Pediatric liver transplantation for primary hepatocellular carcinoma associated with hepatitis virus infection

Abstract

We report two cases of early primary hepatocellular carcinoma (PHC) in children, after probable maternal transmission of hepatitis B, that were treated with orthotopic liver transplantation (OLT). Both children were 8.5 years old and had elevated levels of serum alpha-feto-protein. The diagnosis of PHC was made at 8 years and confirmed histologically. Serum hepatitis B surface antigen (HBs Ag) was detected in the mothers and suggested vertical transmission. An attempt at complete liver tumor resection failed, leading to OLT. In order to prevent recurrence of the hepatitis B virus (HBV) infection, hepatitis B immunoprophylaxis was used. Two years after OLT, one child presented with recurrent HBV infection. No tumor recurrence was observed at follow-up in either of the patients. From these two cases we conclude that (1) HBV infection may play an important causal role in PHC in children, with an even shorter incubation period than that in adults; (2) close follow-up is needed for children who are HBs Ag-positive carriers; and (3) liver transplantation should be proposed early after the diagnosis of PHC, when tumor resection is not feasible.

Viral Hepatitis Necessitating Liver Transplantation in Children

“…91 The median age of tumor occurrence was between age of 6 and 10 y. 90,91 Average survival after diagnosis of HCC is <5 mo. 90,91 An analysis of 25 pediatric LTs for HCC over 33 y (1981-2014) at the Children's Hospital of Pittsburgh, only 2 were found with the background of HBV infection.…”

“…90,91 Average survival after diagnosis of HCC is <5 mo. 90,91 An analysis of 25 pediatric LTs for HCC over 33 y (1981-2014) at the Children's Hospital of Pittsburgh, only 2 were found with the background of HBV infection. Both children had microvascular invasion in the explant liver and both died because of recurrence of HCC.…”

“…90 Historically, it was reported that HCC developed in 70%–90% after perinatal transmission from HBsAg-positive mothers. 91 The median age of tumor occurrence was between age of 6 and 10 y. 90,91 Average survival after diagnosis of HCC is <5 mo.…”

“…91 The median age of tumor occurrence was between age of 6 and 10 y. 90,91 Average survival after diagnosis of HCC is <5 mo. 90,91…”

The Role of Liver Transplantation in the Management of Paediatric Liver Tumours

“…42 Recent results of liver transplantation for hepatocellular carcinoma in children are shown in Table 2. 24,32,36,[43][44][45][46][47][48] One of the largest series 24 was an update of a previous report from Pittsburgh. 49 In this report, 14 of 19 children with hepatocellular carcinoma had underlying chronic liver disease (tyrosinaemia, progressive familial intrahepatic cholestasis, hepatitis B, etc.).…”