Liver transplantation in children with hepatocellular carcinoma Do Milan criteria apply to pediatric patients?

Abstract

HCC constitutes 25-30% of primary malignant liver tumors in children. Conventional surgical excision is not possible in more than 50% of patients. LTx has recently become an important therapeutic option for adults and children with primary liver tumors. The aim of this study was a retrospective analysis of the clinical and pathological data of children with HCC treated with LTx in relation to Milan criteria assessed at diagnosis and then immediately before transplantation, in comparison with a group of patients treated conventionally. Between 1990 and 2007 we have treated 21 children diagnosed with HCC. Patients were divided into two groups: group I, 10 children treated conventionally and group II, 11 children treated with LTx regardless of previous therapy. The outcome of our patients treated conventionally with resection and chemotherapy is very poor--the disease-free survival rate is 30%. In contrast, despite that only 3 children having fulfilled adult Milan criteria, early clinical results of LTx are much superior. Total hepatectomy followed by LTx is the main treatment option for the majority of children with HCC. Decisions on the type of surgical treatment is made individually, but very early in the course of treatment.

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

“…Individual case-control study C NA -4 [89][90][91][92] Case series (and poor-quality prognostic cohort studies) C 4/125 5 (3-6) 5 [93][94][95][96][97][98] Expert opinion without an explicit critical appraisal, bench research, or first principles D 6/NA NA NOTE: n/n: number of studies/number of patients. NA: not available.…”

A Single Center Experience of Management of Hepatocellular Carcinoma in Children and Adolescents

“…In the study by Ismail et al [17], 8 of 11 liver transplantation cases had large and/or multifocal tumors and some cases also had angioinvasion and local extrahepatic extension. However, the survival rate in this study was 72%, which is better than that of conventional liver resection for HCC in the study by Ismail et al [17]. However, good results of liver transplantation despite exceeding Milan criteria in children should be confirmed by analysis of a much larger group, which is possible only by multicenter cooperative studies.…”

“…Also, some studies protest that liver transplantation in pediatric HCC is a good option for treatment even in outside-Milan cases [17][18][19][20]. In the study by Ismail et al [17], 8 of 11 liver transplantation cases had large and/or multifocal tumors and some cases also had angioinvasion and local extrahepatic extension. However, the survival rate in this study was 72%, which is better than that of conventional liver resection for HCC in the study by Ismail et al [17].…”

“…should be screened with α-FP and by imaging techniques to detect tumor at an early stage. Early detection makes earlier liver transplantation possible without the need for chemotherapy [17].…”

Gastrointestinal, Pancreatic and Hepatic Malignancies in Children

“…When given preoperative chemotherapy, 30-50 % show some response [ 78 ]. Other strategies to treat HCC, such as radiofrequency ablation, transarterial chemoembolization and Yttrium-90 radioembolization, are limited in pediatric hospitals.…”