Liver transplantation for primary hepatic malignancies of childhood: The UNOS experience

Liver transplantation for primary hepatic malignancies of childhood: The UNOS experience
Factors associated with patient and graft survival following liver transplantation for children/adolescents with primary hepatic malignancies were analysed. The aim was to identify features associated with better outcomes from transplant. The United Network for Organ Sharing (UNOS) database was reviewed which is a resource containing organ transplant data. Five year patient and graft survival as well as independent predictors of survival were assessed.
All pediatric patients who underwent liver transplant between 1987 and 2012 were included. 574 patients were identified - the majority of whom had hepatoblastoma (HB, 70%), followed by hepatocellular carcinoma (HCC, 15%), and then other primary liver tumors (15%).
Five-year overall survival was 73% - HB did much better than HCC (76% versus 63% overall survival). In the most recent time period, 3-year survival was even better with 85% for HB. The most common cause of death was recurrent or metastatic disease in 57% of deaths.
Features associated with reduced survival were higher PELD scores, hospitalization at the time of transplant, ICU at the time of transplant, and people transplanted under earlier regimes.
Large database study - difficult to identify granular details such as PRETEXT stages, changes in chemotherapy regimes, choices of transplant medications postoperatively etc. Also no information on primary transplant or rescue transplant - potentially overall survival could be even higher for primary transplants.
76% of HB patients who undergo transplant are alive at 5 years post transplant, as are 63% of pediatric HCC patients. HCC and medical condition at the time of transplant were independent predictors of graft failure/death.