Pediatric Liver Transplantation for Unresectable Hepatoblastoma: Our Two-Decade Experience
Angel Flores Huidobro Martinez1,6, Laura Ruiz-Arriaga1,5, Leandra Bitterfeld6, Luis Guadarrama-Sandoval3, Debra Templin6, Jose Manuel Zertuche-Coindreau4, Joshue David Covarrubias-Esquer3, Zachary Kastenberg6, Linda Book6, Manuel I. Rodriguez-Davalos1,2,6.
1Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States; 2Transplant , University of Utah School of Medicine, Salt Lake City, UT, United States; 3Transplant , Fundacion NOIS de Mexico A.C. , Guadalajara, , Mexico; 4Hospital de Pediatria - Trasplante, Centro Medico Nacional de Occidente, IMSS, Guadalajara, , Mexico; 5Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, , Mexico; 6Transplant and Hepatobiliary Surgery, Intermountain - Primary Children's Hospital, Salt Lake City, UT, United States
Introduction: Hepatoblastoma is the most common liver malignancy in children. PRETEXT score is used to classify tumor invasion of the liver in hepatoblastoma, patients with PRETEXT I and II are considered resectable, while patients with scores of III and IV are considered candidates for liver transplantation. We aim to describe our two-decade experience and outcomes in transplant for hepatoblastoma.
Methods: This is a descriptive study, we retrospectively analyzed the charts of patients diagnosed with hepatoblastoma that were transplanted at our center and a partner center in Mexico from the year 2000 to 2022 and collected data on demographics, type of graft, type of transplant, PRETEXT score, waitlist time, 1 and 5 year survival, complications and recurrence after transplant.
Results: Eighteen patients with hepatoblastoma were included in our study, 16 from our center and 2 from our partner center. Twenty pediatric liver transplants were performed in total. Median patient age at time of transplant was 30 months, gender was evenly distributed, 65% of donors were cadaveric graft types were 50% whole livers, technical variants included SPLIT and Living Donor Liver Transplant, 75% had PRETEXT IV, 20% AND 5% had PRETEXT III and II. median waitlist time was 63 days. We observed an 85% 1-year survival, 95% 5-year survival and an overall survival of 75%, causes of death were unrelated to transplant surgery. Most common complication was biliary stricture and recurrence after transplant was 20% with 60%, 20% and 20% being PRETEXT III, IV and II respectively. Two patients were retransplanted and had a PRETEXT IV.
Conclusion: Patients with hepatoblastoma PRETEXT III and IV can safely receive cadaveric liver transplantation, we recommend living donor liver transplantation for centers with insufficient cadaveric donors. Although other studies have reported PRETEXT IV scores as predictors for recurrence, this was not consistent with our results, however, the two patients that were retransplanted in our study had a score of IV. PRETEXT score is an effective tool for determining treatment and opting for transplant in patients with hepatoblastoma. Future studies should further assess the prognostic value of PRETEXT score for recurrence and survival.
