In the last two decades, the indications of liver transplantation (LT) for primary and secondary hepatobiliary malignancies have been increasingly expanded. Although this attractive option still represents the “last court of appeal” in cancer patients, the role of LT is well established in hepatocellular carcinoma (HCC), where transplantation has also demonstrated a benefit for selected patients affected by peri-hilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, and neuroendocrine tumors [1].

Recently, the interest in LT in liver-limited stage IV colorectal cancer (CRC) has increased due to recent advances in transplantation techniques that have led to a re-evaluation of this approach. Encouraging data from small studies and series have demonstrated an overall survival (OS) at 5 years between 50% and 83% in transplant patients, bringing new light on LT in CRC [2-4]. Nevertheless, few data support the use of post-transplant chemotherapy in this setting, given the small number of patients who underwent LT for non-resectable colorectal liver metastases (NRCLM) and the lack of prospective studies comparing LT with the current standard of care. Another controversial issue concerns the possibility to administer or not post-transplant chemotherapy concurrently with immunosuppressive therapy and its role in improving survival in these patients [5]. To our knowledge, there are no published series reporting the administration of postoperative chemotherapy in CRC after LT. We herein report three patients affected by NRCLM who underwent LT and received postoperative treatment with intensive chemotherapy schedules. In each case, the decision to perform LT was taken after discussion of the multidisciplinary team and ethical committee (IRB) approval, considering the young age of the patients, the expected median OS with standard therapeutic options available, and ineligibility in clinical trials. Last follow-up was December 2019.