Cas CliniqueTransplantation hépatique pour métastases d'une tumeur carcinoïdeLiver transplantation for metastasis of a carcinoid tumor

A 30-year-old woman underwent a liver transplantation for metastasis of a carcinoid tumor of the midgut previously resected. Operative manipulation of the liver resulted in arterial hypotension, tachycardia, high pulmonary arterial pressure, oedema of the face and peripheral cyanosis, although the patient was given somatostatin (Modustatine ®, Clin-Midy) (300 μg a hour) prior to the procedure. The improvement of the symptoms was obtained by the increase of somatostatin infusion rate to 750 μg a hour associated with dopamine (6 μg · kg−1 · min−1) and fluid replacement. The diagnosis of carcinoid syndrom is discussed. This unusual observation stresses the difficulty in preventing and/or treating a carcinoid shock. If somatostatin seems to be the treatment of choice of such a syndrom, its role in that case was limited.