AdventHealth Performs Central Florida’s First Liver Transplant for Unresectable Colorectal Liver Metastases

Maurice Lindsay, a 62-year-old radiology technician at AdventHealth Orlando was first diagnosed with stage IV colorectal cancer in 2022. The disease had already metastasized to his liver and was not resectable. Lindsay was put on systemic chemotherapy, and a hepatic artery infusion pump was placed to deliver concentrated chemotherapy directly to his liver. However, the pump eventually caused biliary issues and had to be removed.

In June 2025, AdventHealth Abdominal Transplant Surgeon and Surgical Oncologist Ryan Day, MD, worked with a multidisciplinary team to perform a liver transplant on Lindsay -- Central Florida’s first for unresectable colorectal cancer metastases. Dr. Day reports that Lindsay is doing well and is now completely off chemotherapy for the first time in three years.

“He had come to the end of his available treatment options,” shares Dr. Day. “This liver transplant provided him with a new start on life and a shot at a cure for his cancer.”

A New Treatment Modality for a Challenging Diagnosis

Colorectal cancer is the fourth most diagnosed cancer in the U.S. and the second leading cause of cancer death, with the liver the most common site for metastasis. Approximately half of all colorectal cancer patients develop liver metastases, and in some cases, the cancer has already spread to the liver by the time of initial diagnosis.

While liver transplant has successfully been used as a potential curative treatment for select patients with primary liver cancers such as hepatocellular carcinoma (HCC) for more than 20 years, the earliest attempts at using it for liver metastases yielded poor overall survival. However, more recent advancements in chemotherapy, patient selection and immunosuppression have improved outcomes and brought it back to the forefront as a potential treatment option. The TransMet study, a multicenter, randomized, controlled trial published in The Lancet in 2024, found that liver transplantation plus chemotherapy in selected patients with permanently unresectable colorectal liver metastases yielded a 56-73% five-year survival rate compared to 9-12% for chemotherapy alone. This is comparable to overall liver transplant survival rates.

“Colorectal cancer is an especially challenging disease to treat,” says Dr. Day. “At AdventHealth, our team is committed to advancing care by making every possible effective treatment option available to our patients. This already includes minimally invasive robotic resections, hepatic artery infusion pumps, Y90 radioembolization, histotripsy, and HIPEC (hyperthermic intraperitoneal chemotherapy). Now with the addition of liver transplant for colorectal liver metastases, we have one more tool in our toolbox.”

Selecting and Caring for Liver Transplant Patients – An Individualized, Multidisciplinary Approach

AdventHealth evaluates each case individually to determine if liver transplant for unresectable colorectal liver metastases is the appropriate treatment option. Some of the criteria potential candidates must meet include the following:

• At least one year out from initial colon cancer diagnosis
• Six months of stability on treatment for their liver metastases
• No extra-hepatic disease or spread to lymph nodes, lungs, brain or bone
• Can’t have certain genetic mutations like BRAF V600E
• A carcinoembryonic antigen (CEA) blood biomarker level of less than 80

They must also meet standard liver transplant criteria, which requires comprehensive evaluation and certification by a multidisciplinary medical team.

“When evaluating patients and developing treatment plans, we involve medical oncologists, radiation oncologists, hepatologists, transplant surgeons, transplant psychiatrists, pulmonologists, cardiologists, social workers, dieticians and other specialists as needed,” comments Dr. Day. “It is truly multidisciplinary, and when our medical team makes decisions about the best treatment pathway for a specific patient, we need consensus among the entire group.”

Addressing Organ Availability and Procurement

While the demand for liver transplants exceeds the supply of available donor organs, Dr. Day and his team work closely with the organ procurement organizations, including OurLegacy, east Central Florida’s federally designated organ procurement organization (OPO). To help increase organ availability, AdventHealth established one of the first living donor programs in the nation. Additionally, the liver transplant team has begun using the TransMedics® Organ Care System (OCS™), a portable extracorporeal liver perfusion and monitoring system designed to preserve, assess and maintain donor organs.

“This normothermic machine performs perfusion of the liver while it’s outside the body,” explains Dr. Day. “This allows us to monitor the liver and see if it’s healthy and good for use in transplant. The TransMedics system is allowing us to use organs that we would not have before, expanding our donor pool for these recipients.”

Advancing Transplant Oncology

Dr. Day remains passionate about growing the emerging field of transplant oncology and the potential to cure or significantly improve outcomes for patients with cancers that are not adequately treated by current methods.

“Cases like Mr. Lindsay’s are why I pursued fellowship training in both surgical oncology and transplant medicine,” he says. “People used to think liver transplant for colorectal liver metastases wasn’t a viable treatment option, but with the tremendous advances we’ve made in cancer care, now it is. I think we’re just beginning to explore this new frontier, and I’m excited to see if we can uncover new applications and possibly even cures for a variety of cancers.”

Learn more at the AdventHealth Transplant Institute website.