# Should We Continue Liver Transplantation in Spain for Hepatic Metastases from Neuroendocrine Tumors?

## TL;DR

This study evaluates liver transplantation outcomes for neuroendocrine tumor metastases in Spain and finds that stricter patient selection improves survival.

## Contribution

The study provides the first multicenter analysis of liver transplantation outcomes for neuroendocrine tumors in Spain.

## Key findings

- Recurrence occurred in 57.1% of patients after liver transplantation for neuroendocrine tumors.
- Five-year overall survival was significantly higher in patients meeting Milan criteria (71.0%) compared to those who did not (58.0%).

## Abstract

Background/Objectives: Despite the long-standing history of liver transplantation (LT) in Spain, no multicenter study has reviewed national outcomes for LT in metastatic neuroendocrine tumors (NETs). In the current era of transplant oncology, auditing these results is essential to refine patient selection and improve long-term outcomes. Methods: This retrospective observational study analyzed data from 13 centers, including 91 patients who underwent LT for NET between 1995 and 2024. Patients were stratified into two groups: Milan IN (those meeting the Milan criteria) and Milan OUT (the remainder). Results: Recurrence occurred in 57.1% of cases, and overall mortality was 51.6%. Of the 91 patients, 71 (78.0%) were Milan IN and 20 (22.0%) were Milan OUT. Five-year overall survival was 71.0% in Milan IN and 58.0% in Milan OUT, with a statistically significant difference. The 5-year disease-free survival (DFS) rate was 58.8% in Milan IN and 36.3% in Milan OUT; this difference was not statistically significant. Conclusions: In conclusion, strict adherence to Milan criteria and incorporation of modern prognostic factors are critical to optimize long-term survival in LT for NET. While the overall outcomes in this historical cohort are modest, future improvements are expected through more rigorous selection and the potential use of bridging or downstaging therapies.