Liver re-transplantation for donor-derived neuroendocrine tumor: A case report

Abstract

BACKGROUNDDonor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT).CASE SUMMARYA 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination.CONCLUSIONThe benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.

Long-Term Outcomes of Liver Transplantation for the Management of Neuroendocrine Neoplasms: A Systematic Review

“…A minority of patients with NELM are candidates for resection with curative intent, and even if R0 margins are attained, disease recurrence is a significant hindrance [16], leading some to posit that for many cases, "curative resection" is a palliative endeavour albeit with a sustained duration of disease control [15]. The other aspect of the surgical armamentarium for NELM [17] or advanced primary hepatic NEN [18,19] is liver transplantation, either in the classic orthotopic fashion, or as part of a multivisceral graft [20][21][22][23]. Indications for OLT generally comprise control of medically intractable symptoms from functional tumours, amelioration of effects of hepatic tumour bulk, or for oncological control [24].…”