Pathologic Vascular Invasion Correlates with Worse Outcome in Hepatoblastoma Patients Treated with Liver Transplantation – A Hepatoblastoma Transplant Consortium Study
1Baylor College of Medicine, Houston, TX, 2Texas Children's Hospital, Houston, TX, 3Department of Surgery, Baylor College of Medicine, Houston, TX, 4Department of Surgery, Duke University School of Medicine, Durham, NC, 5Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 6Department of Surgery, Boston Children's Hospital, Boston, MA, 7Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, 8Department of Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, 9Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, 10Department of Pediatric Surgery, Texas Children's Hospital, Houston, TX
Meeting: 2019 American Transplant Congress
Abstract number: D382
Keywords: Liver transplantation, Malignancy, Outcome, Pediatric
Session Information
Session Name: Poster Session D: Late Breaking
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Orthotopic liver transplant (OLTx) is the most common method to treat unresectable hepatoblastoma (HB) in children. There is limited data focusing on the outcomes of children treated with OLTx due to the limited experience of any one center. We organized a consortium of institutions performing OLTx for HB to focus on pathologic vascular invasion within the explant and how this affects outcome.
*Methods: All children less than 18 years old from five institutions transplanted between August 2000 and December 2016 were included in the analysis. Several demographic, clinical, and pathologic factors were analyzed using Log-Rank and multivariate Cox-Proportional Hazard tests to determine 60-month disease-free and overall survival.
*Results: One hundred nine patients were included in the analysis. The median age at diagnosis (dx) was 20.8 months with a median follow up of 50.9 months. 20 patients had metastatic HB, while 89 of the patients had non-metastatic HB. Treatment prior to OLTx included: chemotherapy (108) and surgical resection (10). The median age at OLTx was 25.0 months. Adjuvant chemotherapy was administered in 71% (76) of cases. Pre-operative vascular invasion was defined by imaging and did not correlate with outcome. Explant pathology revealed 47% (47) vascular invasion, 34% (31) microvascular invasion (MiVi), and 28% (28) macrovascular invasion. Univariate analysis demonstrated that MiVi within the primary tumor (MiVi-wpt) and overall MiVi all significantly correlated with worse disease-free and/or overall survival (p< 0.034). The multivariate analysis revealed a statistically significant correlation with MiVi within the primary tumor and worse overall survival (p = 0.0457, hazard ratio = 2.79). The 5 year disease-free for MiVi-wpt vs. no MiVi was 62.2% and 88.1%, respectively. The 5 year overall survival was 68.2% (MiVi-wpt) vs. 90.3% (without MiVi).
*Conclusions: This represents the largest collective experience with OLTx for HB patients. Pathologic MiVi within the primary tumor correlated with worse overall survival, and may be a marker for more intensified chemotherapy to improve outcome.
To cite this abstract in AMA style:
Malik TH, Zhu H, Ha T, Commander S, Trautz C, Sindhi R, Kim S, Vakili K, Vachharajani N, Chapman W, Griesemer A, Martinez M, Goss JA, Vasudevan S. Pathologic Vascular Invasion Correlates with Worse Outcome in Hepatoblastoma Patients Treated with Liver Transplantation – A Hepatoblastoma Transplant Consortium Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/pathologic-vascular-invasion-correlates-with-worse-outcome-in-hepatoblastoma-patients-treated-with-liver-transplantation-a-hepatoblastoma-transplant-consortium-study/. Accessed May 8, 2025.« Back to 2019 American Transplant Congress