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Objective:
To review our institution’s experience with transplantation for the treatment of otherwise unresectable hepatoblastoma.
Design:
Case series, retrospective review of children who underwent transplantation at our institution for the treatment of hepatoblastoma between 2001 and 2010.
Setting:
Free-standing children’s hospital and tertiary referral center.
Patients:
Sixteen patients were identified. Median follow-up time was 4.3 years(1-10). Seven patients had significant preoperative comorbidities including prematurity(2), prior cardiac surgery(2), pulmonary hypertension(1), and congenital nephrotic syndrome(1). Fourteen patients were COG stage three and two were stage four. Median waitlist time was 37 days.
Interventions:
Nine patients received whole livers and six received split liver grafts. One received a living donor graft. One received a multivisceral transplant due to invasion of mesenteric vessels. One received an en-bloc liver-kidney transplant for hepatoblastoma diagnosed during ongoing management of congenital nephrotic syndrome. Immunosuppression included daclizumab/basiliximab induction with the goal of maintenance tacrolimus monotherapy. Chemotherapy regimens varied widely, but were all cisplatin based.
Main Outcome Measures:
Post-operative complications, rejection, recurrence, and patient survival.
Results:
Post-operative complications included cholangitis(3), hepatic artery thrombosis(2), bile leak(1), hematoma(1), and biliary stricture(1). Five patients had steroid responsive acute rejection within the first year after transplant. There have been 2 deaths: one on post-operative day three from complications of pre-existing pulmonary hypertension, and one who had a solitary lung metastasis resected prior to transplant died three years after transplant from a pulmonary recurrence. No other patients have had recurrent malignancy.
Conclusions:
Liver transplantation for hepatoblastoma results in excellent overall outcomes despite the high incidence of pretransplant comorbid conditions and the need for adjuvant chemotherapy. Multiorgan transplantation including multivisceral transplant for mesenteric vascular involvement should be considered in select cases.