Long Term Survival after Transplant for Neuroendocrine Liver Metastases: A Case Report and Literature Review

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Introduction: Liver transplantation (LT) is offered to selected patients of neuroendocrine tumours (NETs) with unresectable liver metastases (NELM).

Aim(s): To present a case of long term survival after recurrence in transplanted liver.

Materials and methods: A 35 year old lady with recurrent upper abdomen pain had multiple bilobar cystic liver lesions on computed tomogram. Fine Needle Aspiration Cytology showed NET. Serum Chromogranin A (S. CgA) was raised and DOTA-PET showed bilobar NELM with unknown primary. Patient underwent Exploratory Laparotomy, and a 1 X 1.5 cm exophytic lesion was found 30cm from DJ flexure. Resection and anastomosis was performed. Histopathology revealed grade 1 NET. Patient underwent LT 6 months later, and was disease free for 5 years. CT and DOTA-PET done 5 years after transplant revealed multiple DOTA positive liver lesions, and S. CgA was raised. She underwent 3 cycles of 177-Lu PRRT, after which the lesions increased in size. She was put on long-acting depot Octreotide (LAR) for 6 months. 2 years after stopping LAR, she presented with carcinoid syndrome and raised S. CgA. She was again put on LAR. Now the patient is being considered for 213-Bismuth PRRT for growing liver metastasis, 11 years after first diagnosis.

Conference: 15th Annual ENETSConcerence (2018)

Presenting Author: Pande P

Authors: Pande P, Desai G, Shah R, Palepu J,

Keywords: : neuroendocrine tumours, liver metastases, liver transplantation,