• Linda S Sher, David M Levi, Julie S Wecsler, Mary Lo, Lydia M Petrovic, Susan Groshen, Lingyun Ji, Teresa Diago Uso, A Joseph Tector, Ann S Hamilton, MarshJ WallisJWDepartment of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., and Myron E Schwartz.
• Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California.
• J Surg Oncol. 2015 Aug 1; 112 (2): 125-32.

BackgroundPatient 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.MethodsA 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.ResultsAnalysis 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).ConclusionIn 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.© 2015 Wiley Periodicals, Inc.

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