Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series

PurposeTo examine the results of the multimodal management of patients with endangering hepatic hemangioma associated with systemic compromise.MethodsRetrospective descriptive case series of children with endangering hepatic hemangioma managed at our institution between January 1996 and June 2006.ResultsSix children (5 females) presented with endangering hepatic hemangioma with systemic effects during the index time period. Mean age at presentation was 1.9 months (range, 2 days to 4 months). All patients received medical treatment, and all patients also underwent hepatic embolization, with a median number of procedures of 2 (range, 1-6). Two patients died, one of sepsis and one of progressive liver failure in a child presenting with advanced liver disease owing to neonatal hemochromatosis that was unrecognized at the time. The remaining 4 patients all recovered and were discharged. With mean postprocedure follow-up of 2.11 years (range, 0-6.2 years), all remain well.ConclusionMultimodal management of endangering hepatic hemangioma is a strategy that deserves consideration in the management of these patients. Although the strategy requires further evaluation as to its safety and efficacy, the procedure has the potential to decrease the need for liver transplantation because of treatment failures in this population.