Multinational randomized trial of liver transplantation plus chemotherapy versus chemotherapy alone for permanently unresectable colorectal liver metastases

Despite the increasing efficacy of chemotherapy, permanently unresectable colorectal liver metastases (CLMs) are associated with poor long-term survival. The randomized TransMet trial, at 20 centers in Belgium, France, and Switzerland, compared liver transplation (LT) plus chemotherapy versus chemotherapy alone for permanently unresectable liver metastases after resection of BRAF wild-type colorectal cancer. Median follow-up was 59.3 months (IQR 42,2-60.6). In the intention-to-treat population, 5-year overall rate was 56.6% with LT plus chemotherapy versus 12.6 with chemotherapy alone (HR 0.37; p=0.0003); in the per-protocol population, 5-year OS rate was 73.3% with LT plus chemotherapy versus 9.3% with chemotherapy alone. Serious adverse events occurred in 80% of patients who underwent LT and in 83% of patients who received chemotherapy alone. Three patients in the LT plus chemotherapy group were retransplanted, one of whom died postoperatively of multi-organ failure. The authors conclude that in selected patients with permanently unresectable CLMs, LT plus chemotherapy significantly improved survival versus chemotherapy alone.