UNRESECTABLE HEPATOBLASTOMA, LIVING DONATION AND PRE-TRANSPLANT FACTORS
ASSOCIATED WITH EVENT-FREE SURVIVAL
Abstract
Background: Hepatoblastoma (HB) treatment has improved over time with
established chemotherapy (Qtx) protocols, and liver resection or liver
transplantation (LT). However, the right timing for LT and adequate
patient selection are key to achieve acceptable disease-free survival
rates in patients with unresectable HB. Few groups have reported such
factors in the setting of living donor liver transplantation (LDLT).
Procedure: This single-center retrospective analysis of 28 children with
HB submitted to LDLT aimed at determining the pre-transplant factors
associated with worse post-transplant event-free survival. Results:
Patients were divided in groups according to the occurrence of the event
(recurrence/death) after LDLT – 10 patients in the event-yes and 18
patients in the event-no. Probability of 5-y event-free survival was
63.9%. Alpha-fetoprotein (AFP) reduction post-Qtx > 70%
had a good performance for the occurrence of the event, with a
calculated AUC of 0.8. A scoring system was derived from the
pre-transplant risk factors (AFP reduction < 70%, time from
diagnosis to LDLT > 12 months, rescue LT) for the
probability of the event: no risk factor present (15.4%), one risk
factor present (33.3%), and > 2 risk factors present
(66.7%), (p=0.02). Conclusion: LDLT for HB is the preferred treatment
option for unresectable HB, with no distant metastasis and adequate
response to Qtx. The pre-transplant factors composing the risk score
should be critically evaluated in order to move forward with the LDLT.
However, due to the limited number of patients in this study, a larger
number of patients is required to corroborate these findings.