Sabin Subedi

Historically, colorectal liver metastases (CRLMs) have been considered a contraindication for liver transplantation (LT), primarily due to limited organ availability and concerns about oncologic efficacy. However, emerging evidence indicates that highly selected patients with unresectable CRLM can achieve long-term survival following LT—often with outcomes superior to those obtained through conventional systemic therapies. To evaluate the evolving role of LT in this setting, we conducted a scoping review of the literature. A comprehensive search was performed across PubMed, Embase, Web of Science, Scopus, and ClinicalTrials.gov, as well as ProQuest Dissertations & Theses and Google Scholar to capture gray literature. The search included English-language articles published between January 2015 and April 2025. Eligible studies included those reporting on the application of LT for patients with unresectable CRLM. This scoping review synthesizes current evidence on patient selection criteria, overall and disease-free survival, recurrence patterns, and emerging biomarkers that may guide transplant eligibility. In addition, we explore innovations in organ utilization—including living donor LT and machine perfusion technologies—that aim to expand access while addressing ethical concerns related to organ allocation. As LT for CRLM transitions from investigational use to clinical implementation, this review outlines the key challenges and future opportunities that will shape its role in the landscape of transplant oncology.

Historically, colorectal liver metastases (CRLM) have been considered a contraindication for liver transplantation (LT), given the limited organ supply and poor oncologic efficacy. Recent studies, however, have demonstrated that highly selected patients with unresectable CRLM can achieve remarkable long-term survival following LT, often surpassing outcomes seen with conventional systemic therapies. This review explores the evolving role of LT for the treatment of unresectable CRLM, examining patient selection criteria, overall survival, disease-free survival, recurrence patterns, and emerging biomarkers that may guide transplant eligibility. Additionally, we discuss innovations in organ utilization, including living donor LT and machine perfusion strategies, to expand access while mitigating ethical concerns surrounding organ allocation. As LT for CRLM transitions from experimental protocols to clinical application, this review highlights key challenges and opportunities that will shape its future role in the field of transplant oncology.

Liver transplantation (LT) in the United States is evolving in response to shifting disease patterns, innovative therapies, and technological advancements. Metabolic-associated fatty liver disease (MAFLD) and alcohol-associated liver disease (ALD) now are the most common indications for LT, reflecting the impact of the obesity epidemic and increased alcohol consumption. Advances in pharmacotherapy for MAFLD and tailored protocols for ALD management are reducing disease progression and improving outcomes. The inclusion of colorectal liver metastases (CRLM) and intrahepatic cholangiocarcinoma (iCCA) as transplant indications highlights progress in chemotherapy and patient selection. Technologies like normothermic machine perfusion (NMP) are expanding the donor pool, while xenotransplantation and organ rehabilitation offer transformative solutions to organ shortages. As the population ages, LT programs must address challenges in older patients and explore minimally invasive approaches for donors and recipients. By integrating innovation and multidisciplinary expertise, LT will continue to provide life-saving care while adapting to the needs of diverse patient populations.