Pediatric Liver Transplantation in the Treatment of Solid Liver Tumors: A Narrative Review.
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Pediatric primary liver malignancies comprise a heterogeneous group of tumors requiring individualized multidisciplinary management. Hepatoblastoma and hepatocellular carcinoma remain the most common malignant liver tumors in children, whereas rare hepatic neoplasms account for a small but clinically significant proportion of cases. Over the past two decades, advances in tumor biology, standardized radiologic staging, multidisciplinary treatment planning, and liver transplantation have substantially improved outcomes, particularly for children with unresectable hepatoblastoma. Contemporary management has shifted from an anatomy-based approach to individualized treatment strategies that integrate molecular characterization, PRETEXT staging, response to neoadjuvant therapy, and careful assessment of surgical resectability. Liver transplantation is now recognized as a definitive oncologic treatment for carefully selected children with unresectable hepatoblastoma, selected cases of hepatocellular carcinoma, and, in exceptional circumstances, other rare hepatic malignancies. In parallel, improvements in post-transplant oncologic surveillance and immunosuppressive management have expanded opportunities for long-term disease control while emphasizing the need to balance graft preservation with recurrence risk. Emerging technologies, including molecular biomarkers, liquid biopsy, artificial intelligence, and advanced surgical planning, together with international collaborative initiatives, are expected to further refine patient selection and post-transplant management. This review summarizes current evidence on the role of liver transplantation in pediatric liver malignancies and discusses contemporary advances reshaping pediatric transplant oncology.