[Liver transplatation for malignant tumors in children]

Area of Science:

• Pediatric oncology
• Hepatobiliary surgery
• Transplant immunology

Context:

• Unresectable malignant liver tumors in children present significant therapeutic challenges.
• Liver transplantation (LTX) is an evolving treatment option for these complex cases.
• Standard chemotherapy and surgical resections have limitations for advanced disease stages.

Purpose:

• To analyze the outcomes of liver transplantation (LTX) in pediatric patients with unresectable malignant liver tumors.
• To evaluate the efficacy of LTX as a primary treatment versus rescue therapy.
• To identify risk factors influencing adverse outcomes after LTX for liver tumors.

Summary:

• This study reports on 12 pediatric patients (6 months-14 years) with hepatoblastoma or fibrolamellar hepatocellular carcinoma undergoing LTX.
• LTX was performed as primary treatment in 10 patients and as rescue therapy in 2.
• Overall survival rates were 91% at 1 year, decreasing to 82% by 14 years, with primary LTX demonstrating superior survival (90%) compared to rescue LTX (50%).
• Tumoral tissue persistence was identified as the sole risk factor for adverse evolution.

Impact:

• Liver transplantation is a feasible therapeutic approach for unresectable malignant liver tumors in children.
• Primary LTX yields better results than rescue LTX, with outcomes comparable to resectable tumors.
• Accurate staging and referral to specialized centers optimize LTX results in pediatric liver cancer.
• Live-related donor transplantation offers a valuable alternative to mitigate waiting list delays.