Belgian protocol for indication and selection of patients with unresectable colorectal cancer liver metastases eligible for liver transplantation
| Journal | Volume 89 - 2026 |
| Issue | Fasc.3 - Guidelines |
| Author(s) | G. Rasschaert 1, M. Vandermeulen 2, M. Van den Eynde 3, H. Eker 4, T. Vandamme 5, B. Bracke 6, X. Verhelst 7, J. Verbeek 8, H. Van Vlierberghe 7, H. Topal 9, V. Labille 10, D. Monbaliu 11, B. Op de Beeck 12, T. Gustot 13, M. Sainz Barriga 11, F. Sclafani 14, V. Vandecaveye 15, T. Vanwolleghem 16, C. Amicone 10, V. Lucidi 17, C. Verslype 1 8, T. Chapelle 6, K. Geboes 18, G. Dahlqvist 19, J. Pirenne 11, O. Detry 2, L. Coubeau 20 |
| Full article |
 PAGES 483-492 VIEW FREE PDF |
| DOI | 10.51821/89.3.14956 |
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Affiliations: (1) Gastrointestinal Oncology Department, University Hospitals Leuven, Leuven, Belgium
(2) Abdominal and Transplant Surgery Department, University Hospital Liège, Liège, Belgium (3) Oncology Department, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (4) General and Hepatopancreatobiliary Surgery Department, University Hospital Gent, Gent, Belgium (5) Oncology Department, University Hospital Antwerpen, Antwerpen, Belgium (6) Hepatopancreatobiliary and Transplant Surgery Department, University Hospital Antwerpen, Antwerpen, Belgium (7) Gastroenterology Department, Hepatology Division, University Hospital Gent, Gent, Belgium (8) Gastroenterology and Hepatology Department, University Hospitals Leuven, Leuven, Belgium (9) Abdominal Surgery Department, University Hospitals Leuven, Leuven, Belgium (10) Gastroenterology Department, University Hospital Liège, Liège, Belgium (11) Abdominal Transplant Surgery Department, University Hospitals Leuven, Leuven, Belgium (12) Radiology Department, University Hospital Antwerpen, Antwerpen, Belgium (13) Gastroenterology and Hepatology Department, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium (14) Gastrointestinal Oncology Department, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium (15) Radiology Department, University Hospitals Leuven, Leuven, Belgium (16) Gastroenterology and Hepatology Department, University Hospital Antwerpen, Antwerpen, Belgium (17) Hepatopancreatobiliary & Liver Transplant Surgery Department, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium (18) Gastroenterology Department, Gastrointestinal Oncology Division, University Hospital Gent, Gent, Belgium (19) Gastroenterology and Hepatology Department, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (20) Abdominal Surgery Department, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium |
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Background and study aims: Colorectal cancer (CRC) is common in Western countries, about 50% of patients develop liver metastases (CLM). While local CLM therapies can achieve 5-year survival up to 60%, most patients eventually become unresectable (uCLM) and have poor outcomes with systemic treatment alone. Prospective studies, including SECA I and II and the TransMet trial, showed that in carefully selected patients, liver transplantation (LTx) can achieve survival outcomes comparable to standard LTx indications. The aim of this work was to develop a harmonized national consensus protocol for the indication and selection of uCLM patients eligible for LTx. Patients and methods: Under the coordination of the Belgian Liver & Intestine Advisory Committee (Be-LIAC), all six Belgian transplant centers delegated a transplant surgeon, an oncologist and an hepatologist to a working group that performed a literature review and drafted preliminary criteria. Three successive national meetings and a structured voting refined these criteria in the current protocol. Results: Consensus was reached on inclusion and exclusion criteria for LTx in uCLM. Two key conditions are liver-only disease and technically uCLM. Strict requirements include a six months disease stability or response on systemic therapy and an obligatory eight-week treatment holiday. Absolute CEA levels and specific somatic mutations are not excluded. A national Be-LIAC governance model was established, combining local prospective decision-making with central auditing and registry-based evaluation. Conclusions: A harmonized national protocol for LTx inuCLM has been established, ensuring consistent patient selection across all Belgian centers. Stricter criteria and a national governance model aim to optimize outcomes while maintaining ethical allocation of donor organs. Keywords: LTx, uCLM, national consensus, selection. |
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© Acta Gastro-Enterologica Belgica. PMID 42872337 |