J Pediatr Surg 1996 Jun;31(6):835-9

Results of liver transplantation in children with unresectable liver tumors.

Superina R, Bilik R

Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract
Liver cancer is an uncommon indication for liver transplantation in children.
Between 1986 and 1995, five children with hepatocellular cancer (HCC), three
with hepatoblastoma (HEP), and one with sarcoma were referred to the transplant
service. All nine tumors were considered unresectable. Four of the five children
with HCC had underlying predisposing conditions (2 hepatitis B, 1 biliary
atresia, 1 tyrosinemia). Preoperative evaluation of all patients included
careful radiological screening and pretransplantation laparotomy for staging.
Two patients with HCC were excluded from further consideration because of
intraabdominal spread. Three patients had transplantation (mean age, 6.0 +/- 7.1
years), and all have survived for 1 to 5 years with no evidence of recurrence.
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 preoperative 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 recurrence within 2 months of transplantation. In summary, liver
transplantation should be considered for all children who have unresectable
hepatic malignancies, given the 83% survival rate and no evidence of tumor
recurrence. Stage 4 disease in HEP does not necessarily exclude patients from
transplantation. Early referral is encouraged so that tumor spread beyond the
liver is minimized