Controversies in NEN: An ENETS position statement on the role of Liver Transplantation (LT) in patients with advanced small‑intestinal and pancreatic NETs

Liver transplantation (LT) may offer survival or symptomatic benefit for highly selected patients with advanced, well-differentiated small-intestinal or pancreatic neuroendocrine tumours and unresectable liver-dominant metastases. However, its role remains controversial, as LT is rarely curative, recurrence is common, and benefits must be weighed against perioperative risk, lifelong immunosuppression, alternative therapies, and organ allocation ethics. This ENETS position statement summarises current evidence and expert consensus, reframing LT within a transplant-benefit model rather than fixed eligibility criteria. It outlines biologically informed selection principles and multidisciplinary assessment, as well as addressing the need for standardised characterisation, prospective registries, and long-term outcome data to better define the net clinical benefit of LT in this rare patient population.