R. Superina et R. Bilik, RESULTS OF LIVER-TRANSPLANTATION IN CHILDREN WITH UNRESECTABLE LIVER-TUMORS, Journal of pediatric surgery, 31(6), 1996, pp. 835-839
Liver cancer is an uncommon indication for liver trans plantation in c
hildren. Between 1986 and 1995, five children with hepatocellular canc
er (HCC), three with hepatoblastoma (HEP), and one with sarcoma were r
eferred to the transplant service. All nine tumors were considered unr
esectable. Four of the five children with HCC had underlying predispos
ing conditions (2 hepatitis B, 1 biliary atresia, 1 tyrosinemia). Preo
perative evaluation of all patients included careful radiological scre
ening and pretransplantation laparotomy for staging. Two patients with
HCC were excluded from further consideration because of intraabdomina
l spread. Three patients had transplantation (mean age, 6.0 +/- 7.1 ye
ars), and all have survived for 1 to 5 years with no evidence of recur
rence. Three patients with HEP were assessed (mean age 2.0 +/- 1 years
); two had stage 4 disease and one had stage 3. All three received pre
operative chemotherapy. The two with stage 4 had thoracotomies as part
of their assessment. Two of three patients had a significant decrease
in the size of the primary tumor during the waiting period. These two
patients and one with stage 4 disease have survived more than 2 years
since transplantation, with no recurrence. The third patient had recu
rrence within 2 months of transplantation. In summary, liver transplan
tation should be considered for all children who have unresectable hep
atic malignancies, given the 83% survival rate and no evidence of tumo
r recurrence. Stage 4 disease in HEP does not necessarily exclude pati
ents from transplantation. Early referral is encouraged so that tumor
spread beyond the liver is minimized. Copyright (C) 1996 by W.B. Saund
ers Company