What is the role of liver transplant in NET?

Identifying the role of liver transplant (txp) in NET patients with all the other therapy options available is challenging. I will admit that there have been several years since I last was involved in the care of a patient that actually ended up having a liver txp. That said, I think certain patients should be considered and referred for evaluation and I often discuss txp as an option.

In 2016, an experienced group in Milan reported on their experience with liver txp in NET patients. Eighty-eight patients who were transplant eligible were offered txp (n=42) vs. non-txp options (n=46). This was not a randomized trial and factors such as patient age and transplant list dynamics played a role in selection of therapy. Not surprisingly, the txp p...

This is a complex question. Now that we have many lines of therapy that are effective at delaying progression (and sometimes inducing response) for patients with NETs, the role of liver transplant is more limited than it used to be.

Patients with metastatic NETs cannot be cured, but rather their disease can be controlled over time. This can effectively be achieved by a combination or sequence of debulking surgery, liver embolization, systemic therapy (multiple lines), or PRRT more recently. Those treatments are much less invasive than a liver transplant.

The traditional criteria for liver transplant are also quite strict, including primary with portal drainage, demonstrated stability of disease (I believe for 1 year), resected primary tum...

Thanks, @Dr. First Last for the thoughtful response. I thought I would post the UNOS/OPTN guidelines for consideration of liver transplant in this setting. Admittedly, they are not entirely straightforward.

Neuroendocrine Tumors (NET) Liver Transplant MELD exception Guidelines

A review of the literature supports that candidates with NET are expected to have a low risk of waiting list drop-out. Initial recommendations included age less than 60. Older patients with a lot of disease burden may be referred to transplant as a last resort, leading to poor outcomes, while data presented at the AASLD show that very young patients with NET and early stage disease do well. Committee members believed that these initial guidelines could include strict ...