*Purpose: Neuroendocrine tumor (NET) metastases are a major cause of morbidity and mortality. The role of liver transplantation to treat unresectable metastases from NET is controversial.

*Methods: We evaluated outcomes of all patients undergoing ‘isolated’ liver transplantation (LT) for metastatic NETs in the United States, from October 1988, through June 2018 using the UNOS dataset.

*Results: During the study period, 160,360 LTs were performed. Two-hundred and six adult patients underwent ‘isolated’ LT for metastatic NETs. The mean (SD) age was 48.2 (11.7) years, ranging from 19 to 75 years, 117 (56.8%) patients were male. Overall 1-, 3-, 5- and 10- year patient survival rates were 89.1%, 75.3%, 64.9% and 46.1%, respectively. Tumor recurrence was seen in 70 of 206 patients who underwent LT (34%). The median time to recurrence was 28 months (range, 1 to 192 months) and median wait time for LT was 112 days. Tumor recurrence was significantly higher in transplanted patients waiting less than 6 months compared to those waiting more than 6 months (74.3 % vs. 25.7%). Patients’ age ≤ 45 years had significantly better survival compared to those > 45 years (p=0.03). Younger patients with carcinoid tumors had better survival but this trend was not observed in the non-carcinoid group. On multivariable analysis, recipient age, donor age, cold ischemic time MELD score, tumor recurrence were significant predictors of poor patient survival.

*Conclusions: Waiting time longer than 6 months is associated to lower rates of tumor recurrence. Younger patients ≤ 45 years had significantly improved survival after LT for NET metastases.

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