Predictors of Long‐Term Survival After Liver Transplantation for Metastatic Endocrine Tumors: An 85‐Case French Multicentric Report

Liver transplantation (LTx) for metastatic endocrine tumors (MET) remains controversial due to the lack of clear selection criteria. From 1989 to 2005, 85 patients underwent LTx for MET. The primary tumor was located in the pancreas or duodenum in 40 cases, digestive tract in 26 and bronchial tree i...

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Bibliographic Details
Published in:American journal of transplantation 2008-06, Vol.8 (6), p.1205-1213
Main Authors: Le Treut, Y. P., Grégoire, E., Belghiti, J., Boillot, O., Soubrane, O., Mantion, G., Cherqui, D., Castaing, D., Ruszniewski, P., Wolf, P., Paye, F., Salame, E., Muscari, F., Pruvot, F. R., Baulieux, J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Endocrine Gland Neoplasms - secondary
Endocrine Gland Neoplasms - surgery
Female
France
Humans
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver Transplantation - mortality
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Metastasis
Middle Aged
multivariate analysis
Neuroendocrine Tumors - secondary
Neuroendocrine Tumors - surgery
patient survival rate
Prognosis
prognostic factors
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Analysis
transplant registry
transplantation outcomes
tumor
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Summary:Liver transplantation (LTx) for metastatic endocrine tumors (MET) remains controversial due to the lack of clear selection criteria. From 1989 to 2005, 85 patients underwent LTx for MET. The primary tumor was located in the pancreas or duodenum in 40 cases, digestive tract in 26 and bronchial tree in five. In the remaining 14 cases, primary location was undetermined at the time of LTx. Hepatomegaly (explanted liver ≥120% of estimated standard liver volume) was observed in 53 patients (62%). Extrahepatic resection was performed concomitantly with LTx in 34 patients (40%), including upper abdominal exenteration (UAE) in seven. Postoperative in‐hospital mortality was 14%. Overall 5‐year survival was 47%. Independent factors of poor prognosis according to multivariate analysis included UAE (relative risk (RR): 3.72), primary tumor in duodenum or pancreas (RR: 2.94) and hepatomegaly (RR: 2.63). After exclusion of cases involving concomitant UAE, the other two factors were combined into a risk model. Five‐year survival rate was 12% for the 23 patients presenting both unfavorable prognostic factors versus 68% for the 55 patients presenting one or neither factor (p < 10−7). LTx can benefit selected patients with nonresectable MET. Patients presenting duodeno‐pancreatic MET in association with hepatomegaly are poor indications for LTx. Upper abdominal exenteration, location of the primary tumor in duodenum or pancreas, and hepatomegaly are predictors of poor outcome.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2008.02233.x