Liver Transplantation in Patient With Neuroendocrine Tumor
Is liver transplantation a reasonable option for patients with metastatic neuroendocrine tumors?

Ivonne Daly, MD

Liver metastases from neuroendocrine tumors are the main cause of death for patients with neuroendocrine tumors originating from the intestine and pancreas. Large liver metastases often cause hormone-related symptoms (carcinoid syndrome) with severe consequences on patient quality of life. Because conventional surgical therapy is limited and several transplant centers have reported long-term survivors, patients with neuroendocrine liver metastases may be under "favorable consideration" for total hepatectomy and liver replacement despite the fact that because of the heterogeneity of this group of tumors, the individual benefit is rather difficult to determine. The first relevant single-center reports came from Pittsburgh, Cambridge, Paris, and Hannover, and they collectively demonstrated that patients receiving liver allografts for nonresectable metastases had acceptable and much better survival rates when compared with most primary liver malignancies.

Within the past few years there have been several single-center publications of results of liver transplantation in the treatment of metastatic neuroendocrine tumors. The Hannover group published their results in 12 patients who underwent liver transplantation. They had 1 operative mortality and 2 patients developed recurrent disease and died secondary to their malignancy. The remaining 75% of their patients were alive with an overall median survival of 55 months. Unfortunately, 7 of their initial 12 patients had tumor recurrence or residual tumor, and the interval between transplantation and the diagnosis of tumor recurrence ranged between 6 weeks and 48 months. The Hannover group published a follow-up report; their 1-, 5-, and 10-year survival rates were 89%, 80%, and 50%, respectively, with all deaths during long-term follow-up associated with tumor. In a 31-case multicentric report from France, the perioperative mortality rate was 19%; 25 patients were discharged home. Nearly half of the discharged patients died secondary to their malignancies. Their actuarial survival rates were 58%, 51%, 47%, 36%, and 36% at 1- 5 years, respectively.

In conclusion, liver transplantation can be performed for patients with metastatic neuroendocrine tumors, but this is offset by the high incidence of recurrent disease. In addition to the current disparity in number of cadaveric donors, a transplant center has to explore cadaveric vs living donor options for these patients.