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Abdominal transplantation for unresectable tumors in children: the zooming out principle

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Abstract

Purpose

To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases.

Methods

This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months).

Results

LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease.

Conclusions

Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.

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Authors and Affiliations

  1. Pediatric and Adolescent Surgery, Schneider Children’s Medical Center, Sackler School of Medicine, Tel Aviv University, 14 kaplan Street, Petach-Tikvha, 49202, Israel

    Inbal Samuk

  2. Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Inbal Samuk, Akin Tekin, Panagiotis Tryphonopoulos, Ignacio G. Pinto, Debbie Weppler, David M. Levi, Seigo Nishida, Gennaro Selvaggi, Phillip Ruiz, Andreas G. Tzakis & Rodrigo Vianna

  3. Universidad de Oviedo, Beca, Spain

    Ignacio G. Pinto

  4. Pediatrics, University of Miami, Miami, USA

    Jennifer Garcia

  5. Pathology, University of Miami, Miami, USA

    Phillip Ruiz

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  1. Inbal Samuk
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  2. Akin Tekin
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  3. Panagiotis Tryphonopoulos
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  5. Jennifer Garcia
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  7. David M. Levi
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  9. Gennaro Selvaggi
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  10. Phillip Ruiz
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  11. Andreas G. Tzakis
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  12. Rodrigo Vianna
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Correspondence to Inbal Samuk.

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Samuk, I., Tekin, A., Tryphonopoulos, P. et al. Abdominal transplantation for unresectable tumors in children: the zooming out principle. Pediatr Surg Int 32, 337–346 (2016). https://doi.org/10.1007/s00383-015-3852-3

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