Durable Survival Outcomes After Liver Transplantation for Colorectal Liver Metastases: A Systematic Review and Single-Arm Meta-analysis

Background: Liver transplantation (LT) has emerged as a potential treatment option for selected patients with colorectal liver metastases (CRLM), but existing meta-analyses are limited by heterogeneous populations and mixed treatment modalities. Methods: A systematic review and single-arm meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting outcomes following LT for CRLM were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS) at predefined time points. Secondary outcomes included adverse events. Pooled proportions were calculated using random-effects models with logit transformation and Hartung–Knapp adjustment. Heterogeneity was assessed using the I² statistic. Results: Pooled analysis demonstrated favorable survival outcomes following LT. The pooled 3-year OS was 69% (95% CI, 52–82%; I² = 0.0%), and the pooled 5-year OS was 62% (95% CI, 36–83%; I² = 14.6%). The pooled 3-year PFS was 33% (95% CI, 7–76%), with substantial heterogeneity (I² = 62.8%). The pooled incidence of adverse events was 41% (95% CI, 25–60%; I² = 0.0%). Sensitivity analyses confirmed the robustness of pooled estimates. Conclusions: In carefully selected patients with CRLM, LT is associated with durable long-term survival and an acceptable safety profile, supporting further prospective evaluation and refinement of selection criteria.