Beyond the Milan criteria for liver transplantation in children with hepatic tumours

The Lancet. Gastroenterology & Hepatology
Jean de Ville de GoyetBruce Morland

Abstract

The Milan criteria were originally defined in the context of adult liver transplantation for patients with hepatocellular carcinoma and cirrhotic livers. The aim of the criteria was to select patients with small tumours and no disease spread who had a good chance of success, thus avoiding futile transplants. This objective was reached successfully. For the management of selected children with unresectable hepatoblastoma, an almost opposite strategy was proposed and has been implemented in the past two decades, in which transplantation is indicated on the basis of large tumour size and anatomy that precludes the possibility of safe and radical resection. This approach has also had great success. Although both strategies are well established for these two different age groups and diseases, a grey area exists with regard to hepatocellular carcinoma or other tumour types in children. In this Viewpoint, we aim to review the existing literature about the indications, selection process, and results of liver transplantation for liver tumours in children, and discuss evidence that supports the implementation of either of the two strategies in the context of managing selected children with liver tumours using transplantation.

Citations

Nov 1, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Jean de Ville de GoyetPiotr Czauderna
Dec 24, 2018·Children·Irene Isabel P LimGregory M Tiao
Apr 21, 2020·Pediatric Blood & Cancer·Amber M D'SouzaJames I Geller
Dec 31, 2019·Case Reports in Oncological Medicine·Abdulrahman Al JassmiSaid Abou Eida
Mar 13, 2021·Surgical Oncology Clinics of North America·Rebecka MeyersGreg M Tiao
Jul 15, 2020·Journal of Pediatric Surgery·Ioannis A ZiogasSophoclis P Alexopoulos

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