Liver Transplantation for Pediatric Liver Cancer

June 7, 2022

Liver cancer accounts for one-tenth of all pediatric liver transplants in the United States today with approximately 80% of these transplants being performed for children diagnosed with hepatoblastoma. The most common pediatric liver malignancy, hepatoblastoma, affects children within the first two to four years of life and typically presents in babies who are born premature. 

The number of hepatoblastoma cases in the United States has been steadily increasing. Hepatoblastoma has high cure rates if it can be resected, but when that is not possible, liver transplantation is an option.  

Led by Rakesh Sindhi, MD, experts at UPMC Children’s Hospital of Pittsburgh are utilizing liver transplantation for unresectable hepatoblastoma that is confined to the liver. The ability to provide the option of a liver transplant to pediatric patients with hepatoblastoma and other advanced liver cancers requires an experienced liver transplant team with the capabilities to take on such difficult cases. Other unresectable liver cancers which require liver transplantation include hepatocellular cancer, embryonal sarcoma, and neuroendocrine tumors. Another option that is being utilized for advanced liver cancers that are at high risk of relapse is extended resections. Availability of 3D imaging aids in planning of extended resection which can be very close to multiple blood vessels in the liver.

The History of Liver Transplantation for Liver Cancer 

Liver transplantation has historically been employed as a treatment option for patients diagnosed with unresectable liver cancer and progressive cirrhotic liver disease. Between 1963 and 1967, the first nine liver transplants were performed at three centers worldwide with seven of those transplants taking place in the United States. Of those seven, six were adult patients with malignancy and included three patients with hepatocellular cancer (HCC), one with bile duct cancer, and two with metastatic colon cancer. The patients did not survive more than four weeks after surgery. In July of 1967, a pediatric patient diagnosed with HCC survived 13 months post-transplant. The first multi-center experience with liver transplantation for hepatoblastoma specifically, included 12 cases from 10 centers, with 50% of the recipients reported recurrence-free survival averaging 44 months.  

At UPMC, we have closely studied the outcomes and survival benefit of liver transplant for patients with hepatoblastoma. Established by Thomas E. Starzl, MD, PhD, 40 years ago, our center is home to one of the oldest and largest pediatric liver transplant programs in the county as our experts have in-depth experience in treating liver cancer and other complex conditions. We are among the busiest pediatric liver transplant centers in the United States, and we are a leading center for pediatric living-donor liver transplantation, performing more of these procedures than any other pediatric transplant center in the country. 

A Personalized Approach to Treating Patients with Hepatoblastoma

When you refer a patient to our team, we will work with you to determine the best treatment option. While liver transplantation can be life-saving for patients with unresectable liver cancer despite chemotherapy, it does introduce the need for life-long immunosuppression. 

As with any other type of liver disease, our multidisciplinary team will evaluate whether transplant or an alternative non-transplant option is most appropriate for your patient. Our team consists of oncologists, pathologists, radiologists, transplant coordinators, and transplant surgeons. We review each patient’s case to determine the most effective treatment approach. From there, we work with you to co-manage the patient to create a seamless transition of care. 

Contact Us 

Our team is available to provide second-opinion consultations and discuss innovative solutions for your patient. Contact our program to speak with a member of our team or to refer a patient. 

- To refer a patient: 412-692-6110
- 24-hour physician referral service: 412-692-5325
- Email: