Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT)

Julia M Boster¹, Riccardo Superina², George V Mazariegos³, Gregory M Tiao⁴, Jonathan P Roach⁵, Mark A Lovell⁶, Brian S Greffe⁷, George Yanni⁸, Daniel H Leung⁹, Scott A Elisofon¹⁰, Suzanne V McDiarmid¹¹, Nitika A Gupta¹², Steven J Lobritto¹³, Caroline Lemoine², Janis M Stoll¹⁴, Bernadette E Vitola¹⁵, James F Daniel¹⁶, Blayne A Sayed¹⁷, Dev M Desai¹⁸, Abigail E Martin¹⁹, Arpit Amin³, Ravinder Anand²⁰, Sarah G Anderson²⁰, Shikha S Sundaram¹

Affiliations

¹ Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
² Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
³ Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Department of Surgery, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁶ Department of Pathology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁷ Department of Pediatric Oncology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁸ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
⁹ Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
¹⁰ Department of Pediatrics, Boston Children's Hospital, Massachusetts, USA.
¹¹ Department of Pediatrics, University of California and Los Angeles Mattel Children's Hospital, Los Angeles, California, USA.
¹² Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA.
¹³ Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
¹⁴ Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁵ Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.
¹⁷ Department of Surgery, University Health Network and the Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁸ Department of Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA.
¹⁹ Department of Surgery, Nemours Children's Hospital Delaware and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA.
²⁰ The Emmes Company LLC, Rockville, Maryland, USA.

PMID: 34990053
DOI: 10.1111/ajt.16945

Free article

Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT)

Julia M Boster et al. Am J Transplant. 2022 May.

Free article

. 2022 May;22(5):1396-1408.

doi: 10.1111/ajt.16945. Epub 2022 Jan 22.

Authors

Affiliations

¹ Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
² Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
³ Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Department of Surgery, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁶ Department of Pathology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁷ Department of Pediatric Oncology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA.
⁸ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
⁹ Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
¹⁰ Department of Pediatrics, Boston Children's Hospital, Massachusetts, USA.
¹¹ Department of Pediatrics, University of California and Los Angeles Mattel Children's Hospital, Los Angeles, California, USA.
¹² Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA.
¹³ Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
¹⁴ Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁵ Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.
¹⁷ Department of Surgery, University Health Network and the Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁸ Department of Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA.
¹⁹ Department of Surgery, Nemours Children's Hospital Delaware and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA.
²⁰ The Emmes Company LLC, Rockville, Maryland, USA.

PMID: 34990053
DOI: 10.1111/ajt.16945

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.

Keywords: cancer/malignancy/neoplasia; clinical decision-making; clinical research/practice; liver disease: malignant; liver transplantation/hepatology; patient survival; pediatrics.

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References

REFERENCES

1. Hamilton EC, Balogh J, Nguyen DT, Graviss EA, Heczey AA, Austin MT. Liver transplantation for primary hepatic malignancies of childhood: the UNOS experience. J Pediatr Surg. 2017;53:163-168.
1. Vinayak R, Cruz RJ Jr, Ranganathan S, et al. Pediatric liver transplantation for hepatocellular cancer and rare liver malignancies: US multicenter and single-center experience (1981-2015). Liver Transpl. 2017;23:1577-1588.
1. Czauderna P, Haberle B, Hiyama E, et al. The Children's Hepatic tumors International Collaboration (CHIC): novel global rare tumor database yields new prognostic factors in hepatoblastoma and becomes a research model. Eur J Cancer. 2016;52:92-101.
1. Meyers RL, Maibach R, Hiyama E, et al. Risk-stratified staging in paediatric hepatoblastoma: a unified analysis from the children’s hepatic tumors international collaboration. Lancet Oncol. 2017;18(1):122-131.
1. Khan AS, Brecklin B, Vachharajani N, et al. Liver transplantation for malignant primary pediatric hepatic tumors. J Am Coll Surg. 2017;225:103-113.

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Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT)

Affiliations

Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT)

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous