Pediatric liver transplantation for hepatoblastoma: a single center experience

The objective of this study was to review our experience with liver transplantation (OLT) for hepatoblastoma (HB) patients. We evaluated retrospectively clinical features of seven pediatric patients with HB who underwent OLT at our institute from 2007 to February 2011. We investigated pretreatment extent of disease (PRETEXT) stage at diagnosis, type of procedure, complications, changes in serum alpha-fetoprotein (AFP) level, recurrences and metastases. The median age at surgery was 47 months (range, 11 months to 10.3 years). OLT was performed for PRETEXT stage III with a central location (n=2) and for PRETEXT stage IV cases (n=5). Five children underwent live donor OLT (LDLT) and two deceased donor OLT including one split deceased donor OLT. One patient received a hepatic vein stent insertion due to stenosis and another experienced biliary leakage which was treated with percutaneous drainage and conservative management. Postoperative serum AFP level remained below 20 ng/mL during follow-up period in six patients who were free of recurrences or metastases. Postoperative serum AFP levels in one patient with pulmonary metastasis were never below 20 ng/mL and increased gradually thereafter. A Pulmonary metastasis was discovered in the 2nd month post-operative. The other 6 patients are free of tumor recurrences with 29.9 month median follow-up. Although the number of cases is small without long term follow-up data, OLT for unresectable HB confined to the liver following chemotherapy seemed to show good clinical results. The role of post transplantation serum AFP levels needs further investigation.