Institute of Liver Studies, King's College Hospital, London, UK.
³ Department of Surgery and Cancer, Imperial College London, UK; Digestive Diseases and Surgery Institute, Cleveland Clinic London, UK.
⁴ Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
⁶ Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, UK.
⁷ Liver Transplantation and HPB Surgery, Leeds Teaching Hospitals, Leeds, UK.
⁸ Sheila Sherlock Liver Centre and UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK.
⁹ Consultant Transplant/Hepatobiliary Surgeon, Royal Infirmary, Edinburgh, UK.
¹⁰ Liver Transplant Patient Representative, UK.
¹¹ Colorectal Patient Representative, UK.
¹² Consultant Hepatologist, Addenbrooke's Hospital, Cambridge, UK.
¹³ Consultant Hepatologist, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁴ Consultant Hepatobiliary and Transplant Surgeon, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
¹⁵ Consultant Oncologist, Queen Elizabeth Hospital, Birmingham, UK.
¹⁶ Consultant Surgeon, Imperial College London, London, UK.
¹⁷ Consultant Hepatobiliary Radiologist, King's College Hospital, London, UK.
¹⁸ Consultant Transplant/Hepatobiliary Surgeon, Queen Elizabeth Hospital, Birmingham, UK.
¹⁹ Consultant Transplant/Hepatobiliary Surgeon, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
²⁰ Consultant Transplant/Hepatobiliary Surgeon, Royal Free Hospital, London, UK.
²¹ Consultant Radiologist and Nuclear Medicine Physician, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
²² Consultant Hepatobiliary Histopathologist, King's College Hospital, London, UK.

PMID: 36948901
DOI: 10.1016/j.hpb.2023.02.011

Abstract

Background: Liver transplantation (LT) for unresectable colorectal liver metastases (CRCLM) demonstrates good overall survival for selected patients in contemporary studies, with 5-year survival of 80%. A Fixed Term Working Group (FTWG), set up by NHS Blood and Transplant (NHSBT) Liver Advisory Group (LAG), advised whether CRCLM should be considered for LT in United Kingdom. Their recommendation was that LT may be undertaken for isolated and unresectable CRCLM using strict selection criteria as a national clinical service evaluation.

Methods: Opinions were sought from colorectal cancer/LT patient representatives, experts in colorectal cancer surgery/oncology, LT surgery, hepatology, hepatobiliary radiology, pathology, and nuclear medicine, and appropriate patient selection criteria, referral and transplant listing pathways were identified.

Results: This paper summarises selection criteria for LT in United Kingdom for isolated and unresectable CRCLM patients, and highlights referral framework and pre-transplant assessment criteria. Finally, oncology-specific outcome measures to be utilised for assessing applicability of LT are described.

Conclusion: This service evaluation represents a significant development for colorectal cancer patients in United Kingdom and a meaningful step forward in the field of transplant oncology. This paper details the protocol for the pilot study, scheduled to begin in the fourth quarter of 2022 in United Kingdom.

MeSH terms

Colorectal Neoplasms* / pathology
Humans
Liver Neoplasms*
Liver Transplantation* / methods
Pilot Projects
United Kingdom