In June 2026, Tartu University Hospital performed Estonia’s first liver transplant on a patient whose primary disease was a malignant tumour of the sigmoid colon with metastases to the liver. Until recently, liver metastases from colorectal cancer were considered a contraindication to liver transplantation.
According to Dr Andrei Uksov, Head of the Department of Abdominal Surgery at Tartu University Hospital and a liver transplant surgeon, liver transplantation for patients with malignant tumours that have metastasised to the liver is still an emerging treatment approach. Twenty years ago, such a treatment would not have been considered.
For a long time, liver metastases from colorectal cancer were a contraindication to liver transplantation. Today, liver transplants for patients with this diagnosis are still performed only in selected cases and at a small number of centres worldwide, as relatively few patients meet the necessary criteria. Oslo University Hospital has been at the forefront in this field. According to studies conducted there, the five-year survival rate among carefully selected patients can be as high as 83%, compared with up to 9% among patients receiving chemotherapy alone.
Dr Andrei Uksov, Head of the Department of Abdominal Surgery at Tartu University Hospital and a liver transplant surgeon
Preparations for the transplant took more than six months. The patient’s treatment plan included removal of the primary tumour followed by six months of chemotherapy. This made it possible to assess the response to treatment and determine the patient’s suitability for liver transplantation.
“Immediately before the liver transplant, we also performed an additional diagnostic laparotomy to ensure that there were no tumour metastases outside the liver. Once this had been confirmed, we were able to proceed with the liver transplant,” Dr Uksov explained.
He added that the entire process was carefully planned and coordinated by the transplant team. The multidisciplinary team included liver transplant surgeons, a vascular surgeon, anaesthetists, intensive care specialists, as well as oncologists and gastroenterologists involved in the patient’s care before the transplant.
The patient’s recovery following the liver transplant has progressed as expected, and treatment is continuing in a regular hospital ward.
Dr Uksov is optimistic about adding this indication to the range of conditions for which liver transplantation may be considered. In Estonia, an estimated two to four patients could potentially require such a life-saving procedure each year.
Only a small number of patients with colorectal cancer metastases to the liver are suitable for transplantation, as they must meet specific criteria to ensure a successful transplant and favourable long-term outcomes. We are working with oncologists and gastroenterologists to develop criteria for Estonia. For now, we are drawing on the experience of Norway and the Netherlands.
Dr Andrei Uksov, Head of the Department of Abdominal Surgery at Tartu University Hospital
Tartu University Hospital is Estonia’s only transplant centre and is a member of Scandiatransplant, an organisation that brings together transplant centres in Estonia, Iceland, Norway, Sweden, Finland and Denmark.
The introduction of this innovative liver transplantation procedure in Estonia further demonstrates the high standard of care available at Tartu University Hospital, comparable with that provided in other Nordic countries.
Liver transplantation has been performed at Tartu University Hospital since 1999. All life-saving transplants are made possible by organ donors, to whom the hospital, transplant recipients and patients currently on the waiting list remain deeply grateful.
