Treatment of unresectable hepatoblastoma with liver transplantation in the pediatric population.
The purpose of our study was to evaluate the outcome of children who underwent liver transplantation as treatment for unresectable hepatoblastoma. We prospectively collected data on 311 consecutive liver transplants performed at Children's Medical Center of Dallas between October 1984 and November 2000. There were nine recipients (five boys, four girls) with a diagnosis of unresectable hepatoblastoma. Postoperative survival of those currently alive ranged from 6 months to 16 years (mean 6.4 years, median 7.7 years). All recipients received preoperative chemotherapy: 67% received postoperative chemotherapy. Mean AFP level prior to transplantation was 1 448000 ng/mL. Mean age at diagnosis was 0.81 years. Mean age at transplantation was 1.87 years. Only two patients experienced acute cellular rejection in the postoperative period. There was a total of three deaths and one recurrence. The only instance in which AFP levels did not decrease to low or undetectable levels post-transplantation was in the patient with recurrent tumor. Liver transplantation has an established role in the treatment of hepatoblastoma. It accounted for 3% of pediatric liver transplants, and provided the only opportunity for survival in otherwise incurable patients. Early diagnosis and treatment were found to be associated with better results. Response to chemotherapy may be an important factor influencing survival. Rising AFP levels after transplantation are associated with recurrence.
Baylor University Medical Center, Transplantation Services, Dallas, TX 75246, USA.
Ernesto P
EP
Molmenti
Krissy
K
Wilkinson
Hebe
H
Molmenti
Jay S
JS
Roden
Robert H
RH
Squires
Carlos G
CG
Fasola
Gail
G
Tomlinson
David E
DE
Nagata
Lisa
L
D'Amico
M James
MJ
Lopez
Leo M
LM
Savino
Shigeru
S
Marubashi
Edmund Q
EQ
Sanchez
Robert M
RM
Goldstein
Marion F
MF
Levy
Walter
W
Andrews
John A
JA
Andersen
Goran B
GB
Klintmalm
D005260:Female; D018197:Hepatoblastoma / Q000601:surgery*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome