Long-term Outcomes of Liver Transplantation for Hepatoblastoma: A Single-Center 14-year Experience.
Gabriel Ramos-Gonzalez MD1, Michael LaQuaglia MD1, Allison F. O'Neill MD2,3, Scott Elisofon MD4, David Zurakowski PhD1,5, Heung Bae Kim MD1, Khashayar Vakili MD1
1Department of Surgery, Boston Children's Hospital, Boston, MA, USA; 2Dana-Farber Cancer Institute, Boston, MA, USA; 3Department of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA; 4Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA; 5Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
Background: Hepatoblastoma is the most common pediatric primary liver tumor. Surgical resection in combination with chemotherapy provides the best chance for cure. When liver resection is not possible, liver transplantation allows for complete tumor excision. We present our 14-year single-institution experience with liver transplantation for hepatoblastoma.
Methods: Retrospective analysis of patients who underwent liver transplantation for hepatoblastoma from June 2001 to June 2015.
Results: Twenty-five patients underwent liver transplantation for hepatoblastoma at a median age of 26 months (IQR: 15-44). All patients received neo-adjuvant chemotherapy. Median post-operative length of stay was 13 days (IQR: 10-17). Sepsis was the most common complication. Five patients (20%) were readmitted for surgical reasons within thirty-days post-transplant. Graft survival was 96%, 87%, 80% at 1, 3, and 5 years, respectively. Three recipients initially presented with pulmonary metastatic disease, of which two are alive at 3.9 years. Of three patients who underwent salvage transplants, two are alive at 1.5 years after transplant. There were four patient deaths in the entire cohort, three of them due to disease recurrence within the first year post-transplant. The 10-year overall survival for our cohort was 84%. Non-survivors showed a significantly lower median alpha- fetoprotein value at presentation than survivors (21707 vs 343214; P=0.04) and higher prevalence of post-tranplant metastases or recurrence (75% vs 0%; P=0.002).
Conclusion: The overall long-term outcome of liver transplantation for hepatoblastoma is excellent. Tumor recurrence was the highest contributor to mortality in our cohort. Even patients with completely treated pulmonary metastases prior to transplant demonstrated a favorable survival after transplant.
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