Few centers in the Southeast offer this procedure, and the national allocation system does not typically prioritize patients with colorectal metastases — meaning extended waits on the transplantation list for these patient populations.The University of Alabama at Birmingham Division of Transplantation offers liver transplantation for patients with metastatic colorectal cancer, only one of a few programs of its kind in the Southeast. Established in 2024, the program treats patients whose liver tumors cannot be removed through traditional surgery.
Liver transplantation as a form of treatment
Colorectal cancer is the third most common cancer in the United States, and the liver is the most frequent site of spread. When tumors cannot be surgically removed, treatment options are limited, and the five-year survival with chemotherapy alone is about 10 percent.
Liver transplantation has emerged as an alternative treatment for this group. Rather than removing individual tumors, surgeons replace the entire diseased liver with a donor organ, eliminating both the visible cancer and the surrounding environment that allows cancer to grow. Clinical trials have shown that, in carefully selected patients, this approach can raise five-year survival to 60 percent to 80 percent.
This represents a shift in how the field views metastatic disease.
“For years, the established thinking was that metastatic disease was a contraindication for transplant. That is no longer the case,” said Robert Cannon, M.D., surgical director of the UAB Liver Transplant Program. “For patients with liver-only colorectal metastases who have responded to chemotherapy, this can become a viable treatment option moving forward.”
Colorectal cancer is now the most common cause for cancer related mortality in young adults, ages 25 to 50, and several young patients will present with metastasis that can potentially be treated with liver transplantation.
“Offering liver transplantation for colorectal cancer metastasis exhibits how UAB and the O’Neal Cancer Center are dedicated to offering the highest level of care for cancer patients in the state of Alabama and across the Southeast,” said Robert Hollis, M.D., MSPH, colorectal surgeon and lead for the O’Neal colorectal cancer management team.
Supporting patients through treatment and transplantation
Because outcomes depend on choosing candidates who best fit the transplantation program protocol, patients interested in the program must undergo a comprehensive evaluation by a multidisciplinary team that includes transplant surgeons, hepatologists and medical oncologists. The team reviews each patient’s treatment history, imaging and chemotherapy response to determine whether transplantation is the right option.
The UAB Liver Transplant Program began in 1983 and maintains robust clinical and basic science research efforts. The program has performed over 3,000 liver transplants — distinguishing it as one of the nation’s most experienced — and boasts outcomes that consistently rank among the best in the United States. The UAB Liver Transplant Program’s research focuses primarily on liver transplant candidate evaluation, management and outcomes for adults and on advancing care across the care continuum.
“Transplant oncology is changing how we approach certain cancers that were previously considered beyond surgical reach, and colorectal liver metastases is one of the clearest examples,” said Sergio Acuna Mancilla, M.D., Ph.D., assistant professor in the UAB Division of Transplantation, who focuses on transplant oncology through his clinical practice and research. “Response to chemotherapy and overall health all factor into whether transplantation is appropriate for a given patient.”
Changing the pathway to transplantation
Even for patients who qualify, regional access has historically been a barrier. Few centers in the Southeast offer this procedure, and the national allocation system does not typically prioritize patients with colorectal metastases — meaning extended waits on the transplantation list for these patient populations.
“Patients in our region have historically had to travel long distances to access this type of care. With UAB’s transplant infrastructure and multidisciplinary expertise, we can now bring this lifesaving treatment closer to home,” said Jacqueline Garonzik Wang, M.D., Ph.D., director of the UAB Division of Transplantation and co-director of the Comprehensive Transplant Institute.
UAB’s recently launched living donor liver transplant program is also helping expand access for patients in this situation. Though not built exclusively for colorectal metastases, the program complements this work by offering an alternative to the deceased donor waitlist. Living donation allows surgeons to schedule the procedure in coordination with cancer treatment rather than waiting for an organ to become available. It also enables the use of smaller donor grafts that can grow before the remaining diseased liver is removed, making transplantation possible for patients who might not otherwise qualify.
“Living donation gives us the ability to plan the procedure in coordination with the patient’s oncology team, which is a meaningful shift for this population,” said Saulat Sajjad Sheikh, MBBS, surgical director of the Living Donor Liver Transplant Program. “It can open the door to treatment for patients who would typically not have a pathway to transplantation through the traditional waitlist.”