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.