BACKGROUND: The role of liver transplantation in management of patients with metastatic neuroendocrine tumors (NETs) is controversial. Because many such patients have low waitlist priority, centers may apply for model for end-stage liver disease (MELD) exception points to increase likelihood of receiving a liver transplant. No formal criteria exist for application or receipt of exception points for this indication. Few studies have assessed waitlist and posttransplantation outcomes in patients with metastatic NETs, and none examined the impact of exception points. METHODS: We analyzed all adult patients waitlisted for liver transplantation for metastatic NETs between February 27, 2002, and June 4, 2014, and fit a multivariable model to evaluate the association between exception point status and posttransplantation outcomes. RESULTS: There was variable use of MELD exception points across the United Network for Organ Sharing regions. Patients with an approved MELD exception were nearly twice as likely to be transplanted as those without exceptions (70.8% vs 39.1%, P < 0.001), and half as likely to be removed for death or clinical deterioration (9.2% vs 18.2%, P = 0.046). In multivariable models, posttransplantation survival was not associated with receipt of exception points, whereas risk of posttransplant mortality increased significantly with elevated serum total bilirubin level at transplantation. The 3-year posttransplant patient survival was 78% in transplant recipients with metastatic NETs whose total bilirubin level at transplantation was 1.3 mg/dL or less, compared to 36% in those with total bilirubin greater than 1.3 mg/dL. CONCLUSIONS: Serum total bilirubin may serve as a predictor of poor posttransplant survival in patients with metastatic NETs and could help risk-stratify patients applying for MELD exception points.
BACKGROUND: The role of liver transplantation in management of patients with metastatic neuroendocrine tumors (NETs) is controversial. Because many such patients have low waitlist priority, centers may apply for model for end-stage liver disease (MELD) exception points to increase likelihood of receiving a liver transplant. No formal criteria exist for application or receipt of exception points for this indication. Few studies have assessed waitlist and posttransplantation outcomes in patients with metastatic NETs, and none examined the impact of exception points. METHODS: We analyzed all adult patients waitlisted for liver transplantation for metastatic NETs between February 27, 2002, and June 4, 2014, and fit a multivariable model to evaluate the association between exception point status and posttransplantation outcomes. RESULTS: There was variable use of MELD exception points across the United Network for Organ Sharing regions. Patients with an approved MELD exception were nearly twice as likely to be transplanted as those without exceptions (70.8% vs 39.1%, P < 0.001), and half as likely to be removed for death or clinical deterioration (9.2% vs 18.2%, P = 0.046). In multivariable models, posttransplantation survival was not associated with receipt of exception points, whereas risk of posttransplant mortality increased significantly with elevated serum total bilirubin level at transplantation. The 3-year posttransplant patient survival was 78% in transplant recipients with metastatic NETs whose total bilirubin level at transplantation was 1.3 mg/dL or less, compared to 36% in those with total bilirubin greater than 1.3 mg/dL. CONCLUSIONS: Serum total bilirubin may serve as a predictor of poor posttransplant survival in patients with metastatic NETs and could help risk-stratify patients applying for MELD exception points.
Authors: Khairuddin Memon; Robert J Lewandowski; Mary F Mulcahy; Ahsun Riaz; Robert K Ryu; Kent T Sato; Ramona Gupta; Paul Nikolaidis; Frank H Miller; Vahid Yaghmai; Vanessa L Gates; Bassel Atassi; Steven Newman; Reed A Omary; Al B Benson; Riad Salem Journal: Int J Radiat Oncol Biol Phys Date: 2011-12-02 Impact factor: 7.038
Authors: Roberto Gedaly; Michael F Daily; Daniel Davenport; Patrick P McHugh; Alvaro Koch; Paul Angulo; Jonathan C Hundley Journal: Arch Surg Date: 2011-08
Authors: Yves Patrice Le Treut; Emilie Grégoire; Jürgen Klempnauer; Jacques Belghiti; Elisabeth Jouve; Jan Lerut; Denis Castaing; Olivier Soubrane; Olivier Boillot; Georges Mantion; Kia Homayounfar; Manuel Bustamante; Daniel Azoulay; Philippe Wolf; Marek Krawczyk; Andreas Pascher; Bertrand Suc; Laurence Chiche; Jorge Ortiz de Urbina; Vladimir Mejzlik; Manuel Pascual; J Peter A Lodge; Salvatore Gruttadauria; François Paye; François-René Pruvot; Stefan Thorban; Aksel Foss; René Adam Journal: Ann Surg Date: 2013-05 Impact factor: 12.969
Authors: Vincenzo Mazzaferro; Josep M Llovet; Rosalba Miceli; Sherrie Bhoori; Marcello Schiavo; Luigi Mariani; Tiziana Camerini; Sasan Roayaie; Myron E Schwartz; Gian Luca Grazi; René Adam; Peter Neuhaus; Mauro Salizzoni; Jordi Bruix; Alejandro Forner; Luciano De Carlis; Umberto Cillo; Andrew K Burroughs; Roberto Troisi; Massimo Rossi; Giorgio E Gerunda; Jan Lerut; Jacques Belghiti; Ilka Boin; Jean Gugenheim; Fedja Rochling; Bart Van Hoek; Pietro Majno Journal: Lancet Oncol Date: 2008-12-04 Impact factor: 41.316
Authors: Brian L Dunfee; Ahsun Riaz; Robert J Lewandowski; Saad Ibrahim; Mary F Mulcahy; Robert K Ryu; Bassel Atassi; Kent T Sato; Steven Newman; Reed A Omary; Al Benson; Riad Salem Journal: J Vasc Interv Radiol Date: 2009-11-25 Impact factor: 3.464
Authors: Mariya L Samoylova; Jennifer L Dodge; Eric Vittinghoff; Francis Y Yao; John Paul Roberts Journal: Liver Transpl Date: 2013-10-21 Impact factor: 5.799
Authors: Juan R Sanabria; Rajan S Kombu; Guo-Fang Zhang; Yana Sandlers; Jizhou Ai; Rafael A Ibarra; Rime Abbas; Kush Goyal; Henri Brunengraber Journal: HPB (Oxford) Date: 2016-10-27 Impact factor: 3.647