title: Living-donor liver transplantation for hepatoblastoma.
abstract: Hepatoblastoma is the most common malignant liver tumor in children. Recently, liver transplantation has been indicated for unresectable hepatoblastoma. We retrospectively reviewed 14 children with a diagnosis of hepatoblastoma who had undergone living-donor liver transplantation (LDLT) at Kyoto University Hospital. During the period from June 1990 to December 2004, 607 children underwent LDLT. Of these interventions, 2.3% were performed for hepatoblastoma. Based on radiological findings, the pre-treatment extent of disease (PRETEXT) grouping was used for pre-treatment staging of the tumor. There were grade III in seven patients and grade IV in seven patients. Thirteen patients received chemotherapy, and seven underwent hepatectomy 11 times. Immunosuppressive treatment consisted of tacrolimus monotherapy in 11 patients. Actuarial 1- and 5-year graft and patient survival rates were 78.6% and 65.5%. The poor prognostic factors were macroscopic venous invasion and extrahepatic involvement with 1-year and 5-year survival rates of 33.0% and 0%. Pediatric patients without these factors showed an acceptable 5-year survival rate of 90.9%. LDLT provides a valuable alternative with excellent results in children with hepatoblastoma because it allows optimal timing of the liver transplantation, given the absence of delay between the completion of chemotherapy and planned liver transplantation.
authors.affiliation: Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. mureo@kuhp.kyoto-u.ac.jp
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Hiramatsu
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Souichi
authors.initials: S
authors.lastname: Adachi
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D018197:Hepatoblastoma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000096:biosynthesis
chemical_list: D007166:Immunosuppressive Agents; D000509:alpha-Fetoproteins; D016559:Tacrolimus