RESULTS OF LIVER-TRANSPLANTATION IN CHILDREN WITH UNRESECTABLE LIVER-TUMORS

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