Retrospective analysis of liver transplantation eligibility based on the Milan criteria in GEP NETs

Dr Manon Verhé, fellow in gastroenterology at UZ Leuven discussed the results of a single-centre retrospective study evaluating liver transplantation (LT) eligibility in 153 patients with liver metastases drawn from a cohort of 699 GEP-NET cases diagnosed between 2012 and 2024. Eligibility was assessed in two steps: initial screening using three Milan criteria (age ≤65 years, Ki-67 index <10%, and absence of extrahepatic disease), followed by full criteria evaluation. Additionally, the study assessed missed opportunities for LT by identifying patients who had at least one year of stable disease and fulfilled Milan criteria but were not considered for transplantation.

Initial screening identified 5.2% (8/153) of patients as potentially eligible; however, only 2% (3/153) met the full Milan criteria. Two patients underwent LT, and one remains under evaluation. The most frequent exclusion criterion was extrahepatic disease (90.3%), followed by age >65 years (53.5%) and Ki-67 index >10% (22.2%). These findings underscore that only a small subset of GEP-NET patients are LT candidates under current criteria, with extrahepatic disease as the principal limiting factor. Comprehensive imaging and multidisciplinary assessment remain essential in the LT evaluation process.