Liver metastases from neuroendocrine tumors (NETs) is an accepted indication for liver transplantation (LT). Despite strict patient selection, post-LT recurrence is observed in 30-50% of cases. Postrecurrence survival is poorly investigated as well as factors influencing postrecurrence outcomes.

Consecutive patients treated at a single Institution for post-LT recurrence of NET between Jan 1st, 2004 and Dec 31th, 2018 were included. Baseline patients' characteristics, data on the primary tumor, pretransplant therapies, posttransplant recurrence and treatments and long-term outcomes were prospectively collected and retrospectively analyzed.

Thirty-two patients presented with post-LT NET recurrence occurring 82.9 months (IQR 29.4-119.1) from LT, and the most common sites were abdominal lymph nodes (59.4%), peritoneum (6.3%) and lungs (6.3%). Fourteen patients (43.8%) underwent surgery with radical intent. Five- and 10-years survival after recurrence were 76.3% and 45.5%, respectively. Only time from LT to recurrence had a significant impact on post recurrence survival, being 5-years OS 89.5% versus 0% for patients recurring > 24 months after LT versus ≤ 24 months, respectively (p=.001). Moreover, for patients with Mib-1 > 2% at recurrence, 5-years OS was 87.5% versus 0% for those undergoing surgery versus loco-regional or systemic treatments (p=0.011).

The presented results, although based on a retrospective and relatively small series, show that excellent long-term survival is observed after post-LT NET recurrence, particularly in those patients recurring long after LT (> 24 months). An aggressive surgical treatment might result in a new chance of cure for a selected subgroup of patients.