LIVER TRANSPLANTATION FOR PANCREATIC NEUROENDOCRINE TUMORS

Subsequent reports demonstrated outstanding outcomes following LT for NELM within the Milan criteria, with 10-year OS and RFS of 88.8% and 13.1%, respectively. The associated ‘transplant benefit’ was clinically and statistically significant at 10 years, equating to an additional 38.43 months of survival. Under such strict selection criteria, LT with perioperative multimodal medical management could enhance the chances of cure for patients with NELM (5). These criteria have been endorsed in the USA by OPTN to approve an LT candidate for NELM as a MELD exception (6). According to ENETS guidelines, LT may be considered in highly selected patients with carcinoid syndrome or other functional NETs and extensive liver disease, refractory to multiple systemic treatments as a salvage procedure (7).

No randomized controlled trials have compared the long-term outcomes between LT and LR or medical treatments. A recent international multi-institutional retrospective study compared long-term outcomes using propensity score matching. Both PFS and OS were significantly better in the LT group than in the LR group, with 5-year PFS rates of 64% and 14%, and 5-year OS rates of 75% and 68%, respectively. This study demonstrates a survival benefit of LT over LR, depending on adherence to the Milan selection criteria (8). Recurrence after LT for NELM requires appropriate management. A study from our group reported on 32 patients who experienced recurrence, including 25 patients who met the Milan criteria. The median time to recurrence was 82.9 months, with the most common site being the abdominal lymph nodes (59%), followed by the peritoneum and lungs (6% each). Surgery was used to manage recurrence in 44% of patients, resulting in a favorable 5-year survival rate of 76% after recurrence. These findings suggest that proper patient selection for LT can lead to good disease control and long-term survival through multimodal treatment, even after recurrence (9).