Living donor liver transplantation for hepatic malignancies in children.

Abstract

Living donor liver transplantation is a treatment option for unresectable hepatic tumors in children. We enrolled 45 living donor transplantations performed between 1993 and 2018 for liver malignacies, which included hepatoblastoma (n=33), hepatocellular carcinoma (n=10), hepatic angiosarcoma (n=1), and rhabdomyosarcoma (n=1). No mortality or major morbidities were encountered in any donor, and the complication rate was 9%.In the hepatoblastoma group, 5-year overall and event-free survival rate in recipients was 87.4% and 75.8%, respectively, andmortality was significantly higher in patients after rescue transplantation (p=.001).Inferior vena cava replacement in these recipients appeared to be associated with reduced mortality (p=.034),but this was not confirmed when rescue patients were excluded (p=.629).In hepatocellular carcinoma group, both 5-year overall and event-free survival rates were 75.4% each, andinvasion of hepatic veins was significantly associated with increased risk of recurrence and death (p=.028).The patient with rhabdomyosarcoma died from EBV-induced lymphoma 2months after transplantation. The patient with angiosarcoma was in complete remission at the last follow-up.Overall, 5-year graft survival rate was 81.3%,and one patient underwent re-transplantation due to chronic rejection. Pediatric oncological liver transplantation has become a key player in the management of malignancies with cancer cure in 84% of patients in this series. Living donor liver transplantation for pediatric recipients with unresectable tumors might be a beneficial surgical option, which is technically safe for donors and recipients, thus, allowing timely planning according to chemotherapy protocols.