Successful Liver Transplantation After Induction Chemotherapy in Children With Inoperable, Multifocal Primary Hepatic Malignancy

BACKGROUND: The prognosis for primary epithelial liver tumor in children in whom radical surgery cannot be performed after chemotherapy is poor. Orthotopic liver transplantation has resulted in mortality up to 50%, largely as a result of problems in determining the criteria for transplantation. METHODS: We report results on liver transplantation for primary epithelial liver malignancy in five children (mean age at transplantation: 6.0 years). Only patients with inoperable residual tumor in the liver after four cycles of multidrug chemotherapy, but without extrahepatic infiltration or metastases, were considered eligible for transplantation. RESULTS: Mean follow-up was 4.6 years. Patient and graft survival was 100%, with no signs of residual or de novo malignancy. CONCLUSION: In children with inoperable primary liver malignancy with no extrahepatic tumor growth, orthotopic liver transplantation has an excellent outcome.