Liver Resection and Transplantation for Hepatoblastoma

Hepatoblastoma (HB) is the most common primary malignant liver tumor in children, predominantly affecting those under five years of age. Advances in neonatal care and chemotherapy have improved survival; however, approximately 20% of cases remain unresectable, necessitating liver transplantation (LT). This review outlines current indications, surgical strategies, and outcomes of LT for HB. Transplantation is indicated when complete resection (R0) is unachievable due to multifocal disease, PRETEXT IV involvement, major vascular invasion, or inadequate future liver remnant. Living donor liver transplantation (LDLT), particularly in Japan and other Asian countries, has become a cornerstone of curative therapy, offering timely intervention without waitlist delay. Technical refinements—such as early inflow control, portocaval shunting, and fluorescence-guided surgery—have enhanced operative safety and reduced recurrence risk. Multicenter studies, including the Japanese Liver Transplantation Society and JPLT3 trial, demonstrate 5-year overall survival rates exceeding 80–90% in appropriately selected patients, comparable to resection outcomes in intermediate-risk disease. Prognostic factors influencing recurrence include vascular invasion, high AFP levels, and poor chemotherapy response. Long-term survivors typically achieve normal growth, school attendance, and psychosocial development. The Japanese experience underscores the importance of early multidisciplinary evaluation, central surgical review, and integration of LT into frontline hepatoblastoma management. With continuous advances in surgical technique, molecular profiling, and immunomodulation, liver transplantation represents a definitive and life-saving treatment for children with advanced, unresectable hepatoblastoma.

Keywords: Hepatoblastoma, hepatectomy, liver transplantation, ICG, AFP