Liver transplantation for pediatric liver malignancies

Abstract

In the last few decades, collaboration between the international pediatric oncology groups has resulted in significant improvement in survival after liver transplantation (LT) for pediatric liver tumors, and LT has become the accepted standard of care for unresectable pediatric liver tumors – either living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT). Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the common pediatric liver malignancies treated by LT, and LT is now the accepted treatment modality for unresectable non-metastatic cases. The long-term survival rate is more than 80% in HB transplants. Furthermore, with the advent of LDLT, the waitlist mortality, availability of a better graft quality with shorter ischemic times, and performance of LT with the appropriate timing between chemotherapy have all improved. Up to 80% of pediatric HCCs are unresectable, and studies have shown that LT for pediatric HCC has better outcomes than liver resection. Furthermore, LT has also shown better results than liver resection for cases of HCC not meeting Milan criteria. Given the rarity of pediatric liver malignancies and challenges in optimal management, a multidisciplinary treatment approach, research models building on what is already known, and consideration of newer treatment modalities are required for further improving the treatment of pediatric liver malignancies.