Living‐Donor Liver Transplantation for Hepatoblastoma

Abstract

Hepatoblastoma is the most common malignant liver tumor in children. Recently, liver transplantation has been indicated for unresectable hepatoblastoma. We retrospectively reviewed 14 children with a diagnosis of hepatoblastoma who had undergone living-donor liver transplantation (LDLT) at Kyoto University Hospital. During the period from June 1990 to December 2004, 607 children underwent LDLT. Of these interventions, 2.3% were performed for hepatoblastoma. Based on radiological findings, the pre-treatment extent of disease (PRETEXT) grouping was used for pretreatment staging of the tumor. There were grade III in seven patients and grade IV in seven patients. Thirteen patients received chemotherapy, and seven underwent hepatectomy 11 times. Immunosuppressive treatment consisted of tacrolimus monotherapy in 11 patients. Actuarial 1-and 5-year graft and patient survival rates were 78.6% and 65.5%. The poor prognostic factors were macroscopic venous invasion and extrahepatic involvement with 1-year and 5-year survival rates of 33.0% and 0%. Pediatric patients without these factors showed an acceptable 5-year survival rate of 90.9%. LDLT provides a valuable alternative with excellent results in children with hepatoblastoma because it allows optimal timing of the liver transplantation, given the absence of delay between the completion of chemotherapy and planned liver transplantation.

Changing treatment and outcome of children with hepatoblastoma: analysis of a single center experience over the last 20 years

“…Total hepatectomy and LTx allow children with unresectable HBL to achieve comparable survival [3,[5][6][7]17,18,[22][23][24][25][26]. The comparison between patients treated with partial liver resection and patients with primary LTx in our center showed that survival rates in both groups are similar (71% vs 80%), but one must acknowledge that patients in both groups are not clinically comparable.…”

“…In patients with borderline resectability, histopathologic subtype should be defined, and other factors such as AFP concentration and response to the initial 2 courses of chemotherapy on computed tomographic imaging may affect the decision for the selection of the surgical procedure. There is no doubt, however, that for children with PRETEXT IV HBL and no extrahepatic disease, total hepatectomy and LTx are the best options, with good prognosis in about 70% to 80% of children [2,[5][6][7]17,18,22,26]. The most problematic group of patients is a group of children with PRETEXT stage III tumors (2 nonadjoining sections free or just 1 section free; in the latter case, 3 sections are involved).…”

“…At present, the small number of pediatric patients undergoing transplantation for malignant hepatic tumors does not allow us to standardize qualifications for LTx and pretransplant and posttransplant therapy [6,[16][17][18]23,26]. The Pediatric Liver Unresectable Tumor Observatory was established as a common registry supported by SIOPEL (Societe Internationale d'Oncology Pediatrique), IPTA (International Pediatric Transplant Association), COG (Children's Oncology Group), GPOG (German Pediatric Oncology Group), and other organizations to help answer some of these questions in the future (http://pluto.cineca.org/).…”

Liver transplantation for hepatoblastoma

“…Caval replacement is often required for complete clearance and can be achieved by the use of donor iliac vein interpositional grafts. [24][25][26][27] The use of grafts from living donors offers some potential advantages over cadaveric donation, including shorter waiting time, better graft quality, more rapid recovery, and improved timing of transplant to comply with chemotherapy regimes.…”

Safety of minimal immunosuppression in liver transplantation for hepatoblastoma

“…Major multicenter studies by International Society of Pediatric Oncology and German Cooperative Pediatric Liver Tumor Study, such as SIOPEL-1 and HB 94, did not control for differing immunosuppression regimens being used by their participating centers [4,6]. Most single center series by major pediatric liver transplantation centers report their immunosuppression regimen but did not comment on the effect of immunosuppression on their outcomes [11][12][13][14][15][16][17].…”