Accessible pediatric liver transplantation in India: A long way to go

Rela, Mohamed; Shanmugham, Naresh

doi:10.1007/s13312-017-1180-5

Cited by 6 publications

(13 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…OLT has become the standard of care in Western countries for patients with multifocal disease and unresectable disease following chemotherapy. While a small study from Southern India has highlighted the feasibility of performing OLT with encouraging results, several factors, including cost, access, need for expertise, donor availability, high incidence of sepsis and malnutrition, and prolonged immunosuppression, are of concern while offering OLT in limited‐resource settings 32–34 . OLT was performed at another center, with a large part of the funding for OLT raised by the transplant team from private donations.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes and prognostic factors in children with hepatoblastoma using a risk‐stratified approach

Srinivasan

Prasad

Parambil

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background Not all the significant progress made in the management of children with hepatoblastoma (HB) has translated into improved outcomes in limited‐resource settings. There are limited data on outcomes in children with HB from India. Methods All patients diagnosed with HB between July 2013 and December 2020 were risk‐stratified and treated as per International Liver Tumor Strategy Group (SIOPEL). Patients with standard‐risk HB received cisplatin monotherapy and those with high‐risk HB received alternating cycles of cisplatin and the combination of carboplatin plus doxorubicin. Data regarding demographic details, chemotherapy, surgery, liver transplantation, outcomes, prognostic factors, and toxicity were collected. Results Of 157 patients with HB, 117 (74%) were high risk, 31 (20%) were standard risk, and nine (6%) unknown. Patients with standard‐risk disease had excellent outcomes, with 3‐year event‐free survival (EFS) and overall survival (OS) of 96% and 100%, respectively. Among high‐risk HB, six underwent orthotopic liver transplantation of which four were alive at last follow‐up. The 3‐year EFS and OS of patients with high‐risk disease was 56% and 66%, respectively. Outcomes of patients with PRETEXT IV (3‐year EFS: 42%, 3‐year OS: 50%) and metastatic disease (3‐year EFS: 30%, 3‐year OS: 50%) were dismal. Patients with serum alpha‐fetoprotein (AFP) reduction greater than 90% following two courses of chemotherapy had favorable outcomes; 3‐year EFS: 80% versus 58% (p = .013) and 3‐year OS: 95% vs. 68% (p < .01). Only two (6%) of 31 patients with relapse/refractory HB were alive at a median follow‐up of 36 months, and both had received salvage chemotherapy and surgery. Conclusions While children with standard‐risk HB had excellent outcomes, those with high‐risk disease continue to do poorly. Serial monitoring of serum AFP values is a cost‐effective and reliable predictor of outcomes. Orthotopic liver transplantation remains a viable option for inoperable disease in resource‐limited settings as well.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment outcomes and prognostic factors in children with hepatoblastoma using a risk‐stratified approach

Srinivasan

Prasad

Parambil

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…Despite morbidity remaining low for left lateral segment donation (which forms the majority of grafts in children), there always remains a finite risk of serious complications and mortality. In addition, the financial aspects of liver transplantation, especially in countries without a well developed state‐funded medical system, cannot be neglected. All of these issues, together with the obvious risk of transplantation for the patient and the importance of not exhausting a limited pool of paediatric cadaveric donors, have prompted interest in resectional surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Government initiatives, non‐governmental organizations and crowd funding have also provided financial support for the treatment of these children. Tertiary paediatric liver transplant centres have achieved outcomes similar to those in Western centres, but there are few data on outcomes for hepatoblastoma, and none for high‐risk hepatoblastoma.…”

Section: Introductionmentioning

confidence: 99%

Outcomes for high-risk hepatoblastoma in a resource-challenged setting

et al. 2020

View full text Add to dashboard Cite

Background: Outcomes of high-risk hepatoblastoma have been dismal, especially in resource-challenged countries where access to chemotherapy and paediatric liver transplantation is limited for the underprivileged. This study aimed to assess the results of treatment of high-risk hepatoblastoma in a tertiary centre, including patients who had non-transplant surgical procedures in the form of extended resection. Methods: A review of patients with high-risk hepatoblastoma treated between January 2012 and May 2018 was carried out. Perioperative data and long-term outcomes were analysed. Results: Of 52 children with hepatoblastoma, 22 were considered to have high-risk hepatoblastoma (8 girls and 14 boys). The mean(s.d.) age at diagnosis was 35(20) months. Of these 22 children, five died without surgery. Of the remaining 17 who underwent surgery, six had a resection (4 right and 2 left trisectionectomies) and 11 underwent living-donor liver transplantation. Median follow-up was 48 (range 12-90) months. Thirteen of the 17 children were alive at last follow-up and four developed disseminated disease (3 had undergone liver transplantation and 1 liver resection). The overall survival rate at 1, 3 and 5 years was 77, 64 and 62 per cent for the whole cohort with high-risk hepatoblastoma. In children who had surgery, 1-, 3-and 5-year survival rates were 91, 82 and 73 per cent for transplantation and 100, 83 and 83 per cent for resection. There was no difference in survival between the two surgical groups. Conclusion: Excellent results in the treatment of high-risk hepatoblastoma are possible, even in resource-challenged countries.

show abstract

“…2,15,19 Additionally, in countries where the private health systems have developed transplant programs, transplant patients are followed in private facilities, although they may have public health coverage or are in low-income households. 2,14 The country's geographic characteristics and the central location of SOT programs may significantly limit the access of patients and their families residing in remote regions to transplant centers. 3,11,14,15,17 This also affects their access to early diagnosis and referral, ultimately reducing their chance of having a transplant.…”

Section: Obs Tacle S To Ped Iatri C Solid Org An Tr An S Pl Antati On...mentioning

confidence: 99%

International pediatric transplant association (IPTA) guidance on developing and/or expanding pediatric solid organ transplantation programs in low‐ and middle‐income countries

Mackie

McCulloch

et al. 2022

Pediatric Transplantation

View full text Add to dashboard Cite

Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end‐stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low‐ and middle‐income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high‐quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC.

show abstract

Accessible pediatric liver transplantation in India: A long way to go

Cited by 6 publications

References 6 publications

Treatment outcomes and prognostic factors in children with hepatoblastoma using a risk‐stratified approach

Treatment outcomes and prognostic factors in children with hepatoblastoma using a risk‐stratified approach

Outcomes for high-risk hepatoblastoma in a resource-challenged setting

International pediatric transplant association (IPTA) guidance on developing and/or expanding pediatric solid organ transplantation programs in low‐ and middle‐income countries

Contact Info

Product

Resources

About