April 2026

GASTROENTEROLOGY

COMPLEX CASE: LIVER TRANSPLANTATION FOR UNRESECTABLE COLORECTAL LIVER METASTASES​​

Featuring: Zachary Dietch, MD, Andres Duarte‑Rojo, MD, and ​Satish Nadig, MD, PhD
A 39-year-old woman with no significant past medical history presented to an ED in Los Angeles, California, in May 2024 after a presumed viral GI illness. Cross‑sectional imaging revealed a colonic mass and hepatic lesions. Biopsy confirmed stage 4 colorectal adenocarcinoma with metastases confined to the liver. The patient reported no prior GI symptoms, no changes in bowel habits and no known family history of colorectal cancer.

She initiated systemic chemotherapy in California and demonstrated a strong radiographic and biologic response, with disease remaining isolated to the liver. Given unresectable colorectal liver metastases (CRLM) and favorable response to treatment, her oncology team referred her for evaluation at a center that offers liver transplantation for metastatic colorectal cancer.

Evaluation and Patient Selection
In September 2025, the patient was evaluated at Northwestern Medicine Comprehensive Transplant Center in Chicago, Illinois. Review confirmed liver‑only disease, absence of extrahepatic involvement, no invasion of adjacent structures, and sustained response to systemic therapy.

“For patients with unresectable colorectal liver metastases, chemotherapy alone historically results in a 10% five‑year survival,” says Zachary Dietch, MD, transplant surgeon. “In carefully selected patients who undergo liver transplantation, five‑year survival can reach 60% to 80%, and some patients achieve long‑term cure.”

The patient was deemed an appropriate candidate for living donor liver transplantation. After listing, a living donor was identified and determined to be a suitable immunologic and anatomic match. Living donation enabled timely transplantation without reliance on deceased donor allocation. In December 2025, surgeons at Northwestern Medicine performed the living donor liver transplant, with complete removal of known disease.

Post‑transplant Course and Surveillance
The patient recovered without reported complications. At three months post-transplant, circulating tumor DNA testing was negative, with no evidence of residual or recurrent disease.

Patients transplanted for metastatic colorectal cancer at Northwestern Medicine undergo more intense oncologic surveillance protocols than standard liver transplant recipients. This includes CT or MRI imaging of the chest, abdomen and pelvis every three months to enable early detection of recurrence.

“Successful transplantation for metastatic colorectal cancer requires meticulous coordination,” says Andres Duarte‑Rojo, MD, director of Liver Transplant at the Comprehensive Transplant Center. “The timing of chemotherapy, imaging, liver‑directed therapy and transplant must be planned precisely. That orchestration is the strength of our program.”

Implications
For unresectable CRLM confined to the liver, transplantation — when paired with strict selection criteria and coordinated care — offers survival outcomes not achievable with systemic therapy alone.

Liver transplantation for CRLM remains a developing field and is only offered at a few centers in the U.S. Northwestern Medicine has a program integrating medical oncology, hepatology, interventional radiology, imaging and transplant surgery to support this population.

“Because transplant for colorectal liver metastases is still so new and offered at only a handful of centers, it’s not yet on the radar for every clinician,” says Satish Nadig, MD, PhD, director of the Comprehensive Transplant Center. 
Zachary Dietch, MD is a transplant surgeon and assistant professor, of organ transplantation in the Department of Surgery at Northwestern Medicine.
Andres Duarte, MD, PhD, the section chief of of Hepatology and director of Liver Transplant at Northwestern Medicine.
Satish N. Nadig, MD, PhD, is director of the Comprehensive Transplant Center, chief of Organ Transplantation in the Department of Surgery, and the Edward G. Elcock Professor of Surgical Research at Northwestern Medicine.

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