title: Liver transplantation for the treatment of liver metastases from neuroendocrine tumors: an analysis of the UNOS database.
abstract: OBJECTIVE
  To determine outcomes in patients undergoing liver transplantation (LT) for metastatic neuroendocrine tumors (NETs).
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  University of Kentucky Medical Center.
  
  
  METHODS
  Patients undergoing LT performed for NET metastases from October 1, 1988, through January 31, 2008, were analyzed using the United Network for Organ Sharing database. Main Outcome Measure  Patient survival.
  
  
  RESULTS
  During the study period, 87 280 LTs were performed. One hundred fifty LTs were performed for metastatic NETs. Among those 150 patients undergoing LT, 51 patients (34.0%) had carcinoid, 6 had insulinoma (4.0%), 3 had glucagonoma (2.0%), 11 had gastrinoma (7.3%), and 9 had vasoactive intestinal peptide-secreting tumors (6.0%); an additional 70 (46.7%) had an unspecified NET. The mean (SE) age of the patients was 45.1 (12.5) years. The mean (SE) cold ischemic time was 8.9 (4.1) hours. One hundred forty-four patients were adults and 6 were children. Thirteen patients received another organ at the time of LT. During the same period, 4693 patients underwent transplantation for hepatocellular carcinoma. Overall, 1-, 3-, and 5-year survival rates for patients with NETs undergoing isolated LT were 81%, 65%, and 49%, respectively. No difference in survival was observed in patients with carcinoid vs noncarcinoid tumors (P = .84). No significant difference was observed in patient survival between those with metastatic NETs and those with hepatocellular carcinoma. Patients waiting for LT longer than 2 months had improved survival (P = .005).
  
  
  CONCLUSIONS
  Patients with liver metastases from NETs who were undergoing LT had long-term survival similar to that of patients with hepatocellular carcinoma. Longer wait times were associated with better outcomes in our series. Waiting for disease to stabilize before considering patients with liver metastases from NETs for transplantation may be appropriate. Excellent results can be obtained in highly selected patients.
authors.affiliation: Transplant Center, University of Kentucky College of Medicine, Lexington, KY 40536-0293, USA. rgeda2@uky.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Gedaly
authors.forename: Michael F
authors.initials: MF
authors.lastname: Daily
authors.forename: Daniel
authors.initials: D
authors.lastname: Davenport
authors.forename: Patrick P
authors.initials: PP
authors.lastname: McHugh
authors.forename: Alvaro
authors.initials: A
authors.lastname: Koch
authors.forename: Paul
authors.initials: P
authors.lastname: Angulo
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Hundley
mesh_terms: D000328:Adult; D002648:Child; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome