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The Long‐Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors
Author(s) -
Mazzaferro V.,
Sposito C.,
Coppa J.,
Miceli R.,
Bhoori S.,
Bongini M.,
Camerini T.,
Milione M.,
Regalia E.,
Spreafico C.,
Gangeri L.,
Buzzoni R.,
Braud F. G.,
De Feo T.,
Mariani L.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13831
Subject(s) - medicine , propensity score matching , hazard ratio , liver transplantation , transplantation , confidence interval , neuroendocrine tumors , proportional hazards model , surgery , gastroenterology
Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors ( NET s) remain uncertain. Eighty‐eight consecutive patients with metastatic NET s eligible for liver transplantation according to Milan‐ NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long‐term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow‐up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time‐to‐progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval ( CI ): 2.4–23.0; p = 0.001). Adjusted transplant‐related survival benefit was 6.82 months (95% CI : 1.10–12.54; p = 0.019) and 38.43 months (95% CI : 21.41–55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NET s under restrictive criteria provides excellent long‐term outcome. Transplant‐related survival benefit increases over time and maximizes after 10 years.