Role of liver transplantation in the management of unresectable neuroendocrine liver metastases.
The use of OLT in the management of liver metastases of any origin is highly controversial, as most patients receiving a transplant for this indication display poor results owing to early tumor spread secondary to the effects of immunosuppression. However, as they have a better biological behavior, neuroendocrine (NE) tumors may be a good indication for OLT. Our aim was to present our experience in the management of unresectable liver metastases of tumors of NE origin.


METHODS
Between January 1996 and April 2006, 10 patients underwent OLT for unresectable liver metastases of a neuroendocrine origin, accounting for 1.2% of all transplants performed to date in our unit (n = 626). The most common location of the primary tumor was the pancreas in six cases: three in the pancreatic tail--one carcinoid tumor, one gastrinoma, and one nonfunctioning NE [NF-NE] tumor; and three cases in the pancreatic head--three NF-NE tumors. In the remaining four cases, including three carcinoid tumours and one NF-NE tumors, two were located in the small bowel (at the ileum and ileocecal valve) and two in the lung. The liver metastases were synchronous with the primary tumor in seven cases and metachronous in three cases.


RESULTS
The morbidity rate was 75% and the mortality rate, 10% (n = 1). The tumor recurrence rate was 33% with 1- and 3-year survival rates of 86% and 57%, respectively.
Marín
C
C
Virgen de la Arrixaca University Hospital, Department of General Surgery, Liver Transplant Unit, Murcia, Spain. rirocam@um.es
Robles
R
R
Fernández
J A
JA
Bueno
F S
FS
Ramírez
P
P
Miras
M
M
Parrilla
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors