Improved contemporary outcomes of liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma

Brian Ezekian, Michael S. Mulvihill, Paul M. Schroder, Brian F. Gilmore, Harold J. Leraas, Brian C. Gulack, Sarah Jane Commander, Alisha M. Mavis, Susan G. Kreissman, Stuart J. Knechtle, Elisabeth T. Tracy, Andrew S. Barbas

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Purpose: Improvement in outcomes of LT for pediatric HB and HCC has been reported in small series. We analyzed national outcomes and changes in donor, recipient, and perioperative factors over time that may contribute to survival differences. Methods: The UNOS database was queried for patients age <21 years that underwent LT for a primary diagnosis of HB or HCC (1987-2017). Subjects were divided into historic (transplant before 2010) and contemporary (transplant after 2010) cohorts. Baseline characteristics were compiled and examined. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: In total, 599 children with HB received LT (320 historic vs 279 contemporary). Concurrently, 141 children with HCC received LT (92 historic vs 49 contemporary). For both tumors, waitlist time decreased (HB 56.2 days historic vs 33.2 days contemporary, P = 0.017; HCC 189.3 days historic vs 71.7 days contemporary, P = 0.012). In the historic cohorts, patients with HB had a 1-year and 5-year OS of 84.6% and 75.1%, respectively. Survival for HCC was 84.4% and 59.9%, respectively. Outcomes improved in the contemporary era to 89.1% and 82.6% for HB, and 94.7% and 80.8% for HCC, respectively (both log-rank test P < 0.0001). Conclusion: Outcomes of LT have improved significantly, with contemporary survival now equivalent between these tumors and exceeding 80% 5-year OS. Future studies are needed to explore whether offering LT in patients that are resectable is justifiable.

Original languageEnglish (US)
Article numbere13305
JournalPediatric transplantation
Volume22
Issue number8
DOIs
StatePublished - Dec 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.

Keywords

  • hepatoblastoma
  • hepatocellular carcinoma
  • liver transplantation
  • outcomes
  • pediatric

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