Liver transplantation for hepatocellular carcinoma in children

We present our experience with living-donor liver transplantation in the treatment of nine children with hepatocellular carcinoma. Between January 2001 and March 2007, we performed 81 liver transplantations in 79 children at our center. Nine of the 79 children (11.3%; mean age, 9.7 +/- 5.5 yr; age range, 12 months-16 yr; male-to-female ratio, 2:1) underwent an living-donor liver transplantation because of hepatocellular carcinoma. Two of nine children received right lobe grafts, three received left lateral segment grafts, and the remaining four children received a left lobe graft. According to the TNM staging system, two children had stage 1 carcinoma, three had stage 2, and four had stage 4A(1). The mean follow-up was 19.8 +/- 10.6 months (range: 7-32 months). There has been only one tumor recurrence, which occurred in the omentum 26 months after liver transplantation. There was no evidence of recurrence or AFP elevation in the other eight children. Both graft and patient survival rates are 100%. In conclusion, liver transplantation is a life-saving procedure for children with chronic liver disease with accompanying hepatocellular carcinoma. During follow-up of patients with chronic liver disease, serial AFP screening and combined radiologic imaging studies should be mandatory.