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.

中文翻译：

---

不可切除结直肠肝转移活体供体肝移植的罗切斯特方案：关于选择、批准和结果的 5 年报告


活体供体肝移植 （LDLT） 是针对特定不可切除结直肠肝转移患者的治疗选择。我们描述了我们中心在 2019 年 3 月首次转诊后患者选择、保险批准和 LDLT 后结果方面的经验。在 206 名评估患者中，23 名接受了 LDLT。我们发现，在肿瘤病程中较早被转诊的患者更有可能符合移植条件。在完成 LDLT 资格的罗切斯特协议后，接受者与保险上诉相关的护理延迟中位为 10 天 （IQR，0-36 天），其中 6 名患者 （30%） 的延迟超过 30 天。LDLT 受者在 1 年和 3 年的总生存率分别为 100% 和 91%，在 1 年和 3 年的无复发生存率分别为 100% 和 40%。所有供体均接受了右肝切除术，其中只有 1 名供体出现 Clavien-Dindo IIIa 并发症并再次入院。没有供体死亡率。我们断言，通过罗切斯特协议进行多学科护理和严格的患者选择对于我们中心的成功至关重要。在适当选择的患者中，对于不可切除的结直肠肝转移，LDLT 可能是合理的，患者应被转诊至移植肿瘤中心进行评估。