Liver transplantation for neuroendocrine tumors in Europe - Results and trends in patient selection: A 213-case European liver transplant registry study

Yves Patrice Le Treut, Emilie Grégoire, Jürgen Klempnauer, Jacques Belghiti, Elisabeth Jouve, Jan Lerut, Denis Castaing, Olivier Soubrane, Olivier Boillot, Georges Mantion, Kia Homayounfar, Manuel Bustamante, Daniel Azoulay, Philippe Wolf, Marek Krawczyk, Andreas Pascher, Bertrand Suc, Laurence Chiche, Jorge Ortiz De Urbina, Vladimir MejzlikManuel Pascual, J. Peter A Lodge, Salvatore Gruttadauria, François Paye, François René Pruvot, Stefan Thorban, Aksel Foss, René Adam

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)807-815
Number of pages9
JournalAnnals of Surgery
Volume257
Issue number5
DOIs
Publication statusPublished - May 2013

Keywords

  • liver transplantation
  • multivariate analysis
  • neuroendocrine tumors
  • prognostic study

ASJC Scopus subject areas

  • Surgery

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    Le Treut, Y. P., Grégoire, E., Klempnauer, J., Belghiti, J., Jouve, E., Lerut, J., Castaing, D., Soubrane, O., Boillot, O., Mantion, G., Homayounfar, K., Bustamante, M., Azoulay, D., Wolf, P., Krawczyk, M., Pascher, A., Suc, B., Chiche, L., De Urbina, J. O., ... Adam, R. (2013). Liver transplantation for neuroendocrine tumors in Europe - Results and trends in patient selection: A 213-case European liver transplant registry study. Annals of Surgery, 257(5), 807-815. https://doi.org/10.1097/SLA.0b013e31828ee17c