title: Modified liver-free multivisceral transplantation for a metastatic small bowel neuroendocrine tumor: a case report.
abstract: Neuroendocrine tumors originating from the small bowel frequently metastasize to the lymph nodes and/or liver. Although surgical extirpation of the primary tumor and locoregional metastases epitomizes the management of patients with such tumors, this is not always possible with conventional surgical techniques. Nonresectable, slow-growing tumors involving the mesenteric root represent a generally accepted indication for deceased donor intestinal and multivisceral transplantation. Furthermore, vascularized sentinel forearm flaps offer opportunities for monitoring graft rejection and tailoring immunosuppression regimens. Here, we report the first documented case of modified liver-free multivisceral transplantation preceded by neoadjuvant 177-lutetium peptide receptor radionuclide therapy in a patient with a small bowel neuroendocrine tumor and extensive lymph node metastases in the mesenterium. At a follow-up of 21 months the patient is biochemically and radiologically disease-free.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, United Kingdom. Electronic address: a.frilling@imperial.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Frilling
authors.affiliation: Department of Plastic and Reconstructive Surgery, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Giele
authors.affiliation: Oxford Transplant Centre, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Vrakas
authors.affiliation: Oxford Transplant Centre, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Oxford Transplant Centre, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Macedo
authors.affiliation: Department of Nuclear Medicine, Imperial College London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Al-Nahhas
authors.affiliation: Department of Surgery and Cancer, Imperial College London, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Wasan
authors.affiliation: School of Medicine, Imperial College London, United Kingdom.
authors.forename: A K
authors.initials: AK
authors.lastname: Clift
authors.affiliation: Instituto de Trasplante Multiorgánico, Fundación Favaloro, Buenos Aires, Argentina.
authors.forename: G E
authors.initials: GE
authors.lastname: Gondolesi
authors.affiliation: Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Fla., United States.
authors.forename: R M
authors.initials: RM
authors.lastname: Vianna
authors.affiliation: Oxford Transplant Centre, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Friend
authors.affiliation: Oxford Transplant Centre, Oxford University NHS Trust, Oxford, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Vaidya
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008643:Mesentery / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000601:surgery*; D016377:Organ Transplantation / Q000379:methods*; D018000:Receptors, Peptide; D017481:Receptors, Somatostatin; D013524:Surgical Flaps; D014781:Viscera / Q000637:transplantation*
chemical_list: D018000:Receptors, Peptide; D017481:Receptors, Somatostatin