Liver Transplantation for Pediatric Hepatoblastoma and Hepatocellular Carcinoma

Cheng, Elaine; Busuttil, Ronald W.

doi:10.1001/jamasurg.2015.1875

Cited by 4 publications

(3 citation statements)

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“…In patients with very early stage disease, resection has demonstrated a 5‐year overall survival of up to 80% . Liver transplantation, in contrast, offers the advantage of removing the field defect of concurrent underlying liver disease (if present) while eradicating the tumor and has demonstrated excellent long‐term survival and a cure rate of approximately 75%‐80% . In patients who present with unresectable and untransplantable disease, systemic chemotherapy is often administered with the goal of downstaging to resection or transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…defect of concurrent underlying liver disease (if present) while eradicating the tumor and has demonstrated excellent long-term survival and a cure rate of approximately 75%-80%. 10 In patients who present with unresectable and untransplantable disease, systemic chemotherapy is often administered with the goal of downstaging to resection or transplantation. However, systemic chemotherapy does not reliably achieve these goals, secondary to toxicity and limited efficacy.…”

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confidence: 99%

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Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Weiss

Sze

Rangaswami

et al. 2018

Pediatric Transplantation

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Children with unresectable HCC have a dismal prognosis and few approved treatment options. TACE is an effective treatment option for adults with HCC, but experience in children is very limited. Retrospective analysis was performed of 8 patients aged 4-17 years (4 male, mean 12.5 years) who underwent TACE for unresectable HCC. Response to TACE was evaluated by change in AFP, RECIST and tumor volume, PRETEXT, and transplantation eligibility by UCSF and Milan criteria. Post-procedure mean follow-up was 8.2 years. Mean overall change in tumor volume for the 8 patients was 51%. Percent change in AFP ranged from a decrease of 100% to an increase of 89.3%, with a mean change of -49.6%. Two patients did not undergo resection or transplantation and died of progressive disease. Six patients underwent orthotopic liver transplantation with mean first TACE-to-transplant interval of 141 days (range 11-514). Following transplantation, 5 patients were alive at the end of the follow-up period and one died of recurrent disease. Based on our initial experience, TACE for children with unresectable HCC appears to be a safe and effective method for managing hepatic tumor burden and for downstaging and bridging to liver transplantation.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Weiss

Sze

Rangaswami

et al. 2018

Pediatric Transplantation

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“…Compelling evidence shows that, in the setting of highly sensitized recipients, a co-transplanted liver can provide immunoprotection for kidney or cardiac grafts [ 13–15 ]. Several mechanisms have been hypothesized to explain the better outcomes associated with a co-transplanted liver [ 16 ]. The immunoprotective property of a co-transplanted liver on intestinal allografts has been described earlier [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection

Cruz

2017

Gastroenterology Report

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Background and aimsA co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx).MethodsBetween May 2000 and May 2010, 212 adult patients undergoing LITx (n =76) and LETx (n =136) were included. LITx underwent either liver combined intestinal or full multivisceral transplantation. LETx underwent either isolated intestinal or modified multivisceral transplantation.ResultsDuring 44.9 ± 31.4 months of follow-up, death-censored intestinal graft survival was significantly higher for LITx than LETx (96.9%, 93.2% and 89.9% vs 91.4%, 69.3% and 60.0% at 1, 3 and 5 years; p =0.0001). Incidence of graft loss due to rejection was higher in LETx than in LITx (30.9% vs 6.6%; p <0.0001), while infection was the leading cause of graft loss due to patient death in LITx (25.0% vs 5.1%; p <0.0001). Despite similar immunosuppression, the average number (0.87 vs 1.42, p =0.02) and severity of acute cellular rejection episode (severe grade: 7.9% vs 21.3%; p =0.01) were lower in LITx than in LETx. Incidence of acute antibody-mediated rejection was also significantly lower in LITx than in LETx (3.6% vs 15.2%; p =0.03). Incidence of chronic rejection was reduced in LITx (3.9% vs 24.3%; p =0.0002).ConclusionsIntestinal allografts with a liver component appear to decrease risk of rejection but increase risk of infection. Our findings emphasize that LITx has characteristic immunologic and clinical features. Lower immunosuppression may need to be considered for patients who undergo LITx to attenuate increased risk of infection.

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Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma

Amer

Manas

2019

European Journal of Surgical Oncology

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Liver Transplantation for Pediatric Hepatoblastoma and Hepatocellular Carcinoma

Cited by 4 publications

References 4 publications

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection

Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma

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