Liver Transplantation for Pediatric Liver Cancer

Sindhi, Rakesh; Rohan, Vinayak; Tadros, Sameh; Goyet, Jean de Ville de; Rapkin, Louis; Ranganathan, Sarangarajan

doi:10.3390/cancers12030720

Cited by 27 publications

(40 citation statements)

References 91 publications

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“…Liver tumors are not very common in children 19,20 and in line with these results 88.4% children did not report a tumor. However, both hepatocellular carcinoma (1%) and hepatoblastoma (18.5%) were highest in group D (Table 1).…”

Section: Resultssupporting

confidence: 82%

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Jain

Anand

Lerret

et al. 2021

American Journal of Transplantation

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Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre‐, intra‐, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0‐<3, 3‐<6, 6‐<12 months, and 1‐<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5‐10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1‐3.9] and 16.7 [6.8‐29.7] mg/dL) and those <5 kg (2.6 [1.8‐3.4] and 13.5 [3.0‐28.4] mg/dL). A pediatric end ‐stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.

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Section: Resultssupporting

confidence: 82%

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Jain

Anand

Lerret

et al. 2021

American Journal of Transplantation

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“…It accounts for 1% of the pediatric malignancies [9] and it is usually diagnosed before the age of 3 years [8] . These type of liver tumors arise from pluripotent stem cells derived from hepatoblast which can differentiate mainly into epithelial and mesenchymal elements [10] . According to the component of the tumors, different subtypes are defined, each of them with different management and prognosis [10] .…”

Section: Discussionmentioning

confidence: 99%

“…These type of liver tumors arise from pluripotent stem cells derived from hepatoblast which can differentiate mainly into epithelial and mesenchymal elements [10] . According to the component of the tumors, different subtypes are defined, each of them with different management and prognosis [10] . The overall survival is 70%-80%, with 30%-60% of patients having unresectable tumors at presentation and 10%-20% metastatic disease, being the lungs the most common site [8] .…”

Section: Discussionmentioning

confidence: 99%

“…The best outcomes are associated with full surgical resection with negative margins, however, in extensive disease (with vascular invasion) the treatment remains controversial and patient specific [8] . Liver transplant is an alternative, however, the decision to proceed depends on the different institution's criteria of resectability, biologic aggressiveness of the tumor, metastatic disease, and response to chemotherapy [8 , 10] . In this case, the tumor was initially managed with chemotherapy, followed by resection.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic vein stenosis is a known complication after liver transplantation, being described in 2%-9% of pediatric patients [12] , [13] , [14] , [15] , [16] . The treatment with intraluminal balloon angioplasty is the modality most commonly used in late onset stenosis showing good results with primary patency rate of 56% at 60 months and excellent primary assisted and secondary patency rates [10] . Stent placement is not recommended as an initial approach as some patients may respond well to balloon angioplasty alone; in the pediatric patients the long-term patency is unpredictable (due to intimal hyperplasia) and in a growing child a stent with fixed diameter can be a determinant of stenosis; and as many patient will require retransplantation, a metal stent may pose a high technical challenge [12] , [13] , [14] .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient

Parra

Brandão

2020

Radiology Case Reports

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Drug-coated balloons (DCB) are a treatment alternative to conventional angioplasty in arterial, hemodialysis fistulas, and venous stenoses. This case report describes a child with the diagnosis of hepatoblastoma treated with chemotherapy and a right extended hepatectomy with venous reconstruction. The patient presented with signs and symptoms of portal hypertension due to a hepatic venous outflow obstruction secondary to stenosis of the surgical anastomosis. The response to conventional angioplasty was limited with frequent recurrence of symptoms. DCBs were used as an alternative prior to stent consideration aiming to assess if these devices could provide improvement of the symptoms and as a long-term therapy. The use of DCBs increased the time interval of reinterventions in comparison with conventional angioplasty. The patient eventually required stents due to recurrence of the primary disease. While this report does not provide an in-depth evaluation in terms of the efficacy and safety of DCB, this case illustrates a potential novel treatment modality to be considered for children, when stenotic venous lesions not amenable for stenting are present.

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Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults

Commander

Cerullo

Arjunji

et al. 2022

Intl Journal of Cancer

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Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children with a 5‐year overall survival of 30%. Few studies have examined the similarities and differences between pediatric and adult HCC. This article aims to examine the relationship between tumor characteristics, treatments and outcomes in pediatric and adult patients with HCC. The 2019 National Cancer Database was queried for patients with HCC. Patients were stratified by age: pediatric <21 years (n = 214) and young adults 21 to 40 (n = 1102). Descriptive statistics and chi square were performed. The mean age at diagnosis was 15.5 years (SD 5.6) in the pediatric and 33 years (5.3) in the adult group. Children had a comparable rate of metastasis (30% vs 28%, P = .47) and increased fibrolamellar histology (32% vs 9%). Surgical resection was more common in children compared to adults (74% vs 62%, P < .001), children also had more lymph nodes examined (39% vs 19%, P < .001), positive lymph nodes (35% vs 17%, P = .02) and surgical resection when metastasis were present at diagnosis (46% vs 18%, P < .001). The 1‐, 3‐ and 5‐year overall survival was higher for pediatric patients than adults (81%, 65%, 55%, vs 70%, 54%, 48%). Despite higher prevalence of fibrolamellar histology, greater number of positive lymph nodes and comparable rates of metastasis at diagnosis, children with HCC have improved overall survival compared to adults. Age did not significantly contribute to survivorship, so it is likely that the more aggressive surgical approach contributed to the improved overall survival in pediatric patients.

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Liver Transplantation for Pediatric Liver Cancer

Cited by 27 publications

References 91 publications

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient

Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults

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