1
|
Sindhi R, Rohan V, Bukowinski A, Tadros S, de Ville de Goyet J, Rapkin L, Ranganathan S. Liver Transplantation for Pediatric Liver Cancer. Cancers (Basel) 2020; 12:cancers12030720. [PMID: 32204368 PMCID: PMC7140094 DOI: 10.3390/cancers12030720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Unresectable hepatocellular carcinoma (HCC) was first removed successfully with total hepatectomy and liver transplantation (LT) in a child over five decades ago. Since then, children with unresectable liver cancer have benefitted greatly from LT and a confluence of several equally important endeavors. Regional and trans-continental collaborations have accelerated the development and standardization of chemotherapy regimens, which provide disease control to enable LT, and also serve as a test of unresectability. In the process, tumor histology, imaging protocols, and tumor staging have also matured to better assess response and LT candidacy. Significant trends include a steady increase in the incidence of and use of LT for hepatoblastoma, and a significant improvement in survival after LT for HCC with each decade. Although LT is curative for most unresectable primary liver sarcomas, such as embryonal sarcoma, the malignant rhabdoid tumor appears relapse-prone despite chemotherapy and LT. Pediatric liver tumors remain rare, and diagnostic uncertainty in some settings can potentially delay treatment or lead to the selection of less effective chemotherapy. We review the current knowledge relevant to diagnosis, LT candidacy, and post-transplant outcomes for these tumors, emphasizing recent observations made from large registries or larger series.
Collapse
Affiliation(s)
- Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
- Correspondence: ; Tel.: +1-412-692-7123
| | - Vinayak Rohan
- Medical University of South Carolina, Charleston, SC 29403, USA;
| | - Andrew Bukowinski
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Sameh Tadros
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Jean de Ville de Goyet
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy;
| | - Louis Rapkin
- Department of Hematology/Oncology, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA;
| | - Sarangarajan Ranganathan
- Department of Pathology, Children’s Hospital Medical Center of Cincinnati, Cincinnati, OH 45229, USA;
| |
Collapse
|
2
|
Affiliation(s)
- Jean-François Bach
- Necker Hospital, Nephrology Clinic, 161, rue de Sèvres, Paris 15e, France
| | - Mireille Dardenne
- Necker Hospital, Nephrology Clinic, 161, rue de Sèvres, Paris 15e, France
| |
Collapse
|
3
|
Abstract
This article describes the evolution of solid organ kidney and liver transplantation and expounds on the challenges and successes that the early transplant researchers and clinicians encountered. The article highlights the surgical pioneers, delves into the milestones of enhanced immunosuppression protocols, discusses key federal legislative and policy changes, and expounds on the ongoing disparities of organ supply and demand and the need for extended criteria and live donor organs to combat these shortages. Finally, recent changes in organ allocation and distribution policies are discussed. The authors also spotlight novel interventions that will further revolutionize abdominal transplantation in the next 50 years.
Collapse
Affiliation(s)
- David A Sass
- Liver Transplantation, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Suite 480, Main Building, Philadelphia, PA 19107, USA.
| | - Alden M Doyle
- Kidney and Pancreas Transplantation, Division of Nephrology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North Broad Street, Suite 12318, New College Building, Philadelphia, PA 19102-1101, USA.
| |
Collapse
|
4
|
Polak WG, Peeters PM, Slooff MJ. The evolution of surgical techniques in clinical liver transplantation. A review. Clin Transplant 2009; 23:546-64. [DOI: 10.1111/j.1399-0012.2009.00994.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
5
|
Starzl TE, Murase N. Immunological Tolerance: One of Biology's Most Intriguing Mysteries. Proc (Bayl Univ Med Cent) 1999. [DOI: 10.1080/08998280.1999.11930189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Thomas E. Starzl
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Noriko Murase
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Aided by project grant no. DK 29961 from the National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
6
|
Abstract
Biliary tract complications are often referred to as the "Achilles' heel" of liver transplantation and various techniques have been developed to overcome them. The two major methods of bile duct reconstruction currently in use consist of either (1) choledochocholedochostomy over a T-tube or, when duct-to-duct approximation is not feasible, choledochojejunostomy over an internal stent, or (2) interposition of the donor gallbladder as a conduit between the donor bile duct and either the recipient bile duct or a jejunal loop. Although these standardizations of biliary tract reconstruction have resulted in a reduction of biliary complications after liver transplantation, further advancement in the elucidation of ampullary obstruction and viability of the donor bile duct is needed.
Collapse
Affiliation(s)
- K Yanaga
- Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | |
Collapse
|
7
|
Abstract
Five cases of subcapsular liver necrosis were found in a series of 55 hepatic orthotopic allografts examined at hepatectomy or autopsy during a 3-yr period at Children's Hospital of Pittsburgh. There was a pronounced rise in liver enzymes in the first few days in all of the cases after transplantation followed by a decrease in values in four of the cases over the next few days. All were characterized by an irregular subcapsular band of necrotic tissue involving both lobes, to a variable degree, but most frequently the right lobe. There were no obstructions or occlusions of the extrahepatic arteries, portal or hepatic veins. Hepatocyte necrosis was frequently observed in periportal areas, although centrilobular necrosis was also common. Varying degrees of steatosis were seen in the rest of the liver. Various etiological possibilities are discussed, particularly the role of hypoperfusion. Focal subcapsular necrosis of liver allografts may be more frequent than is presently realized. Awareness that hepatic necrosis in allografts may occur as localized subcapsular phenomenon may prevent misinterpretation of superficial biopsy findings as being representative of the entire organ, thus over-estimating the degree of damage.
Collapse
|
8
|
Abstract
The first significant successes with human liver transplantation took place only in 1968, but the future for this new surgical procedure now seems assured. Its success is heavily dependent upon the provision of pathology services, in particular from clinical biochemistry. The experiences with some of the 39 British liver transplants carried out so far are recorded. At operation, a minimum of 20 technician-hours, usually outside normal working hours, is called for. In the immediate post-operative period, intensive biochemical monitoring is essential. Once the major homeostatic mechanisms are re-established after surgery, the principal biochemical investigations are those of organ function. While no specific test for rejection is yet available, the diagnosis of rejection can be made from results of the routine pathology investigations. The role of the clinical biochemistry laboratory in the management of these patients is to provide reliable results seven days a week on a range of tests. The clinical biochemist is also well placed to contribute to the solution of some of the outstanding problems of organ transplantation.
Collapse
Affiliation(s)
- J G Lines
- Department of Biochemistry, University of Cambridge, and Addenbrooke's Hospital, Cambridge
| |
Collapse
|
9
|
Cavallaro A, Vincenti R, Palestini M, Schillaci A, Stipa S. "A five-minute ischemia technique of orthotopic liver homotransplantation in the dog". J Surg Res 1973; 15:340-4. [PMID: 4586301 DOI: 10.1016/0022-4804(73)90098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
10
|
Savan B, Mooney CS, Griffen WO. A useful arterial anastomosis technique in orthotopic liver homotransplantation. J Surg Res 1970; 10:63-6. [PMID: 4903367 DOI: 10.1016/0022-4804(70)90011-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
11
|
|
12
|
|
13
|
Sheil AG, Rogers J, May J, Storey B, Kuruvila JT, George C, Berry FR, Stewart JH. Simplified technic for human auxiliary liver transplantation. Am J Surg 1969; 117:359-62. [PMID: 4888024 DOI: 10.1016/0002-9610(69)90370-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
14
|
|
15
|
Starzl TE, Brettschneider L, Martin AJ, Groth CG, Blanchard H, Smith GV, Penn I. Organ transplantation, past and present. Surg Clin North Am 1968; 48:817-38. [PMID: 4875039 PMCID: PMC2972678 DOI: 10.1016/s0039-6109(16)38585-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
16
|
Terblanche J, Peacock JH, Bowes J, Hobbs KE. The technique of orthotopic liver homotransplantation in the pig. J Surg Res 1968; 8:151-60. [PMID: 4867882 DOI: 10.1016/0022-4804(68)90077-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
17
|
|
18
|
|
19
|
Starzl TE, Marchioro TL, Porter KA, Faris TD, Carey TA. The Role of Organ Transplantation in Pediatrics. Pediatr Clin North Am 1966; 13:381-422. [PMID: 26549894 PMCID: PMC4634894 DOI: 10.1016/s0031-3955(16)31843-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Thomas E Starzl
- Departments of Surgery, University of Colorado School of Medicine and the Veterans Administration Hospital, Denver; and the Department of Pathology, St. Mary's Hospital and Medical School, London, England
| | - Thomas L Marchioro
- Departments of Surgery, University of Colorado School of Medicine and the Veterans Administration Hospital, Denver; and the Department of Pathology, St. Mary's Hospital and Medical School, London, England
| | - Ken A Porter
- Departments of Surgery, University of Colorado School of Medicine and the Veterans Administration Hospital, Denver; and the Department of Pathology, St. Mary's Hospital and Medical School, London, England
| | - Tanous D Faris
- Departments of Surgery, University of Colorado School of Medicine and the Veterans Administration Hospital, Denver; and the Department of Pathology, St. Mary's Hospital and Medical School, London, England
| | - Thomas A Carey
- Departments of Surgery, University of Colorado School of Medicine and the Veterans Administration Hospital, Denver; and the Department of Pathology, St. Mary's Hospital and Medical School, London, England
| |
Collapse
|