Annals of Diagnostic Paediatric Pathology

Annals of Diagnostic Paediatric Pathology 2004, 8(3-4):
© Copyright by Polish Paediatric Pathology Society
Liver transplantation for primary malignant liver tumors
in children – single center experience
Piotr Kaliciñski 1 , Hor Ismail 1 , Andrzej Kamiñski 1 , Danuta Perek 2 , Joanna Paw³owska 3 ,
Przemys³aw Kluge 4 , Joanna Teisserye 1 , Marek Szymczak 1 , Tomasz Drewniak 1 ,
Pawe³ Nachulewicz 1 , Bo¿ena Dembowska-Bagiñska 2 , Marek Stefanowicz 1 ,
Andrzej Byszewski 5 , Ma³gorzata Manowska 5
Annals of
Diagnostic
Paediatric
Pathology
1
Department of Pediatric Surgery and Organ Transplantation
2
Department of Oncology
3
Department of Gastrology, Hepatology and Immunology
4
Department of Patomorphology
5
Department of Anesthesiologu and Intensive Care
The Children’s Memorial Health Institute,
Warsaw, Poland
Abstract
The aim of the study was to analyse results of treatment of primary liver tumors in children in a center
performing the liver transplant program. Clinical material consisted of 42 children treated for hepatoblastoma
or hepatocarcinoma since 1990, since liver transplantant program was established. Retrospective comparison
of results was performed according to type of the tumor and different treatments protocols. Survival of
patients with hepatoblastoma is similar after primary conventional treatment (chemotherapy and resection)
and primary transplantation after chemotherapy, however number of transplanted patients is to low to draw
any conclusions. Patients with tumor recurrence after resection probably should not be qualified for transplantation
as their prognosis is very poor. In hepatocarcinoma group overall results after chemotherapy and
primary transplantation seem to be much better than after conventional therapy. This observation should be
confirmed however with longer follow-up of these patients. In conclusion liver transplantation should be
considered as an option early in the process of treatment of primary malignant tumors in children particularly
with hepatocarcinoma, and transplantation as a primary surgical treatment in all patients with unresectable or
marginally resectable tumors and without extrahepatic extension.
Key words: children, hepatoblastoma, hepatocellular carcinoma, liver transplantation, primary liver tumors
Introduction
Primary hepatic malignancies are main indication for liver
transplantation in 2-4% pediatric recipients. This is well less
than in adult population, where patients with hepatocellular
carcinoma account for 11-12% of liver transplantations [3-5].
In contrast to adult group, there are no established strict criteria
for qualification for transplantation in children with primary
liver tumors, particularly that various types of hepatic
tumors may develop in childhood (hepatoblastoma,
hepatocarcinoma, undifferentiated sarcoma, angiosarcoma
etc.) [1, 7, 12]. The aim of this study is to summarize our
experience with this particular group of liver transplant recipients.
Material and methods
Liver transplant program was initiated in our institution in
march 1990. Since then 222 liver transplants were performed
till July 2004. We have analysed retrospectively data of 42
children treated for hepatoblastoma (HBL) or hepatocarcinoma
(HCC) within the same period in our institution.
Patients with HBL
Between 1990 and 2004, 23 patients aged 5 months to 16
years, most with advanced tumors, were treated for HBL.
Twenty children with HBL were treated initially with chemotherapy
and then by conventional surgery – partial liver resection.
In two of them recurrence was suspected despite of mul-
Address for correspondence
Piotr Kalicinski MD, PhD
Al. Dzieci Polskich 20
04-736 Warsaw, Poland
Phone: +48-22-8151360
Fax: +48-22-8151450
E-mail: piokal@czd.waw.pl