title: Liver transplantation for metastatic neuroendocrine tumors: Outcomes and prognostic variables.
abstract: BACKGROUND
  Patient selection for liver transplantation for metastatic neuroendocrine tumors remains a topic of debate. There is no established MELD exception, making it difficult to obtain donor organs.
  
  
  METHODS
  A multicenter database was created assessing outcomes for liver and multivisceral transplantation for metastatic neuroendocrine tumors and identifying prognostic factors for survival. Demographic, transplant, primary tumor site and management, pathology, recurrent disease and survival data were collected and analyzed. Survival probabilities were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Analysis included 85 patients who underwent liver transplantation November 1988-January 2012 at 28 centers. One, three, and five-year patient survival rates were 83%, 60%, and 52%, respectively; 40 of 85 patients died, with 20 of 40 deaths due to recurrent disease. In univariate analyses, the following were predictors of poor prognosis: large vessel invasion (P < 0.001), extent of extrahepatic resection at liver transplant (P = 0.007), and tumor differentiation (P = 0.003). In multivariable analysis, predictors of poor overall survival included large vessel invasion (P = 0.001), and extent of extrahepatic resection at liver transplant (P = 0.015).
  
  
  CONCLUSIONS
  In the absence of poor prognostic factors, metastatic neuroendocrine tumor is an acceptable indication for liver transplantation. Identification of favorable prognostic factors should allow assignment of a MELD exception similar to hepatocellular carcinoma.
authors.affiliation: Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Sher
authors.affiliation: Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.affiliation: Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Wecsler
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Mary
authors.initials: M
authors.lastname: Lo
authors.affiliation: Department of Pathology, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Lydia M
authors.initials: LM
authors.lastname: Petrovic
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.affiliation: Department of General Surgery and Transplant Center, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Teresa Diago
authors.initials: TD
authors.lastname: Uso
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: Department of Surgery, Recanati/Miller Transplantation Institute Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013156:Splenectomy; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: liver transplantation; neuroendocrine tumor; prognostic indicators