Liver Transplantation for Metastatic Neuroendocrine Tumors: A Single-Center Experience in a Brazilian Referral Center

Liver transplantation (LT) has emerged as a potential therapeutic option for selected patients with unresectable liver-confined metastatic neuroendocrine tumors (NETs), although evidence remains limited, particularly in low- and middle-income countries.

To describe the experience of a Brazilian referral center with orthotopic LT for metastatic NETs and to evaluate post-transplant outcomes.

A retrospective descriptive cohort study was conducted, including patients who underwent deceased-donor LT between 2002 and 2025 at a tertiary referral center in Brazil. Among 2312 liver transplants, six patients transplanted for unresectable hepatic metastases from well-differentiated NETs were identified. Demographic, clinical, oncological, and transplant-related variables were analyzed, with outcomes assessed over a 5-year follow-up period.

The cohort consisted predominantly of middle-aged men, with a median age of 47.5 years. All patients had preserved liver function at transplantation, reflected by low MELD-Na scores. The median Ki-67 index was 10% (range: 1%-20%). Overall survival was 100%, and tumor recurrence occurred in two patients (33.3%). Acute rejection was infrequent and successfully managed, with no cases of chronic rejection. Post-transplant complications were limited, mainly involving biliary events. Immunosuppressive regimens were predominantly tacrolimus-based, with selective use of mycophenolate and everolimus.

LT for metastatic NETs was associated with excellent survival and low morbidity in this highly selected cohort. Despite the small sample size, these findings support LT as a feasible therapeutic option in carefully selected patients treated at specialized referral centers.