Excellent Outcome Following Liver Transplantation for Hepatoblastoma Using an Extensive En Bloc Hepatectomy Technique.

BACKGROUND: Hepatoblastoma is a rare malignancy but the most common primary hepatic malignancy in childhood. Pediatric liver transplantation (LT) offers the possibility to achieve a complete resection in otherwise unresectable tumors. Almost no data are available regarding specific surgical technique of LT in children with hepatoblastoma. METHODS: We analyzed all children with hepatoblastoma and LT between 2007 and 2012. Special regard was given to the surgical technique and long-term follow-up. RESULTS: Overall 7 children were transplanted with the diagnosis of hepatoblastoma (5 male, 2 female). Thereof, 4 children (median age was 11 months, range, 6-31 months) underwent "primary" LT for hepatoblastoma Pretreatment Extent of Disease III to IV. A 4-year-old boy received "salvage" LT for recurrent hepatoblastoma 2.5 years after successful liver resection. Another 15-year-old boy was transplanted as a prophylactic treatment after repeated liver resection for hepatoblastoma due to the high recurrence risk. A 14-year-old boy underwent LT due to complications following liver resection for hepatoblastoma during infancy. In all children, extensive en bloc hepatectomy was performed together with resection of the adjoining retroperitoneal tissue and regional lymphadenectomy. Actually, all children are alive without tumor recurrence median 7.1 years after LT (range, 5.7-10.7 years). CONCLUSION: Our data show an excellent long-term outcome in selected children with hepatoblastoma undergoing standardized en bloc hepatectomy for "primary" and "rescue" LT with 100% overall and recurrence-free survival.

The role of an organ exchange organization in increasing split-liver transplantation.

Eurotransplant introduced a new allocation policy in January 2003 to increase the number of liver transplants by offering centers an incentive to split deceased donor livers for 2 recipients. Centers were granted the option of choosing a suitable recipient for the second portion of the split liver from their own waiting list and, to increase the awareness for liver splitting, centers were asked by the Eurotransplant duty officer whether they would consider splitting whenever a liver that met the 50/50 rule (donor age <50 and weight >50 kg) was available. During the first year after implementing this policy, split-liver transplants increased by 67% and again by 10% during the second year (a total of 288 transplants in the 2-year period). The number of pediatric recipients of a split liver increased from 44 in 2002 to 76 in 2004 and the pediatric waiting list decreased by 36% (73 to 47) one year after implementation of the new policy. More than 95% of the 288 split liver transplants involved one adult and one pediatric recipient. Nearly three-quarters of the split liver transplants were performed at 3 centers with both a pediatric and adult waiting list and with surgeons experienced in the procedure. We conclude that Eurotransplant's liver allocation policy has increased the number of liver transplants, particularly among children, by rewarding centers that split livers for transplantation to 2 recipients without prolonging cold ischemia time. The number of centers that could benefit from this policy will increase as more surgeons are trained in the splitting procedure.