A transplant is usually reserved for people with liver cancer who have 1 tumor that is up to 5 centimeters in diameter, or 2 or 3 tumors that are each less than 3 centimeters in diameter. A transplant is not an option when the cancer has metastasized or spread to other parts of the body.

Thank you Dr Zaim

Such indications are less well developed for HCC in children where liver transplantation is employed more sporadically. This is due in part to the heterogeneity of HCC presentations in children including incidental tumors in chronic liver conditions, large bulky de novo tumors in healthy livers, and more adult-like tumors such as those arising in the context of cirrhosis and fibrolamellar tumors. In patients who have a liver transplant for other reasons and are found to have an incidental HCC, outcomes are uniformly good. More challenging is the children with otherwise normal livers who present with usually large de novo HCC tumors, especially when the size of the tumor exceeds adult established “Milan-type” criteria.

The indication would be very restrictive and well accepted by the transplantation team

Regarding liver transplantation in malignant primary liver tumor mainly Hepatocellular Carcinoma (HCC), since the introduction of the so-called Milan criteria (MC) introduced by Mazzaferro in 1996, restrict transplantation in adults with HCC as follows: (1) single tumor diameter less than 5 cm; (2) not more than three foci of tumor, each one not exceeding 3 cm; (3) no vascular invasion; (4) no extrahepatic involvement.

Actually, the 5-year overall survival (OS) of patients within the MC reaches similar rates as those of nontumoral indications (65%-70% for HCC patients). As a result, the MC have been included in the Barcelona-Clínic Liver Cancer (BCLC) pretransplant staging, and the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver-European Organisation for Research and Treatment of Cancer (EASL-EORTC) practice guidelines.

In the other hand, 70% of pediatric liver cancer are hepatoblastoma and it is estimated that a fifth of tumors may require liver transplantation. The Mian criteria is not applied in pediatric patients.

Chemotherapy is started immediately upon diagnosis and is also given after liver transplantation. Up to 80 percent of children treated with liver transplantation survive longer than 20 years without experiencing recurrences, if the tumor is confined to the liver.

The indication would be very restrictive and well accepted by the transplantation team