Liver transplantation and neuroendocrine tumors: lessons from a single centre experience and from the literature review.
Neuroendocrine tumor (NET) metastases represent at this moment the only accepted indication of liver transplantation (LT) for liver secondaries. Between 1984-2007, nine (1.1%) of 824 adult LTs were performed because of NET. There were five well differentiated functioning NETs (four carcinoids and one gastrinoma), three well differentiated non functioning NETs and one poorly differentiated NET. Indications for LT were an invalidating unresectable tumor (4x), and/or a diffuse tumor localization (3x) and/or a refractory hormonal syndrome (5x). Median post-LT patient survival is 60.9 months (range 4.8-119). One-, 3- and 5-year actuarial survival rates are 88%, 77% and 33%; 1, 3 and 5 years disease free survival rates are 67%, 33% and 11%. Due to a more rigorous selection procedure, results improved since 2000; three out of five patients are alive disease-free at 78, 84 and 96 months. Review of these series together with a review of the literature reveals that results of LT for this oncological condition can be improved using better selection criteria, adapted immunosuppression and neo- and adjuvant surgical as well as medical treatment. LT should be considered earlier in the therapeutic algorithm of selected NET patients as it is the only therapy that can offer a cure.
Bonaccorsi-Riani
Eliano
E
Starzl Unit of Abdominal Transplantation, University Hospitals St Luc, Université catholique de Louvain, Brussels, Belgium.
Apestegui
Carlos
C
Jouret-Mourin
Anne
A
Sempoux
Christine
C
Goffette
Pierre
P
Ciccarelli
Olga
O
Borbath
Ivan
I
Hubert
Catherine
C
Gigot
Jean François
JF
Hassoun
Ziad
Z
Lerut
Jan
J
D000328:Adult; D002276:Carcinoid Tumor / Q000473:pathology / Q000556:secondary / Q000601:surgery; D005260:Female; D015408:Gastrinoma / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome