Purpose: To examine if patients with hepatoblastoma (HB) treated with both immunosuppression and chemotherapy have different rates of infection post-operatively than those treated with chemotherapy alone.

Methods. All patients <18 years-old treated surgically for HB from 1998 to 2016 at our institution were included. Infectious complications were captured by either culture results or clinical management of an infection. All patients treated with orthotropic liver transplant (OLT) received both chemotherapy and immuosuppression. Patients treated with partial hepatectomy (PH) were treated with chemotherapy only. Potential predictors of infectious complications were assessed with univariate and multivariate regression analyses.

Results. Sixty-two patients were found to have surgically treated HB. Nineteen patients (31%) underwent OLT and 43 patients (69%) underwent PH. Post-operative infectious complications were more common after OLT (infections-per-person: 0.66 in PH vs 1.30 in OLT, p=0.04). Early infections (<30 days post-op) were more common with OLT (p=0.04); there was no significant difference in the incidence of late infections (>30 days, p=0.3). Univariate analysis identified several risk factors for infection: PRETEXT score (OR 2.4, p<0.01), administration of neoadjuvant therapy (OR 4.3, p=0.02), and OLT (OR 3.2, p=0.05). Multivariate regression identified PRETEXT (OR 2.4, p=0.02) and neoadjuvant therapy (OR 7.3, p<0.01) as independent predictors of an infectious complication.

Conclusions. Patients with HB treated with both immunosuppression and chemotherapy have higher rates of infection post-operatively than those treated with chemotherapy alone. Independent predictors of infection were neoadjuvant therapy and increased PRETEXT score. Further studies should be considered to examine the compatibility of chemotherapy with immunosuppression in HB.

CITATION INFORMATION: Commander S, Kueht M, Ha T.-A, Rana A, Goss J, Vasudevan S. Infectious Complications Following Hepatectomy for Pediatric Hepatoblastoma. Am J Transplant. 2017;17 (suppl 3).

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