Role and Utility of Living Donor Liver Transplantation for Unresectable Neuroendocrine Tumors in Transplant Oncology: Evaluating Evidence, Emerging Insights, and Future Directions
摘要
Liver transplantation (LT) is a crucial treatment modality for patients with unresectable neuroendocrine tumors (NETs). Living donor liver transplantation (LDLT) is particularly useful in these patients as it addresses the challenges of organ shortages and long waiting times associated with deceased donor liver transplantation (DDLT).This review describes the clinical evidence from original studies and case reports and the state of the art of LDLT for NETs. We did a scoping literature review of studies published in the last decade. This review also summarizes the available protocols for patient inclusion for LDLT.
ResultsWe reviewed 19 original studies, nine retrospective cohort studies and ten case report/ series, to study the reported inclusion criteria and outcomes of LDLT for NETs indication; one study reported multi-visceral transplantation. Protocols such as Milan Criteria, and UNOS criteria were predominantly followed for patient selection. In these studies, survival rates were up to 94.7% at one year, 88% at three years, 80% at five years and 50% at ten years after LDLT. Peri-operative regimens and additional treatments included resection, TACE and somatostatin analogues with or without mTOR inhibitors in some cases. Finally, we found there was a lack of ongoing prospective trials to validate findings from retrospective studies.
ConclusionAppropriate recipient selection and an experienced multidisciplinary team can make a difference in outcomes after LDLT for NET. A personalized treatment plan should be made for the postoperative period based on tumor biology and aggressiveness.