Unresectable GIST liver metastases and liver transplantation: A review and theoretical basis for a new indication

Background Liver metastases from gastrointestinal stromal tumors (GIST) can be found synchronously to a primary tumor and in the medium/long term after resection of a high-risk GIST. In these cases, treatment with tyrosine kinase inhibitors like imatinib has provided good results, but drug resistance is common after two years of treatment. Liver resection of potentially resectable metastases can improve the results of medical treatment. In cases of unresectability, the role of liver transplantation (LT) has not been well-studied. Materials and methods A review of the literature was undertaken from January 1995 to December 2020 following the PRISMA and AMSTAR guidelines. Results Fifteen cases were identified. In eight cases, the LT was carried out before 2002. Mutational status was only studied in seven cases. LT was performed in 12 cases with a deceased donor and in three cases with a living donor. After a mean follow-up of 52.4 months, overall survival was 86.6% with disease-free survival of 53.3% Conclusion LT in the management of unresectable GIST metastases has rarely been performed. Although its application has a solid theoretical basis, its use understood as a radical extension of a standard resection can only be recommended within prospective studies by groups with considerable experience in both GIST and transplantation care. Highlights Transplant Oncology is evolving as an emerging speciality as part of surgical oncology. LT for unresectable GIST-LM has been carried out anecdotically. Liver transplantation for unresectable GIST liver metastases could be an option in the spectrum of therapeutic indications. Prospective randomised studies are necessary to provide the evidence needed.