Liver transplantation (LT) in liver limited metastatic colorectal cancer (CRC): Insights and opportunities.

3608 Background: Liver transplantation (LT) for liver limited metastatic colorectal cancer (LL-mCRC) remains underutilized. Reasons for transplant ineligibility are not well described and the acceptance of this procedure for mCRC remains limited. Herein, we describe our initial experience with LT in patients with LL-mCRC. We characterize patient outcomes, characterize the pattern of failure for patients undergoing LT evaluation, and describe the prognostic implication of lymphadenectomy in LT evaluation. Methods: Patients with LL-mCRC potentially eligible for LT were identified, discussed in multidisciplinary tumor boards and liver transplantation clinics, and managed. The Weill Cornell Liver Transplant institutional database was queried to identify patients evaluated for LT, those who were transplanted, and those who were not. Demographic, surgical data, and clinical outcomes abstracted from medical record. Results: Between 7/2020 and 3/2025, 20 patients with LL-mCRC were evaluated for LT. Median age (range) 55 years (29-63); N=10 (50%) white; N=18 (90%) male. All had adenocarcinoma histology with N=14 (70%) left sided primary disease. At diagnosis, N=11 (55%) had ≥1 liver lesion >5.5cm and median CEA (range) was 200 (4.8-6945). The most common mutations were APC (60%), KRAS (55%), TP53 (45%), and PIK3CA (35%). N=6 (30%) had a LT with a median time from diagnosis to transplant of 23.7 months (mo) (range 16-42). The median overall survival (OS) from LT is 64.5 mo (range 22-87). N=5 (83%) are alive with a median follow up of 67 mo (range 22-87). N=3 patients had recurrent disease with a median time to recurrence of 3 mo (range 2-9), 2 in lungs, and 1 retrocrural lymph nodes. At this time, N=4 (67%) patients have no evidence of disease, and one with retrocrural lymph node disease is responding to treatment. The single patient who underwent LT and died was portal lymph node positive at the time of transplant and had an early recurrence (at 2 mo post-transplant). For the 14 patients who were evaluated for transplant, but did not undergo transplant, their mOS is 28 mo (range 13-44). Reasons why these patients did not undergo LT are shown in Table 1. The majority failed transplant evaluation due to progressive disease (lung 43%, liver 21%, abdomen 14%). Positive portal lymphadenectomy was a poor prognostic characteristic, with all 3 patients deceased. Conclusions: LT is a treatment option that confers durable remission and improved OS in LL-mCRC. Recurrent disease after transplant is generally controllable with local treatment modalities. Patient selection is critical in identifying appropriate LT candidates. Portal lymphadenectomy is prognostic and should be considered in all transplant evaluations. Not Transplanted N=14 New lung metastases 6 (43) Progression in liver 3 (21) Worsening liver function 2 (14) Progression in lymph nodes 1 (7) Peritoneal metastases at surgery 1 (7) Patient preference 1 (7)