Multivisceral Transplantation for Unresectable Hepatoblastoma: Single Center Experience
Surgery, Boston Children's Hospital, Boston, MA
Meeting: 2013 American Transplant Congress
Abstract number: A717
Purpose: Optimal treatment of hepatoblastoma requires complete resection and extensive portomesenteric vascular extension provides a unique challenge.
Methods:Two patients undergoing MVT for unresectable hepatoblastoma at our institution were retrospectively reviewed.
Results:Patient 1 presented at age 2 years and patient 2 at age 15 months. Both presented as COG stage III and PRETEXT IV with direct tumor extension into the portal, superior mesenteric, and splenic veins. Patient 1 had CIT of 6h59m and WIT of 18m. Postoperative complications included abdominal hematoma requiring evacuation, adenovirus infection, steroid responsive intestinal rejection, and rituximab responsive hemolytic anemia. Patient 2 had CIT of 6h3m and WIT of 15m. Postoperative complications included acute on chronic respiratory failure, tracheitis and fungemia. In both patients, postoperative adjuvant chemotherapy was stopped after one cycle due to complications. At most recent follow up of 4 years(patient 1) and 1 year(patient 2), both have satisfactory graft function, normal AFP levels, and no evidence of recurrence.
| Patient 1 | Patient 2 | |
|---|---|---|
| Gestational Age(weeks) | 28 | 23 |
| Comorbidities | FTT, CLD, ROP, hypothyroidism, GT dependence, DD | FTT, ROP, IVH, CLD/ventilator dependence, hypothyroidism, GT dependence, DD |
| COG Stage | III | III |
| Vascular Extension | PV, SMV, IMV, splenic vein | PV, SMV, splenic vein |
| AFP(diagnosis) | 893,915 | 1,601,333 |
| AFP(transplant) | 293 | 65 |
| AFP(follow-up) | 7 | 1 |
| Neoadjuvant Chemotherapy | Cisplatin based; 2.5 cycles | VCN/IRN; 3 cycles |
| Waitlist Days | 43 | 63 |
| Graft | Liver, small bowel, pancreas, stomach | Liver, small bowel, pancreas, stomach, spleen |
| Immunosuppression | Thymoglobulin, prednisone, FK | Thymoglobulin, prednisone, FK |
| Length of Stay(days) | 32 | 219 |
Conclusion:MVT should be considered for patients with hepatoblastoma and mesenteric vascular involvement mandating total portomesenteric resection.
To cite this abstract in AMA style:
Potanos K, Fullington N, Cauley R, Vakili K, Kim H. Multivisceral Transplantation for Unresectable Hepatoblastoma: Single Center Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/multivisceral-transplantation-for-unresectable-hepatoblastoma-single-center-experience/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress