Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT). Issue 5 (22nd January 2022)

• Record Type: Journal Article
• Authors: Boster, Julia M.; Superina, Riccardo; Mazariegos, George V.; Tiao, Gregory M.; Roach, Jonathan P.; Lovell, Mark A.; Greffe, Brian S.; Yanni, George; Leung, Daniel H.; Elisofon, Scott A.; McDiarmid, Suzanne V.; Gupta, Nitika A.; Lobritto, Steven J.; Lemoine, Caroline; Stoll, Janis M.; Vitola, Bernadette E.; Daniel, James F.; Sayed, Blayne A.; Desai, Dev M.; Martin, Abigail E.; Amin, Arpit; Anand, Ravinder; Anderson, Sarah G.; Sundaram, Shikha S.
• Is Part Of: American journal of transplantation. Volume 22:Issue 5(2022)
• Page Start: 1396
• Page End: 1408
• Publication Date: 2022-01-22
• Subjects: cancer/malignancy/neoplasia -- clinical decision‐making -- clinical research/practice -- liver disease: malignant -- liver transplantation/hepatology -- patient survival -- pediatrics; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16945
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Management of unresectable pediatric hepatoblastoma (HB) and hepatocellular carcinoma (HCC) remains challenging. The Society of Pediatric Liver Transplantation (SPLIT) database was used to study survival predictors in pediatric liver transplantation (LT) for HB and HCC. Event‐free survival (EFS), associated risk factors, and postoperative complications were studied in children requiring LT for HB/HCC at 16 SPLIT centers. Three‐year EFS was 81% for HB ( n = 157) and 62% for HCC ( n = 18) transplants. Of HB transplants, 6.9% were PRETEXT II and 15.3% were POST‐TEXT I/II. Tumor extent did not impact survival ( p = NS). Salvage ( n = 13) and primary HB transplants had similar 3‐year EFS (62% versus 78%, p = NS). Among HCC transplants, 3‐year EFS was poorer in older patients (38% in ≥8‐year‐olds vs 86% <8‐year‐olds) and those with larger tumors (48% for those beyond versus 83% within Milan criteria, p = NS). Risk of infection (HR 1.5, 95% CI 1.1–2.2, p = .02) and renal injury (HR 2.4, 95% CI 1.7–3.3, p < .001) were higher in malignant versus nonmalignant LT. Survival is favorable for pediatric HB and HCC LT, including outcomes after salvage transplant. Unexpected numbers of LTs occurred in PRE/POST‐TEXT I/II tumors. Judicious patient selection is critical to distinguish tumors that are potentially resectable; simultaneously, we must advocate for patients with unresectable malignancies to receive organs. Abstract : A multicenter analysis identifies increased rates of infection and renal injury in children who undergo liver transplant for hepatic malignancies but favorable event‐free survival for those with advanced hepatoblastoma and acceptable survival for those with hepatocellular carcinoma.