Results of liver transplantation in children with unresectable liver tumors

Survival after liver transplantation for hepatoblastoma: a 2-center experience

“…Metastases from hepatoblastoma appear to be an exception to this rule because of their sensitivity to chemotherapy. There are various reports of patients with pulmonary metastases at the time of diagnosis that had resolved by the time of transplantation and who had a successful long-term outcome [4,7,12,14,21]. In our series, only 2 patients had pulmonary metastases at the time of diagnosis, and 1 survived after a local resection followed by chemotherapy.…”

“…This includes tumors that extend into all 4 hepatic sectors, those with hilar involvement of the portal vein, hepatic venous involvement of all 3 hepatic veins, and tumors that recur after a prior resection [10]. Since the first description of Starzl et al [11] regarding transplantation for an unresectable hepatic tumor in a child in 1968, the posttransplantation survival rates for pediatric malignant liver disease have improved from 30% to 50% to the current survival of 60% to 92% [5,7,9,[12][13][14]. This improvement in survival is because of advances in immunosuppression, more sophisticated surgical techniques, and more effective chemotherapy.…”

Association between surgical margins and long-term outcome in advanced hepatoblastoma

“…Although studies are producing promising results, they have stressed the importance of careful patient selection, concerns with long-term immunosuppression in patients with malignant disease (both intraand extrahepatic), and concerns over secondary tumor induction with immunosuppression. [14][15][16][17] As long-term follow-up becomes available, the role of OLT in the management of unresectable hepatoblastoma is almost certain to become a treatment option in carefully selected patients. 19 The goal of hepatic tumor resection in general is to completely excise the tumor with at least a 1 cm margin while preserving as much viable liver as possible.…”

Childhood Cancers: Hepatoblastoma

“…Distant metastasis was responsible for the two deaths. Patients with metastatic disease at diagnosis that resolves with chemotherapy or can be removed surgically can be considered transplant candidates [51].…”