Introduction: Neuroendocrine tumors (NET) comprise a heterogeneous group of rare neoplasms. Liver metastatic or primer hepatic NETs are amenable to various therapeutic modalities including liver transplantation (LT).

Case Report: 45 years old woman, from another country, suffers from dyspepsia, weight loss and early satiety. She underwent blood analysis, it revealed, gamaglutamyl transferase and alkaline phosphatase as high as 1172 and 369 respectively. She was cachectic and gross hepatomegaly detected in physical examination. Computerized tomography of the abdomen revealed 12x18cm in right and 8x6cm tumor in the left liver lobe. Intrahepatic bile ducts were dilated and there was moderate amount of ascites in the abdomen. The tumor had been accepted as unresectable from another center. She admitted to our center. Liver biopsy was performed and sample was consisted with NET type I, Ki67 1%. Histology revealed trabeculated pattern coexisting PGP 9.5 cytokeratin-19 and CD56 positivity and chromografin low positivity. Also CEA, HCC, Insulin, Gastrin, TTF-1 and CDX-2 staining were negative. The pathology yielded primary liver NET or metastasis of pancreatic NET. PET CT was performed and no tumor other than liver was founded. Endoscopic ultrasound (EUS) was performed, but did not find any pathology. We considered her for living donor liver transplantation based on unresectable primer liver NET, no extrahepatic disease and well-differentiated tumor (Ki67 < 10%) reasons. After her older brother was prepared for living donor liver transplantation, right lob liver transplantation was succesfully performed. Liver specimen revealed same with the pre-surgical biopsy. No lymph node metastasis was found in the hilum of the liver. She has been doing very well free of metastasis 4 years after surgery. Conclusion: The use of LT for NET is controversial. As organs are in short supply, it is important to select patients who are most likely to benefit from this demanding procedure. Beyond the consensual criteria, i.e., it has been shown that the use of stringent criteria to select patients for LT could achieve spectacular overall and disease-free survival rates.