Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: New trends and future opportunities

Ruy J. Cruz, Sarangarajan Ranganathan, George Mazariegos, Kyle Soltys, Navdeep Nayyar, Qing Sun, Geoffrey Bond, Peter Shaw, Kimberly Haberman, Lakshmanan Krishnamurti, J. Wallis Marsh, Abhinav Humar, Rakesh Sindhi

Research output: Contribution to journalArticle

Abstract

Background: Liver transplantation (LTx) for hepatoblatoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. Methods: To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). Results: In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P =.049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P =.016), and tumor necrosis <50% (P =.013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P =.0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy. Conclusion: Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.

Original languageEnglish (US)
Pages (from-to)150-159
Number of pages10
JournalSurgery (United States)
Volume153
Issue number2
DOIs
Publication statusPublished - Feb 2013
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

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