Minireviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2018; 24(20): 2152-2162
Published online May 28, 2018. doi: 10.3748/wjg.v24.i20.2152
Liver transplantation and multivisceral transplantation in the management of patients with advanced neuroendocrine tumours
Ashley Kieran Clift, Andrea Frilling
Ashley Kieran Clift, Andrea Frilling, Department of Surgery and Cancer, Imperial College London, London W12 0HS, United Kingdom
Author contributions: Both authors contributed equally to this work and approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andrea Frilling, MD, PhD, Professor, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, United Kingdom. a.frilling@imperial.ac.uk
Telephone: +44-208-3833941 Fax: +44-203-3133963
Received: April 3, 2018
Peer-review started: April 4, 2018
First decision: April 19, 2018
Revised: May 3, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: May 28, 2018
Processing time: 54 Days and 21 Hours
Abstract

Orthotopic liver transplantation (OLT) represents a generally accepted albeit somewhat controversially discussed therapeutic strategy in highly selected patients with non-resectable hepatic metastases from neuroendocrine tumours (NET). Whilst there are some exclusion criteria, these are not universally followed, and the optimal set of inclusion parameters for deeming patients eligible has not yet been elucidated. This is due to heterogeneity in the study populations, as well differing approaches employed and also divergences in selection criteria between centres. Recent data have suggested that OLT may represent the most efficacious approach in terms of overall and disease-free survival to the management of NET metastatic to the liver when conducted in accordance with the modified Milan criteria. Therefore, a consensus set of selection criteria requires definition to facilitate stringent and fair allocation of deceased-donor organs, as well as consideration for living-donor organs. In the context of classically non-resectable metastatic tumour bulk, multivisceral transplantation with or without the liver may also be indicated, yet experience is very limited. In this review, we discuss the diagnostic work-up of patients in whom the aforementioned transplantation approaches are being considered, critically analyse the published experience and also anticipate future developments in this field, including a discussion of immediate and longer-term research priorities.

Keywords: Neuroendocrine; Transplantation; Metastases; Liver; Multivisceral

Core tip: Liver transplantation is a generally accepted option in selected patients with advanced neuroendocrine tumours metastatic to the liver. Outcomes may be favourable in exquisitely selected patients, yet the optimal selection criteria have not yet been elucidated. Multivisceral transplantation is valid but rarely utilised, for example, in cases of metastatic bulk threatening gut vascular supply.