Liver transplantation in children with hepatoblastoma and initial pulmonary metastases

Introduction: Hepatoblastoma (HB), as the most common primary malignant liver tumor in children, demonstrates the presence of initial pulmonary metastases with frequency of up to 20% at time of primary diagnosis.Complete eradication of synchronous pulmonary metastases (SPM) is a prerequisite for liver transplantation and may require staged metastasectomies during neoadjuvant chemotherapy (NACT). Methodology:From 2008 to 2024, 152 children with HB underwent surgical treatment in the Liver Transplant Department of Petrovsky National Research Centre of Surgery.The SPM were diagnosed in 29 (19%) of 152 patients.Living-related liver transplantation (LRLT) was performed in thirty-six patients, 14 (39 %) of whom had the pulmonary metastases at the time of diagnosis.Regression of metastases during NACT was achieved in 6 (43%) cases.In 8 (57%) patients with widespread lesions of both lungs, metastasectomies were performed during NACT.