Recurrence of Metastatic Pancreatic Neuroendocrine Tumor After Liver Transplantation

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Neuroendocrine (NET) tumors frequently metastasize to the liver requiring multi-faceted approaches. Liver transplantation (LT) presents a feasible treatment choice for patients with inoperable liver metastases from NET. We present a case of a recurrent carcinoid tumor after LT. Case Description/Methods: A 61-year-old woman with a history of pancreatic NET with extensive liver metastasis, diabetes mellitus and hypertension presented to the emergency department with abdominal pain. She was first diagnosed with pancreatic NET 6 years prior. Abdominal magnetic resonance imaging showed a 3.3 x 1.8 cm mass in the mid pancreas and innumerable hepatic lesions. She underwent laparoscopic resection of a large liver lesion and received octreotide as medical therapy. A decision was made to proceed with LT for the NET confined liver metastasis, and in preparation for LT, she underwent laparoscopic distal pancreatectomy and splenectomy. She then underwent uncomplicated orthotopic LT. Two years later, she started to experience poor appetite, weight loss, and she was found to have a recurrence of hepatic metastatic disease on screening imaging. The patient was hospitalized due to severe acute kidney injury requiring hemodialysis and bilateral lower extremity deep vein thrombosis. A renal biopsy showed findings of acute tubular necrosis and pyelonephritis for which she was treated with antibiotics. She was also given pulse steroids for fear of graft rejection as liver function tests peaked at aspartate aminotransferase 1356 U/L , alanine aminotransferase 176 U/L, alkaline phosphatase 447 U/L with altered mentation. Further labs showed Chromogranin A 18420 (0-95 ng/mL), serotonin 236 (#230 ng/mL), and positive cytomegalovirus DNA. Ganciclovir was started. Magnetic resonance cholangiopancreatography showed marked hepatomegaly, progression of metastasis and abdominal lymphadenopathy (Figure 1). Despite maximal treatment, she continued to decline and was transferred to inpatient hospice and passed soon after. Discussion: LT should be considered in patients with NET with confined liver metastasis. However, significant recurrence rates have been documented ranging from 31.3% 56.8%. Selection criteria include: recipient age , 60 years, bilobar confined hepatic involvement not amenable to resection, resection of primary malignancy without evidence of recurrence for at least 6 months, and well to moderately differentiated tumors. Our patient did fit into most of the criteria other than being 61 years old at LT time. Given the considerable recurrence rates, careful selection of patients is needed due to scarcity of donor grafts.

Volume

119

Issue

10S

First Page

S1792

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

DOI

10.14309/01.ajg.0001039548.54661.63

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