J Pediatr 2000 Jun;136(6):795-804

Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular
cancer in childhood and adolescence

Reyes JD, Carr B, Dvorchik I, Kocoshis S, Jaffe R, Gerber D, Mazariegos GV,
Bueno J, Selby R

University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA, USA

Abstract
OBJECTIVE: To describe our experience with total hepatectomy and liver
transplantation as treatment for primary hepatoblastoma (HBL) and hepatocellular
carcinoma (HCC) in children. STUDY DESIGN: A retrospective analysis of the
perioperative course of 31 children with unresectable primary HBL (n = 12) and
HCC (n = 19) who underwent transplantation between May 1989 and December 1998.
Systemic (n = 18) and intraarterial (n = 7) neoadjuvant chemotherapy were
administered; follow-up ranged from 1 to 185 months. RESULTS: For HBL, 1-year,
3-year, and 5-year posttransplantation survival rates were 92%, 92%, and 83%,
respectively. Intravenous invasion, positive hilar lymph nodes, and contiguous
spread did not have a significant adverse effect on outcome; distant metastasis
was responsible for 2 deaths. Intraarterial chemotherapy was effective in all
patients treated. For HCC, the overall 1-year, 3-year, and 5-year disease-free
survival rates were 79%, 68%, and 63%, respectively. Vascular invasion, distant
metastases, lymph node involvement, tumor size, and gender were significant risk
factors for recurrence. Intraarterial chemotherapy was effective in 1 of 3
patients. Six patients died of recurrent HCC, and 3 deaths were unrelated to
recurrent tumor. CONCLUSION: Liver transplantation for unresectable HBL and HCC
can be curative. Risk factors for recurrence were significant only for HCC, with
more advanced stages amenable to cure in the HBL group