Liver Transplantation Is Highly Effective in Children with Irresectable Hepatoblastoma

Abstract

Background and Objectives: In children, hepatoblastoma preferentially is managed by liver resection (LR). However, in irresectable cases, liver transplantation (LT) is required. The aim of our study was to compare short- and long-term results after LR and LT for the curative treatment of hepatoblastoma. Materials and Methods: Retrospective analysis of all patients treated surgically for hepatoblastoma from January 2000 until December 2019 was performed. Demographic and clinical data were collected before and after surgery. The primary endpoints were disease free survival and patient survival. Results: In total, 38 patients were included into our analysis (n = 28 for LR, n = 10 for LT) with a median follow-up of 5 years. 36 patients received chemotherapy prior to surgery. Total hospital stay and intensive care unit (ICU) stay were significantly longer within the LT vs. the LR group (ICU 23 vs. 4 days, hospital stay 34 vs. 16 days, respectively; p < 0.001). Surgical complications (≤Clavien–Dindo 3a) were equally distributed in both groups (60% vs. 57%; p = 1.00). Severe complications (≥Clavien–Dindo 3a) were more frequent after LT (50% vs. 21.4%; p = 0.11). Recurrence rates were 10.7% for LR and 0% for LT at 5 years after resection or transplantation (p = 0.94). Overall, 5-year survival was 90% for LT and 96% for LR (p = 0.44). Conclusions: In irresectable cases, liver transplantation reveals excellent outcomes in children with hepatoblastoma with an acceptable number of perioperative complications.

Surgical resection of pediatric PRETEXT III and IV hepatoblastoma: A retrospective study investigating the need for preoperative chemotherapy

“…Postoperative complications were assessed using the Clavien–Dindo classification system. If the patient had more than one complication, the most serious complication was recorded ( 17 ). Patients were staged for risk classification using the Evans surgical staging guidelines ( 18 ), wherein Stage I is defined as complete resection with microscopically negative margins, whereas Stage II is defined as complete resection with microscopic residual disease at the resection margins.…”

The immunotherapy advancement targeting malignant blastomas in early childhood

“…Furthermore, other symptoms like fever, decreased body mass, anorexia, and obstructive jaundice are seldom observed among children with hepatoblastoma. Clinical therapies recommended for treating hepatoblastoma include surgical procedures, radiotherapy, liver transplantation, and chemotherapy ( 36 ). A mong these, immunotherapy, which principally engages active immune responses, is exceptional in managing hepatoblastoma.…”

Liver Transplant Oncology: Towards Dynamic Tumor-Biology-Oriented Patient Selection

“…Outcome after LT in HB in general is excellent. Recurrence rates for HB are 0% for LT at 5 years and hence much better than after resection (~10%); 5-year survival was more than 80% [ 51 , 54 ]. Higher risk in HB is classified by the Children’s Hepatic tumors International Collaboration (CHIC) [ 55 ] by several parameters, including histology (pure fetal better than small cell undifferentiated), biological behavior (worse prognosis with lower AFP levels <100 U/mL, spontaneous tumor rupture at involvement or locally advanced tumors with macroscopic vascular invasion and metastatic disease), and age at time of diagnosis [ 56 ].…”