title: Liver transplantation for patients with metastatic endocrine tumors: single-center experience with 15 patients.
abstract: In contrast to other secondary liver malignancy, orthotopic liver transplantation (OLT) is considered as a treatment modality for nonresectable endocrine liver metastases in selected patients. However, only few series have assessed patient selection criteria and long-term results, and no reports have focused on the impact of new technologies in this regard. Between 1992 and 2004, 28 patients with malignant endocrine tumors underwent evaluation for OLT according to our protocol. Data were entered into a prospective database. During pretransplant evaluation, somatostatin receptor scintigraphy detected extrahepatic metastases not diagnosed in standard imaging in 10 patients. Of them, 3 showed aberrant Ki67 labeling results. One patient was excluded from further evaluation due to severe carcinoid heart. Thus far, 15 patients, 10 men and 5 women, aged 37 to 67 years, were subjected to the transplant procedure (11 deceased donor OLT, 3 living donor liver transplantations, and 1 cluster transplantation). Four patients died during the hospital treatment. The median follow-up of the discharged patients was 60.8 months. The actuarial patient survival was 78.3% at 1 year and 67.2% at 5 years. The actuarial 1-, 2-, and 5-year tumor-free survival amounted to 69.4%, 48.3%, and 48.3%, respectively. Two patients underwent surgery for isolated tumor recurrence. In 2 patients, peptide receptor radiotherapy was carried out because of multilocular recurrent disease. In conclusion, liver transplantation is a realistic therapeutic option for highly selected patients with hepatic metastases of endocrine tumors. Our strategy, which implements strict pretransplant selection and aggressive surgical approach, in case of disease recurrence, in addition to systemic radiopeptide treatment, led to an excellent long-term survival cure, however, is unlikely to be achieved.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany. frilling@uni-essen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Vito
authors.initials: V
authors.lastname: Cicinnati
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.forename: Jan
authors.initials: J
authors.lastname: Mueller-Brand
authors.forename: Michael
authors.initials: M
authors.lastname: Hofmann
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Schmid
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D015996:Survival Rate