title: Abdominal transplantation for unresectable tumors in children: the zooming out principle.
abstract: OBJECTIVE
  To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases.
  
  
  METHODS
  This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months).
  
  
  RESULTS
  LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease.
  
  
  CONCLUSIONS
  Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.
authors.affiliation: Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, 14 kaplan Street, Petach-Tikvha, 49202, Israel. inbalsabl@clalit.org.il.|Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. inbalsabl@clalit.org.il.
authors.forename: Inbal
authors.initials: I
authors.lastname: Samuk
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tryphonopoulos
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.|Universidad de Oviedo, Beca, Spain.
authors.forename: Ignacio G
authors.initials: IG
authors.lastname: Pinto
authors.affiliation: Pediatrics, University of Miami, Miami, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Garcia
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Weppler
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.|Pathology, University of Miami, Miami, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.affiliation: Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vianna
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004067:Digestive System Neoplasms / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008643:Mesentery / Q000473:pathology; D016377:Organ Transplantation / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014781:Viscera / Q000637:transplantation*
chemical_list: D007166:Immunosuppressive Agents
keywords: Intestinal autotransplantation; Liver; Liver transplantation; Multivisceral transplantation; Neoplasms; Unresectable abdominal neoplasms