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Liver Transplantation for Unresectable Neuroendocrine Tumor Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Liver transplantation (LT) is performed in selected patients with neuroendocrine hepatic metastases. Survival benefit and the risk of tumor recurrence after LT, also exacerbated by immunosuppressive therapy, remain important clinical issues. Whether patients with particular types of neuroendocrine tumors (NET) benefit more than others is unclear.

Methods

Bibliographical searches were performed in PubMed for the terms “liver transplantation and neuroendocrine tumors,” “liver transplant and neuroendocrine tumors,” “liver transplantation and immunosuppressive therapy,” “tumor recurrence.”

Results

Promising results have been reported for LT for NET metastases with 5-year survival of up to 90 % in patients with well-differentiated gastroenteropancreatic NETs, but only few patients are free of tumor 5 years after LT. Better outcomes have been reported for gastrointestinal tumors than for pancreatic NETs for both survival and risk or recurrence after LT. Selection criteria for LT are limited and include the 2007 Milan Criteria and the 2012 European Neuroendocrine Tumor Society guidelines, including: well-differentiated NET (Ki-67 <10 %), age <55 years, absence of extrahepatic disease, primary tumor removed before transplantation, stable disease for at least 6 months before LT, and <50 % liver involvement.

Conclusions

LT might be considered in carefully selected patients. The risk of tumor recurrence remains a significant clinical problem after LT, but data focused on immunosuppression issue are lacking, and there are no currently approved strategies for prevention of recurrence or follow-up protocols. Further studies are needed to define universally accepted inclusion criteria, reliable predictors of better outcome, and optimal timing for LT.

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Neuroendocrine Tumour Unit, Centre of Gastroenterology, Royal Free Hospital, London, UK

    Roberta Elisa Rossi MD & Martyn Evan Caplin BSc Hons, DM, FRCP

  2. Department of Pathophysiology and Transplant, Universita’ degli Studi di Milano and Gastroenterology Unit II, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Roberta Elisa Rossi MD

  3. Sheila Sherlock Liver Centre, Royal Free Hospital and Institute of Liver and Digestive Health, UCL, London, UK

    Andrew Kenneth Burroughs MBChBHons, HonDSc(Med), FRCP, FMedSci

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  1. Roberta Elisa Rossi MD
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  2. Andrew Kenneth Burroughs MBChBHons, HonDSc(Med), FRCP, FMedSci
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  3. Martyn Evan Caplin BSc Hons, DM, FRCP
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Correspondence to Martyn Evan Caplin BSc Hons, DM, FRCP.

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Rossi, R.E., Burroughs, A.K. & Caplin, M.E. Liver Transplantation for Unresectable Neuroendocrine Tumor Liver Metastases . Ann Surg Oncol 21, 2398–2405 (2014). https://doi.org/10.1245/s10434-014-3523-y

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  • DOI: https://doi.org/10.1245/s10434-014-3523-y

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