Liver transplantation for hepatocellular carcinoma in children

Abstract

Hepatocellular carcinoma is a relatively uncommon tumor in children which is usually advanced in stage at presentation and responds poorly to chemotherapy. Optimal treatment includes complete surgical resection. The role of liver transplantation in the treatment of unresectable hepatocellular carcinoma in children is not fully defined. The purpose of this review is to discuss the important and unique aspects of hepatocellular carcinoma in children and review the available outcome data on liver transplantation for hepatocellular carcinoma in children. Overall survival of children with hepatocellular carcinoma is 20–40%. Complete surgical resection is frequently limited by tumor size, location, extent, and underlying liver disease. Only 20–30% of children may actually be able to achieve complete resection. Total hepatectomy and liver transplantation are indicated for unresectable hepatocellular carcinoma localized to the liver, with patient survival of 70–80% at 1 year and 60–70% at 5 years. Recurrent or metastatic tumor accounts for the majority of patient mortality after transplant. Current outcomes of liver transplantation for unresectable hepatocellular carcinoma in children are encouraging. Further studies are needed to define tumor and patient characteristics that will optimize the role of liver transplantation in pediatric hepatocellular carcinoma.