Two Patients in Which Living Donor Liver Transplantation was Carried Out for Unresectable Hepatoblastoma With Lung Metastasis

Abstract

For unresectable hepatoblastomas that occur as complications associated with extrahepatic lesions, typically lung metastasis, the indication and timing of liver transplantation (LT) are still not well established. In this paper, we report the cases of 2 patients in whom we performed living donor liver transplantation (LDLT) for unresectable hepatoblastomas with lung metastasis. In patient 1, at the age of 4 years, the shadow of a pulmonary mass was identified, and hepatoblastoma (PRETEXT IV, with lung metastasis) was diagnosed. After resection of the lung lesion and chemotherapy, LDLT was performed at the age of 5 years. In patient 2, fever, abdominal distension, and splenohepatomegaly were noted, and hepatoblastoma (PRETEXT IV, with lung metastasis) was diagnosed. After chemotherapy, the right lung lesion was resected, and after the completion of the second cycle of chemotherapy, the left lung lesion also disappeared. At the age of 2 years, LDLT was performed. In both patients, postoperative α-fetoprotein level normalized. No relapse was observed in patient 1 within 2 years following surgery, and he is currently visiting the hospital as an outpatient. Patient 2 had a good postoperative course, but she died suddenly 17 days after surgery. We believe that even in cases in which lung metastasis is identified during diagnosis, if the viability of the tumor can be controlled by surgical resection and chemotherapy, there is still a possibility of saving the patient by LT.