UKINETS2021 Poster Presentations Abstracts (12 abstracts)
Setting up of a national liver transplant programme for neuroendocrine tumour liver metastases in UK and Ireland: opportunities for clinical study and research
Tahir Shah 1 , Joanna Moore 2 , Hema Venkataraman 1 , Martyn Caplin 3 , Stacey Smith 1 , Dermot O’Toole 4 , Emir Hoti 5 , Bobby Dasari 1 , Samuel Ford 1 , Vincenzo Mazzaferro 6 , Paul Gibbs 7 , Derek Manas 8 , John Isaac 1 & Douglas Thorburn 3
1Queen Elizabeth Hospital, Birmingham, United Kingdom; 2St James’s Hospital, Leeds, United Kingdom;3Royal Free Hospital, London, United Kingdom;4St James’s Hospital, Dublin, Ireland;5St Vincent’s University Hospital, Dublin, Ireland;6Istituto dei Tumori, Milan, Italy;7Addenbrooke’s Hospital, Cambridge, United Kingdom;8The Freeman Hospital, Newcastle, United Kingdom
Background: Transplantation for cancer indications is evolving rapidly in UK and Ireland. Liver transplantation [LT] for unresectable neuroendocrine tumour liver metastases [NET LM] is one of three new cancer indications. It has the potential to significantly improve survival outcomes however, transplant benefit has likely been achieved only by highly experienced Centre(s). Since eligible patients for transplantation also have excellent prognosis with standard management, careful patient selection [Table 1] and meticulous management is required to prevent harm.
Aims: To achieve enhanced overall survival and deliver an equitable and safe service. To develop national infrastructure and expertise for NET LT; promote scientific collaborations and clinical studies/trials; ultimately deliver a randomised clinical trial of transplantation v standard care.
Progress: Framework, infrastructure and manpower
• Documentation completed – patient information sheet, programme manual, patient pathway document, referral proformer, data fields.
• Core National MDT formed and participants from liver transplant / NET Centres identified.
• Infrastructure arranged – MDT room and IT support for combined physical/virtual participation.
• Administrative support arranged – MDT co-ordinator, NET CNS, liver transplant co-ordinator, data manager.
Monthly MDT commenced 27/08/2021; 2 meetings held to date and 4 patients discussed – 2 suitable for commencing liver transplant pathway. 2 deemed not suitable due to unresectable primaries. tems for further development identified – checklist of essential points for discussion, formal patient presentation document containing opinions of relevant specialists.
| Pilot phase | 1 [0-10 liver transplants] | 2 [11-50 liver transplants] |
| Histology | G1/G2 WD NET | G1/G2 WD NET |
| Primary site | GEP | GEP + Other |
| Primary and associated lymphadenopathy | Completely resected before liver transplant surgery | Can be left in-situ if small volume and stable |
| Liver metastatic burden | <50% by volume | < or > 50% by volume |
| Disease stability | Stable disease/response to therapies for at least 6 months prior to transplant consideration | Stable disease/response to therapies for at least 6 months prior to transplant consideration |
| Patient age | < 60 (relative criteria) | < 60 (relative criteria) |
Conclusion: National programme of LT for NET LM has commenced. There is a need for dissemination of eligibility criteria to all NET specialists in order to make the programme equitable and fair.
Volume 80
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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