Orthotopic liver transplantation for unresectable XXXX .

@entity1 @entity5 @entity879 @entity900 @entity1576 @entity4177
BACKGROUND: The outcome of treatment for advanced @entity4177 has recently improved after the introduction of preoperative or pre- and postoperative @entity900 -containing chemotherapy combined with complete surgical excision. The role of liver transplantation in a population of @entity1 who have received this regimen has not been clearly defined. METHODS: Orthotopic liver transplantation (OLT) was performed in 13 @entity1 , aged 5 months to 11 years (median 27 months), who were assessed with unresectable @entity4177 , and whose pretreatment extent-of-disease was based on radiologic findings of group III (n=11) and group IV (n=2). One @entity1 with a multifocal @entity5 showed pulmonary metastases at presentation, but, according to radiologic studies, the deposits resolved with chemotherapy before liver transplantation. One other @entity1 showed exophytic extension of the @entity5 infiltrating the porta hepatis and body of the pancreas. All 13 @entity1 received preoperative chemotherapy to reduce the size of the @entity5 (s) and to treat metastatic spread. RESULTS: Twelve @entity1 underwent elective OLT; all are alive and show normal graft function at a mean follow-up of 33 months (range 1-108). One @entity1 shows evidence of recurrent disease in the form of pulmonary metastases. One @entity1 underwent emergency OLT for @entity879 after (incomplete) extended right hepatectomy and died from @entity1576 , with no evidence of recurrent @entity5 3 weeks posttransplant. CONCLUSIONS: Liver transplantation is an effective treatment for unresectable unifocal or multifocal @entity4177 confined to the liver. A multidisciplinary approach to the management of @entity4177 , with thoughtful collaboration between pediatric oncologists, hepatologists, and liver surgeons, is essential.
