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Updated: Aug 9, 2025
The Influence of Liver Resection on Intrahepatic Tumor Growth
Published on: April 9, 2016
Long-Term Outcome Following Liver Transplantation for Primary Hepatic Tumors-A Single Centre Observational Study over
Christoph Leiskau1,2, Norman Junge2, Frauke E Mutschler2
1Pediatric Gastroenterology, Department of Pediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Goettingen, 37075 Goettingen, Germany.
Insights
Pediatric liver tumors are increasing, leading to more liver transplants. This study identifies risk factors for tumor recurrence and mortality in children receiving transplants for hepatoblastoma, aiming to improve care.
Area of Science:
- Pediatric oncology
- Hepatology
- Transplantation medicine
Background:
- The incidence of pediatric liver tumors is rising, increasing the need for liver transplantation.
- Hepatoblastoma is the most common primary liver tumor in children undergoing transplantation.
Purpose of the Study:
- To describe the outcomes and identify risk factors for tumor recurrence and mortality in pediatric liver transplant recipients with hepatoblastoma.
- To compare outcomes between hepatoblastoma and other liver malignancies in pediatric transplant patients.
Main Methods:
- Retrospective analysis of 39 children who underwent liver transplantation for malignancy between 1983 and 2022.
- Comparison of characteristics and outcomes between hepatoblastoma and other liver malignancies.
- Nominal logistic regression analysis to identify influential factors on tumor recurrence and mortality.
Main Results:
- The proportion of malignant tumors as an indication for liver transplantation rose significantly over decades.
- Hepatoblastoma patients were younger at transplant and had higher rates of post-transplant bile flow impairment and hearing loss.
- Risk factors for tumor recurrence in hepatoblastoma included higher pre-transplant alpha-fetoprotein (AFP), a low AFPmax/AFPpre-LTX ratio, and salvage transplantation.
Conclusions:
- Liver malignancies are an increasing indication for pediatric liver transplantation.
- While primary tumor resection can avoid transplantation, recurrence may lead to poorer outcomes post-transplant.
- Further investigation is needed into rejection and biliary complication rates in this cohort.
Abstract:
The incidence of pediatric liver tumors in general has been rising over the last years and so is the number of children undergoing liver transplantation for this indication. To contribute to the ongoing improvement of pre- and post-transplant care, we aim to describe outcome and risk factors in our patient cohort. We have compared characteristics and outcome for patients transplanted for hepatoblastoma to other liver malignancies in our center between 1983 and 2022 and analysed influential factors on tumor recurrence and mortality using nominal logistic regression analysis. Of 39 children (16 f) who had transplants for liver malignancy, 31 were diagnosed with hepatoblastoma. The proportion of malignant tumors in the transplant cohort rose from 1.9% (1983-1992) to 9.1% in the current decade (p < 0.0001). Hepatoblastoma patients were transplanted at a younger age and were more likely to have tumor extent beyond the liver. Post-transplant bile flow impairment requiring intervention was significantly higher compared to our total cohort (48 vs. 24%, p > 0.0001). Hearing loss was a common side effect of ototoxic chemotherapy in hepatoblastoma patients (48%). The most common maintenance immunosuppression were mTor-inhibitors. Risk factors for tumor recurrence in patients with hepatoblastoma were higher AFP before transplant (AFPpre-LTX), a low ratio of AFPmax to AFPpre-LTX and salvage transplantation. Liver malignancies represent a rising number of indications for liver transplantation in childhood. Primary tumor resection can spare a liver transplant with all its long-term complications, but in case of tumor recurrence, transplantation might have inferior outcome. The rate of acute biopsy-proven rejections and biliary complications in comparison to our total transplant cohort needs further investigations.
