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Calinescu et al. Hepatoma Res 2021;7:59 Hepatoma Research
DOI: 10.20517/2394-5079.2021.26

Review Open Access

A practical approach to pediatric liver

transplantation in hepatoblastoma and
hepatocellular carcinoma

3,#
2
1
Ana M. Calinescu , Geraldine Héry , Jean de Ville de Goyet , Sophie Branchereau 2,#
1
Division of Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals,
Geneva 1205, Switzerland.
2
Pediatric Surgery Unit, Bicêtre Hospital, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre
94270, France.
3
Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT
(Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo 90127, Italy.
# Authors contributed equally.
Correspondence to: Dr. Ana M. Calinescu, Division of Pediatric Surgery, University Center of Pediatric Surgery of Western
Switzerland, Geneva University Hospitals, 6 Rue Willy Donze, Geneva 1205, Switzerland. E-mail: ana-maria.calinescu@hcuge.ch
How to cite this article: Calinescu AM, Héry G, Goyet JdVd, Branchereau S. A practical approach to pediatric liver
transplantation in hepatoblastoma and hepatocellular carcinoma. Hepatoma Res 2021;7:59.
https://dx.doi.org/10.20517/2394-5079.2021.26

Received: 28 Feb 2021 First Decision: 6 May 2021 Revised: 7 Jun 2021 Accepted: 6 Jul 2021 First online: 14 Jul 2021
Academic Editors: Piotr Czauderna, Guang-Wen Cao Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Progressively, as chemotherapy has become more effective, more children with liver malignancies are amenable to
liver transplantation, and indications have expanded from a limited range of cases (mostly hepatoblastoma) to a
range of other unresectable malignant liver tumors; as a result, more children with hepatocellular carcinoma are
also now proposed to transplantation, even and often outside the Milan criteria, for a cure. Recent series have
highlighted that patient and graft survivals after transplantation for hepatoblastoma and hepatocellular carcinoma
have improved in the last decade. Although consensus has not yet been reached about transplantation as a
possible cure for other tumor types than hepatoblastoma and hepatocellular carcinoma, liver transplantation,
generally speaking, has become an important pillar in the management of pediatric liver malignancies. Remaining
limitations and inquiries relate to patient selection (in term of selection criteria considering the risk of recurrence),
the role and usefulness of chemotherapy after transplantation, or the best immunosuppression strategy to both
protect renal function and improve outcome. Although some prospective studies are on the way regarding these
aspects, more studies are needed to explore this rapidly changing aspect of care.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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