RESULTS OF LIVER-TRANSPLANTATION FOR GASTROENTEROPANCREATIC TUMOR-METASTASES

During the early 1980s liver transplantation (LTx) was expected to be a promising therapeutic option for patients with primary or secondary tumors confined to the liver. Because of disappointing results owing t o death from early recurrence, LTx is currently restricted to well sel ected patients with small primary tumors and, in the case of liver met astases, to those with metastases of gastroenteropancreatic (GEP) tumo r origin only. In our series of 300 liver transplantations four patien ts with GEP tumor metastases underwent LTx. The primary tumors were on e neuroendocrine kidney tumor, one glucagonoma of the pancreas, and tw o cases of carcinoids of the pancreas. Because of local metastatic lym ph node involvement upper gastrointestinal exenteration followed by LT x was performed in two patients. No patient survived beyond 33 months after LTx. Three patients died from tumor recurrence. In one patient w ho died from fungal sepsis autopsy revealed spine metastases that had been missed before LTx. Our dismal results do not compare well with pr omising data published previously by others for this particular patien t group. Under the pressure of an increasing donor organ shortage, pat ients with GEP tumor metastases should be selected carefully for LTx.