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Emerging oncological indications to liver transplantation

The use of liver transplantation (LT) for oncological indications has recently expanded from hepatocellular carcinoma (HCC) to other primary hepatobiliary malignancies such as cholangiocarcinoma (CCA) and secondary malignancies including neuroendocrine and colorectal metastases. This expansion has been made possible through a careful patient selection that has allowed to achieve superior oncological outcomes with respect to available treatments and compelling overall survival compared to non-oncological indications to LT. Indeed, given organ shortage, as for other indications, the benefit for the single patient must be balanced with an ‘acceptable’ expected survival, set to at least 70% at 5 years. The aim of this article is to review the present selection criteria for LT in the case of colorectal liver metastases (CRLMs), neuroendocrine tumors (NETs) and cholangiocarcinoma to guide practitioners in timely referringeligible patients to transplantation centers.

Colorectal carcinoma (CRC) is the third most common malignancy world-wide.1 At the time of diagnosis, only 20% of patients are resectable, but even with resection, survival remains poor, with high disease-recurrence rates and 5-year overall survival (OS) of only 30–40%.2 The liver is the most frequent site of metastatic CRC, and margin negative liver resection (LR) along with systemic and locoregional therapies (LRT) offer the only chance for a cure. Patients with CRLMs not amenable to resection have a dismal survival (5–10% at 5 years). Liver transplantation (LT) has been offered as savage therapy but, because of inadequate patient selection, resulted in poor outcomes in early experiences.3

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