Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma : Experience from the Society of Pediatric Liver Transplantation (SPLIT)
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - 22(2022), 5 vom: 15. Mai, Seite 1396-1408 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Boster, Julia M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.05.2022 Date Revised 24.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/ajt.16945 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM335254101 |
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| 100 | 1 | |a Boster, Julia M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma |b Experience from the Society of Pediatric Liver Transplantation (SPLIT) |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 10.05.2022 | ||
| 500 | |a Date Revised 24.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The American Society of Transplantation and the American Society of Transplant Surgeons. | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a cancer/malignancy/neoplasia | |
| 650 | 4 | |a clinical decision-making | |
| 650 | 4 | |a clinical research/practice | |
| 650 | 4 | |a liver disease: malignant | |
| 650 | 4 | |a liver transplantation/hepatology | |
| 650 | 4 | |a patient survival | |
| 650 | 4 | |a pediatrics | |
| 700 | 1 | |a Superina, Riccardo |e verfasserin |4 aut | |
| 700 | 1 | |a Mazariegos, George V |e verfasserin |4 aut | |
| 700 | 1 | |a Tiao, Gregory M |e verfasserin |4 aut | |
| 700 | 1 | |a Roach, Jonathan P |e verfasserin |4 aut | |
| 700 | 1 | |a Lovell, Mark A |e verfasserin |4 aut | |
| 700 | 1 | |a Greffe, Brian S |e verfasserin |4 aut | |
| 700 | 1 | |a Yanni, George |e verfasserin |4 aut | |
| 700 | 1 | |a Leung, Daniel H |e verfasserin |4 aut | |
| 700 | 1 | |a Elisofon, Scott A |e verfasserin |4 aut | |
| 700 | 1 | |a McDiarmid, Suzanne V |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Nitika A |e verfasserin |4 aut | |
| 700 | 1 | |a Lobritto, Steven J |e verfasserin |4 aut | |
| 700 | 1 | |a Lemoine, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Stoll, Janis M |e verfasserin |4 aut | |
| 700 | 1 | |a Vitola, Bernadette E |e verfasserin |4 aut | |
| 700 | 1 | |a Daniel, James F |e verfasserin |4 aut | |
| 700 | 1 | |a Sayed, Blayne A |e verfasserin |4 aut | |
| 700 | 1 | |a Desai, Dev M |e verfasserin |4 aut | |
| 700 | 1 | |a Martin, Abigail E |e verfasserin |4 aut | |
| 700 | 1 | |a Amin, Arpit |e verfasserin |4 aut | |
| 700 | 1 | |a Anand, Ravinder |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, Sarah G |e verfasserin |4 aut | |
| 700 | 1 | |a Sundaram, Shikha S |e verfasserin |4 aut | |
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