John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Role of liver transplantation in treatment of unresectable liver metastases Volume 26, issue 6, Juin 2019

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Authors
1 Hôpital Beaujon, Service d’hépatologie, 100, boulevard du Général Leclerc, 92110 Clichy
2 Inserm UMR 1149, Centre de Recherche sur l’Inflammation, Université Paris-Diderot, 75018 Paris
3 Hôpital Pitié Salpêtrière, Sorbonne Université, Service de chirurgie digestive, hépato-biliopancréatique et transplantation hépatique, 47-83, boulevard de l’Hôpital, 75013 Paris
* Correspondance

Liver metastases are a classical contraindication for liver transplantation (LT). However, neuroendocrine tumors are slow-growing, and several registry studies have shown that LT was associated with prolonged overall survival in patients with unresectable liver metastases of gastrointestinal endocrine tumors. Therefore, LT has been validated in this indication as a MELD exception. Patients should meet the following selection criteria: A primary tumor resected at the time of LT, a low-grade tumor (Ki67 <10%), symptomatic disease without massive hepatomegaly, stabilization of metastases before LT, and absence of extrahepatic metastases. The optimal delay to respect between the resection of primary tumor and LT to assess tumor progression is still a debate. LT has also been proposed as therapeutic option for unresectable liver metastases of colorectal cancer. Recent studies have shown encouraging results regarding to 5-year overall survival in patients with no extrahepatic involvement. The largest metastasis diameter, time from primary tumor resection to LT, carcinoembryonic antigen level, and evolution of metastases over time seem to be factors associated with survival. On the other hand, disease-free survival is very low, and the small number of patients who undergone LT in this indication preclude to support its broader application. In the current context of organ shortage, we need strong selection criteria to identify patients who would really benefit from LT. Ongoing trials should help us to define the place of LT in the management of these patients.

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