Abstract
We report two cases of early primary hepatocellular carcinoma (PHC) in children, after probable maternal transmission of hepatitis B, that were treated with orthotopic liver transplantation (OLT). Both children were 8.5 years old and had elevated levels of serum alpha-fetoprotein. The diagnosis of PHC was made at 8 years and confirmed histologically. Serum hepatitis B surface antigen (HBs Ag) was detected in the mothers and suggested vertical transmission. An attempt at complete liver tumor resection failed, leading to OLT. In order to prevent recurrence of the hepatitis B virus (HBV) infection, hepatitis B immunoprophylaxis was used. Two years after OLT, one child presented with recurrent HBV infection. No tumor recurrence was observed at follow-up in either of the patients. From these two cases we conclude that (1) HBV infection may play an important causal role in PHC in children, with an even shorter incubation period than that in adults; (2) close follow-up is needed for children who are HBs Ag-positive carriers; and (3) liver transplantation should be proposed early after the diagnosis of PHC, when tumor resection is not feasible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adson MA (1988) Primary hepatocellular cancers. Western experience. In: Blumgart LH (ed) Surgery of the liver and biliary tract. Churchill Livingstone, Edinburgh, pp 1153–1165
Alagille B, Odievre M (1979) Liver and biliary tract diseases in children. Wiley, New York, pp 311–338
Beasley RP (1982) Hepatitis B virus as the etiologic agent in hepatocellular carcinoma—Epidemiological considerations. Hepatology 2: 21–26
Beasley RP (1988) Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer 61: 1942–1956
Beasley RP, Hwang L (1984) Hepatocellular carcinoma and hepatitis B virus. Semin Liver Dis 4: 113–121
Beasley RP, Shiao IS, Wu TC, Hwang LY (1982) Hepatoma in an HBs Ag carier seven years after perinatal infection. J Pediatr 101: 83–84
Bernard O, Houssin D, Valayer J (1988) Aspects pratiques de la surveillance après transplantation hépatique chez l'enfant. Arch Fr Pediatr 45: 749–754
Bismuth H, Castaing D, Ericzon BG, Otte JB, Rolles K, Ringe B, Slooff M (1987) Hepatic transplantation in Europe. First report of the European Liver Transplant Registry. Lancet II: 674–676
Calmus Y, Hannoun L, Dousset B, Wolf P, Miguet JP, Doffoel M, Gillet M, Cinqualbre J, Houssin D (1989) HLA class I matching is responsible for the hepatic lesions in recurrent viral hepatitis B after liver transplantation (abstract). J Hepatol 9: S16
Chang MH, Chen PJ, Chen JY, Lai MY, Hsu HC, Lian DC, Liu YG, Chen DS (1991) Hepatitis B virus integration in hepatitis B virus-related hepatocellular carcinoma in childhood. Hepatology 13: 316–320
Cheah PL, Looi LM, Lin HP, Yap SF (1990) Childhood primary hepatocellular carcinoma and hepatitis B virus infection. Cancer 65: 174–176
Demetris AJ, Jaffe R, Sheahan DG, Burnham J, Spero J, Iwatsuki S, Van Thiel DH, Starzl TE (1986) Recurrent hepatitis B in liver allograft recipients. Differentiation between viral hepatitis B and rejection. Am J Pathol 125: 161–172
De Potter C, Robberecht E, Laureys G, Cuvelier CA (1987) Hepatitis B related childhood hepatocellular carcinoma. Childhood hepatic malignancies. Cancer 60: 414–418
Dousset B, Calmus Y, Merrigi F, Houssin D (1989) Recidive de la maladie initiale après transplantation hépatique. Gastroenterol Clin Biol 13: 984–996
Hayvard WL, Bender TR, Lanier AR, Francis DP, McMahon BJ, Maynard JE (1982) Serological markers of hepatitis B virus and alfafetoprotein levels proceeding primary hepatocellular carcinoma in Alaskan Eskimos. Lancet II: 889–891
Koneru B, Cassavilla A, Bowman J, Iwatsuki S, Starzl TE (1988) Liver transplantation for malignant tumors. Gastroenterol Clin North Am 17: 177–193
Lack E, Neave C, Vanter GF (1983) Hepatocellular carcinoma: review of 32 cases in childhood and adolescence. Cancer 52: 1510–1515
Lauchart W, Muller R, Pichlmayr R (1987) Long-term immunoprophylaxis of hepatitis B (HBV) reinfection in recipients of human liver allografts. Transplant Proc 19: 4051–4053
Lohiya GS, Pirkle H, Nguyen H, Lohiya S, Vuu T (1988) Hepatocellular carcinoma in hepatitis B surface antigen carriers in eight institutions. West J Med 148: 426–429
Mowatt A (1979) Liver disorders in childhood. Butterworth, London, pp 319–330
O'Grady JG, Polson RJ, Rolles K, Calne RY, Williams R (1988) Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann Surg 207: 373–379
Ringe B, Pichlmayr R, Wittekind C, Tusch G (1991) Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 15: 270–285
Samuel D, Bismuth A, Mathieu D, Arulnaden JL, Reynes M, Benhamou JP, Brechot C, Bismuth H (1991) Passive immunoprophylaxis after transplantation in HBs Ag-positive patients. Lancet 337: 813–815
Shimoda T, Uchida T, Miyata H, Abe K, Ariga H, Shikata T, Fujii Y (1980) A 6-year-old boy having hepatocellular carcinoma associated with hepatitis B surface antigenemia. Am J Clin Pathol 74: 828–831
Tollais P, Pourcel C, Dejean A (1985) The hepatitis B virus. Nature 317: 489–495
Wu TC, Tong MJ, Hwang B, Lee SD, Hu MM (1987) Primary hepatocellular carcinoma and hepatitis B infection during childhood. Hepatology 7: 46–48
Author information
Authors and Affiliations
About this article
Cite this article
Yandza, T., Alvarez, F., Laurent, J. et al. Pediatric liver transplantation for primary hepatocellular carcinoma associated with hepatitis virus infection. Transplant Int 6, 95–98 (1993). https://doi.org/10.1007/BF00336652
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00336652