Dismal survival following liver transplantation for liver-only metastases in patients with ocular malignant melanoma

Metastases from ocular malignant melanoma spread to the liver in 80-90% of the cases. The only life prolonging modality in metastatic disease is liver resection, with overall survival ranging from 20-41% after five years. The aim of the study was to determine if patients with liver only metastases may obtain long survival after liver transplantation. Two patients with ocular malignant melanoma received liver transplantation. Patient 1 had a large tumor load, the largest tumor measuring 160mm, and multiple smaller lesions, histology showed breach of the liver capsule and occluding thrombosis in the portal vein. Recurrence occurred after 5.6 months and she died of disseminated disease 8.2 months post-transplantation. Patient 2 had a total of 3 lesions, and largest lesion was 15mm at histological examination. Liver recurrence occurred at 14.7 months and she died 26.6 months post-transplantation. These two patients with liver only metastatic disease on CT, MRI and PET/CT scan had short disease-free survival, short survival from time of relapse as well as from time of transplantation. The results obtained from this pilot study do not justify further exploration of liver transplantation for patients with ocular malignant melanoma confined to the liver based on tumor size and numbers.