[Liver trasplantation for the treatment of non-resectable metastases of neuroendocrine tumors: first report in Argentina]

Abstract

Neuroendocrine tumors are uncommon cancers characterized by a slow grow rate. Unresectable liver metastases are the main cause of death in patients with these tumors. This is the first Argentine report of a liver transplantation as an indication for the treatment of unresectable liver metastases from a pancreatic neuroendocrine tumor. We present a 48-year-old woman with diagnosis of a pancreatic neuroendocrine tumor with multiple bilobar unresectable liver metastases. A splenopancreatectomy was performed after a complete staging revealed absence of extrahepatic disease. Six months later, a follow-up performed with thoracoabdominal CT scan and octreo-scan was consistent with no tumor recurrence or extrahepatic disease. As the huge hepatomegaly caused a notorius deterioration in the patient's quality of life, we decided to include her in the waiting list for liver transplantation. Priority points were requested to the MELD (model for end stage liver disease) Exceptions Experts Committee with a positive response. Twelve months after the primary surgery, with a MELD score of 23 points, a deceased donor liver transplantation was performed without evidence at that moment of residual disease. Eighteen months after liver transplantation, the patient required the surgical repair of a stenosis in the biliary anastomosis. At the surgery peritoneal tumor recurrence was diagnosed. Now, 24 months after liver transplantation the patient has an excellent quality of life and a well functioning graft. We report this case of a liver transplantation as an indication for the treatment of liver metastases from a neuroendocrine tumor and we review the literature on this controversial issue.