Effects of transplantation-related immunosuppression on co-existent neuroendocrine tumours

摘要

Background Here we detail our experience of managing patients found to have a neuroendocrine neoplasm (NEN) whilst on immunosuppression for a transplanted organ. Aim We aimed to quantify the behaviour of NENs under solid-organ transplant-related immunosuppression. Design This was an observational, retrospective case series. Methods Ten patients were identified from a prospectively kept database. Three were excluded. Results Four patients received a liver, two a kidney, and one a heart transplant. All but one received calcineurin-based immunosuppression. NENs were found in five patients post-transplant: one had surgery for transverse colonic neuroendocrine carcinoma NEC (pT4N1M0, Ki67 60), was cancer-free after four years; one had cold biopsy of duodenal NEN (pT1N0M0, Ki67 2), cancer-free at four months; one 7 mm pancreatic NEN (pT1N0M0), untreated and stable for seven years; one small-bowel NEN with mesenteric metastasis (pTxNxM1), alive four years after diagnosis; and one untreated small-bowel NEN with mesenteric metastasis, stable at 1 year after liver transplantation. Two NENs were discovered pre-transplant, one pancreatic NEN (pT1N0M0, Ki67 5), remains untreated and stable at three years. One gastric NEN (type 3, pT1bN0M0, Ki67 2) remains stable without treatment for two years. Conclusions NENs demonstrate indolent behaviour in the presence of transplant-related immunosuppression.