The Rochester Protocol for Living Donor Liver Transplantation of Unresectable Colorectal Liver Metastasis: A 5-Year Report on Selection, Approval, and Outcomes
Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center’s experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients,...
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| Published in: | American journal of transplantation |
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| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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25-09-2024
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| Abstract | Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center’s experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, 23 underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR, 0-36 days) related to insurance appeal, with 6 patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1 and 3 years and a recurrence-free survival proportion of 100% and 40% at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only 1 donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center’s success. In the appropriately selected patient, LDLT for unresectable colorectal liver metastasis may be justified, and patients should be referred to transplant oncology centers for evaluation. |
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| AbstractList | Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center’s experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, 23 underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR, 0-36 days) related to insurance appeal, with 6 patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1 and 3 years and a recurrence-free survival proportion of 100% and 40% at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only 1 donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center’s success. In the appropriately selected patient, LDLT for unresectable colorectal liver metastasis may be justified, and patients should be referred to transplant oncology centers for evaluation. Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis (uCRLM). We describe our center's experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, twenty-three underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR 0-36) related to insurance appeal, with six patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1, and 3 years; and a recurrence-free survival proportion of 100% and 40%, at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only one donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center's success. In the appropriately selected patient, LDLT for uCRLM may be justified, and patients should be referred to transplant oncology centers for evaluation. Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center's experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, 23 underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR, 0-36 days) related to insurance appeal, with 6 patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1 and 3 years and a recurrence-free survival proportion of 100% and 40% at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only 1 donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center's success. In the appropriately selected patient, LDLT for unresectable colorectal liver metastasis may be justified, and patients should be referred to transplant oncology centers for evaluation.Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center's experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, 23 underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR, 0-36 days) related to insurance appeal, with 6 patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1 and 3 years and a recurrence-free survival proportion of 100% and 40% at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only 1 donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center's success. In the appropriately selected patient, LDLT for unresectable colorectal liver metastasis may be justified, and patients should be referred to transplant oncology centers for evaluation. |
| Author | Pineda-Solis, Karen Nair, Amit Chávez-Villa, Mariana Endo, Yutaka Jimenez-Soto, Cristina Ramaraju, Gopal A. Dunne, Richard F. Orloff, Mark Hernandez-Alejandro, Roberto Tomiyama, Koji Byrne, Matthew M. Farooq, Priya D. Loria, Anthony Melaragno, Jennifer I. Niewiemski, Amber Ruffolo, Luis I. |
| Author_xml | – sequence: 1 givenname: Matthew M. orcidid: 0000-0001-5106-4424 surname: Byrne fullname: Byrne, Matthew M. organization: Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 2 givenname: Mariana orcidid: 0000-0002-5197-4070 surname: Chávez-Villa fullname: Chávez-Villa, Mariana organization: Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA – sequence: 3 givenname: Luis I. orcidid: 0000-0001-6002-9559 surname: Ruffolo fullname: Ruffolo, Luis I. organization: Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 4 givenname: Anthony orcidid: 0000-0003-0877-6500 surname: Loria fullname: Loria, Anthony organization: Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 5 givenname: Yutaka orcidid: 0000-0001-7187-0124 surname: Endo fullname: Endo, Yutaka organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 6 givenname: Amber surname: Niewiemski fullname: Niewiemski, Amber organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 7 givenname: Cristina orcidid: 0000-0003-2238-3076 surname: Jimenez-Soto fullname: Jimenez-Soto, Cristina organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 8 givenname: Jennifer I. orcidid: 0000-0001-5488-7960 surname: Melaragno fullname: Melaragno, Jennifer I. organization: Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA – sequence: 9 givenname: Gopal A. surname: Ramaraju fullname: Ramaraju, Gopal A. organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 10 givenname: Priya D. surname: Farooq fullname: Farooq, Priya D. organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 11 givenname: Richard F. orcidid: 0000-0001-6608-660X surname: Dunne fullname: Dunne, Richard F. organization: Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 12 givenname: Karen orcidid: 0000-0001-8021-6386 surname: Pineda-Solis fullname: Pineda-Solis, Karen organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 13 givenname: Amit orcidid: 0000-0003-1344-392X surname: Nair fullname: Nair, Amit organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 14 givenname: Mark surname: Orloff fullname: Orloff, Mark organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 15 givenname: Koji surname: Tomiyama fullname: Tomiyama, Koji organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA – sequence: 16 givenname: Roberto orcidid: 0000-0002-2312-3498 surname: Hernandez-Alejandro fullname: Hernandez-Alejandro, Roberto email: roberto_hernandez@urmc.rochester.edu organization: Transplant Institute, University of Rochester Medical Center, Rochester, New York, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39332681$$D View this record in MEDLINE/PubMed |
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| Copyright | 2024 American Society of Transplantation & American Society of Transplant Surgeons Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved. |
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| Keywords | LDLT OS surgical innovation LT transplant oncology insurance approval colorectal liver metastasis CRC uCRLM SECA selection criteria living donor liver transplant CEA RFS Transplant oncology |
| Language | English |
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| Snippet | Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center’s... Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis (uCRLM). We describe our... Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis. We describe our center's... |
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| Title | The Rochester Protocol for Living Donor Liver Transplantation of Unresectable Colorectal Liver Metastasis: A 5-Year Report on Selection, Approval, and Outcomes |
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