Liver Transplantation for Pediatric Hepatocellular Carcinoma: A Systematic Review

Abstract

Liver transplantation (LT) is the only potentially curative option for children with unresectable hepatocellular carcinoma (HCC). We performed a systematic review of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases (end-of-search date: 31 July 2020). Our outcomes were overall survival (OS) and disease-free survival (DFS). We evaluated the effect of clinically relevant variables on outcomes using the Kaplan–Meier method and log-rank test. Sixty-seven studies reporting on 245 children undergoing LT for HCC were included. DFS data were available for 150 patients and the 1-, 3-, and 5-year DFS rates were 92.3%, 89.1%, and 84.5%, respectively. Sixty of the two hundred and thirty-eight patients (25.2%) died over a mean follow up of 46.8 ± 47.4 months. OS data were available for 222 patients and the 1-, 3-, and 5-year OS rates were 87.9%, 78.8%, and 74.3%, respectively. Although no difference was observed between children transplanted within vs. beyond Milan criteria (p = 0.15), superior OS was observed in children transplanted within vs. beyond UCSF criteria (p = 0.02). LT can yield favorable outcomes for pediatric HCC beyond Milan but not beyond UCSF criteria. Further research is required to determine appropriate LT selection criteria for pediatric HCC.

Risk for Recurrence in Long-Term Follow-Up of Children after Liver Transplantation for Hepatoblastoma or Hepatocellular Carcinoma

“…We evaluated the impact of a number of different risk factors on recurrence-free survival after LT in patients with HB and HCC. In this analysis, we used the risk factors for potential poor outcomes often discussed in the literature [1,[6][7][8][9]. Our analysis included rescue LT, PRETEXT IV, metastases at diagnosis, tumor multifocality, tumor rupture, extrahepatic disease (defined as the presence of metastases after partial liver resection, presence of extrahepatic extension or lymph node metastases found during LT, or a positive margin after total hepatectomy), presence of angioinvasion, and unfavorable histology of tumors (macrotrabecular and small-cell undifferentiated pattern for HB, and fibrolamellar for HCC).…”

“…In the pediatric population, hepatoblastoma (HB) is the most common primary malignant liver tumor, followed by hepatocellular carcinoma (HCC) [1]. Treatment of these tumors remains a significant clinical challenge.…”

“…In patients with unresectable tumors, total hepatectomy during liver transplantation (LT) allows for complete surgical resection and improved survival of children with HB and HCC [4]. LT improves the survival of patients with HCC and underlying liver diseases [5], while living donor LT (LDLT) has been shown to offer better survival outcomes than deceased donor LT [1].…”

Liver cirrhosis in children – the role of imaging in the diagnostic pathway

“…CT is faster than MRI, has excellent spatial resolution and has advantages in depicting vascular anatomy before surgery and before liver transplantation [ 115 ]. If surgical resection of HCC is not possible, liver transplantation has been shown to be a curative option, with a 5-year disease-free survival of 84.5% [ 116 ].…”

Comparison of surgical resection and radiofrequency ablation for stages I and II elderly hepatocellular carcinoma patients (≥ 65 years): A SEER population-based propensity score matching’s study

“…Tumor stage is the strongest prognostic indicator in HCC patients, with curative treatments only available for patients with early stage HCC. Patients who satisfy the Milan criteria ( 2 ) (single lesion less than 5 cm) are optimal candidates for liver transplantation (LT), but high costs, donor shortage, and lifelong immunosuppression often limits LT ( 3 ), and surgery resection (SR) is still the first-line treatment for primary HCC. However, less than 20% of HCC patients receive radical SR. For HCC patients who are unsuitable for SR or LT, the best choice is radiofrequency ablation (RFA) ( 4 ), but many studies have revealed that RFA is only comparable with hepatic resection in terms of long-term survival for HCC patients with single lesion less than 3cm ( 5 – 7 ).…”