Improving post-transplant outcomes for pediatric patients with liver cancer

A recent study looking at the long-term outcomes of all pediatric patients across the United States who underwent liver transplantation after a malignant liver tumor diagnosis is giving Vanderbilt physicians reason to smile.

According to the findings reported in the Vanderbilt study, patient survival has seen a marked improvement over the last decade.

The study looked at two liver cancers: hepatoblastoma, although rare, is the most common form of liver cancer in childhood; and hepatocellular carcinoma, the most common type of liver cancer usually occurring in people with viral hepatitis or cirrhosis.

“There were three very important conclusions as we analyzed all the data,” said Douglas Hanto, M.D., Ph.D., senior author of the paper. “There was a fairly remarkable improvement in long-term post-transplant survival in the last decade for both groups of tumor patients, and this was particularly true for patients younger than 18 months of age. The third finding was that liver transplantation is very beneficial and can be curative when resection of the liver is not feasible.

“It showed that patients do well for long periods post transplant without evidence of recurrence or metastatic disease,” said Hanto, director of the Vanderbilt Transplant Center and chief of the Pediatric Liver Transplant Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

The paper “Long-term Outcomes after Pediatric Liver Transplantation for Malignant Liver Tumors: Effects of Era and Age,” was presented at the American Transplant Congress in May.

Standard therapy for the treatment of hepatoblastoma involves chemotherapy and surgical removal of the tumor. While many patients respond to traditional treatment, some do not and other patients may not be candidates for surgical resection, Hanto said.

The goal, he said, is the ultimate resection of the liver with clear margins, but if that is not possible, transplantation is the next possible step.

“Liver transplant is a life-saving procedure for many children diagnosed with the two most common pediatric liver cancers,” said Howard Katzenstein, M.D., professor of Pediatrics and Scott and Tracie Hamilton Professor of Cancer Survivorship at Vanderbilt.

Although post-cancer survival has improved significantly, Katzenstein stressed the importance of seeing a liver transplant physician when resection is not an option.

“Early consultation with a transplant center is vital to avoiding excessive chemotherapy that will have both short- and long-term side effects,” he said.

– by Jessica Pasley