title: Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study.
abstract: OBJECTIVE
  The purpose of this study was to assess outcomes and indications in a large cohort of patients who underwent liver transplantation (LT) for liver metastases (LM) from neuroendocrine tumors (NET) over a 27-year period.
  
  
  BACKGROUND
  LT for NET remains controversial due to the absence of clear selection criteria and the scarcity and heterogeneity of reported cases.
  
  
  METHODS
  This retrospective multicentric study included 213 patients who underwent LT for NET performed in 35 centers in 11 European countries between 1982 and 2009. One hundred seven patients underwent transplantation before 2000 and 106 after 2000. Mean age at the time of LT was 46 years. Half of the patients presented hormone secretion and 55% had hepatomegaly. Before LT, 83% of patients had undergone surgical treatment of the primary tumor and/or LM and 76% had received chemotherapy. The median interval between diagnosis of LM and LT was 25 months (range, 1-149 months). In addition to LT, 24 patients underwent major resection procedures and 30 patients underwent minor resection procedures.
  
  
  RESULTS
  Three-month postoperative mortality was 10%. At 5 years after LT, overall survival (OS) was 52% and disease-free survival was 30%. At 5 years from diagnosis of LM, OS was 73%. Multivariate analysis identified 3 predictors of poor outcome, that is, major resection in addition to LT, poor tumor differentiation, and hepatomegaly. Since 2000, 5-year OS has increased to 59% in relation with fewer patients presenting poor prognostic factors. Multivariate analysis of the 106 cases treated since 2000 identified the following predictors of poor outcome: hepatomegaly, age more than 45 years, and any amount of resection concurrent with LT.
  
  
  CONCLUSIONS
  LT is an effective treatment of unresectable LM from NET. Patient selection based on the aforementioned predictors can achieve a 5-year OS between 60% and 80%. However, use of overly restrictive criteria may deny LT to some patients who could benefit. Optimal timing for LT in patients with stable versus progressive disease remains unclear.
authors.affiliation: Hôpital La Conception, Marseille, France.
authors.forename: Yves Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.forename: Emilie
authors.initials: E
authors.lastname: Grégoire
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jouve
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Georges
authors.initials: G
authors.lastname: Mantion
authors.forename: Kia
authors.initials: K
authors.lastname: Homayounfar
authors.forename: Manuel
authors.initials: M
authors.lastname: Bustamante
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolf
authors.forename: Marek
authors.initials: M
authors.lastname: Krawczyk
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Bertrand
authors.initials: B
authors.lastname: Suc
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: Jorge Ortiz
authors.initials: JO
authors.lastname: de Urbina
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mejzlik
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: François
authors.initials: F
authors.lastname: Paye
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.forename: Stefan
authors.initials: S
authors.lastname: Thorban
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult