High survival rates after liver transplantation for hepatoblastoma and hepatocellular carcinoma

Abstract

Unresectable malignant liver tumors may be treated by LTx. We evaluated the results of LTx for HB and HCC. All patients transplanted for HB or HCC between 1990 and 2007 were included. Effects of histologic tumor type, primary tumor resection, disease staging, and serum AFP levels at diagnosis and at transplantation on disease recurrence and survival were evaluated. Twelve patients with median age of five (range, 2-16) were transplanted and followed for a median of 11 (2-18) yr. Six patients had HB and six had HCC. At diagnosis, eight patients were staged as PRETEXT III and four patients as PRETEXT IV. Two patients had pulmonary metastases. All patients received neoadjuvant chemotherapy. Median time from diagnosis to LTx was seven (2-133) months. At LTx, none of the patients had radiological evidence of extrahepatic disease, and the median AFP level was 85 (6-15 180) microg/L. No routine chemotherapy after LTx was used.The overall one-, five-, and 10-yr cumulative survival rates were 100%, 80%, and 67%, respectively. Survival was comparable between the two tumor types (4/6 for both). Two deaths occurred secondary to tumor recurrence, one of each tumor type. Both of these patients had an AFP response of <99%. Six of eight patients with primary LTx survived, when compared to two of four transplanted after primary resection. PRETEXT tumor staging had no effect on survival. LTx even without post-transplantation chemotherapy is an effective treatment option for unresectable HB and HCC with comparable survival. Incomplete AFP response to chemotherapy and primary tumor resection were associated with decreased survival.

Abdominal transplantation for unresectable tumors in children: the zooming out principle

“…LT is the only treatment option for unresectable tumors following chemotherapy. The reported 5-year survival rate post-primary LT for HB is 56-83 % [20][21][22][23][24][25]. Our series shows a calculated 5-year survival rate of 53.5 % for all transplantation techniques employed for HB including rescue transplant.…”

“…In our series, two patients with HB who presented with lung metastases were downstaged by neoadjuvant chemotherapy or metastasectomy. Patients with metastatic disease at diagnosis can still be considered for liver transplantation in cases of complete regression of these lesions after chemotherapy or surgical resection, while the primary tumor remains unresectable [17,21,23,25,27,29]. It has been emphasized that complete eradication of metastatic disease is a paramount prerequisite for transplantation [30].…”

Pediatric Liver Transplantation

“…Patient and graft survival for children undergoing LDLT is 100, 83.3, and 83.3 % at 1, 5, and 10 years, respectively. Two North American series of 25 (HCC, 10 cases; hepatoblastoma, 15 cases) and 12 patients (HCC, 6 cases; hepatoblastoma, 6 cases) reported similar medium-and long-term survival rates for both tumors [13,14]. Salvage transplantation for recurrent hepatoblastoma after conventional liver resection is less satisfactory with 5-year survival of 40 % with a high rate of further recurrence.…”

“…These strictures may occur anywhere in the biliary tree and if extensive inevitably lead to retransplantation. A recent report of 126 LT in 108 children identified biliary complications in 30 cases, including leak (14), stricture (14), necrosis (9), and biliary occlusion caused by a drain (1) [72]. Fifty-six percent of those with complications required surgery.…”

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

“…But, these consist of small, single-institution reviews. No study has compared survival after resection and liver transplantation for pediatric liver tumors while adjusting for patient and tumor specific factors [9][10][11][12][13]. In addition, the value of the Milan criteria, the criteria for selecting candidate of liver transplantation with HCC, has not been verified in the pediatric population undergoing liver transplantation [14][15][16].…”