结直肠癌是全球最常见的恶性肿瘤之一，近一半的患者会发生结直肠癌肝转移(CRLM)。过去30年来，系统治疗和肝切除一直是CRLM的主要治疗策略，但仅适用于约20%的病例。不可切除结直肠癌肝转移(nrCRLM)预后极差，5年总生存率几乎为零。20世纪80年代，外科医师曾尝试将肝移植应用于nrCRLM患者，但由于围手术期死亡率及术后复发率较高，该治疗模式一度停滞。随着全身系统治疗及肝移植技术的不断进步，已有研究证实经严格筛选的nrCRLM患者行肝移植后5年生存率可达60%，提示该策略在特定人群中具有潜在的长期生存获益，这也使得肝移植成为此类经过筛选的患者潜在治愈方法。本文就肝移植治疗nrCRLM相关研究进展进行综述，主要包括其发展历程、预后因素、受者选择标准、肝源短缺和供者分配等关键问题。

Colorectal cancer is among the most common malignancies worldwide, and nearly half of patients will develop colorectal liver metastases (CRLM). Over the past three decades, systemic therapy and hepatic resection have remained the cornerstone treatment strategies for CRLM. However, only about 20% of cases are amenable to curative-intent resection. The prognosis of nonresectable colorectal liver metastases (nrCRLM) is dismal, with 5-year overall survival approaching zero. In the 1980s, surgeons attempted to extend liver transplantation to patients with nrCRLM, but this approach was largely abandoned because of high perioperative mortality and frequent post-transplant recurrence. With continued advances in systemic therapy and transplant techniques, accumulating evidence indicates that, in carefully selected patients with nrCRLM, liver transplantation can achieve 5-year overall survival of up to 60%, suggesting a potential long-term survival benefit in selected populations and positioning transplantation as a potentially curative option for a subset of patients. This review summarizes recent progress in liver transplantation for nrCRLM, focusing on its historical development, prognostic factors, recipient selection criteria and key challenges related to organ scarcity and allocation policies.