Abstract

Background: Hepatoblastoma is the most common malignant tumor in the paediatric age group. Liver transplantation(LT) eliminates macroscopic residual disease, hence it’s a preferred treatment for high risk hepatoblastoma. While improved outcomes with standardized protocols have demonstrated in the west, there remains very little data from the Indian subcontinent. We attempt to bridge this gap by presenting data on outcomes of living donor liver transplantation(LDLT) for hepatoblastoma.

Methods: A retrospectively collected database of over a decade (2010-2022) of children with hepatoblastoma who underwent LT was analyzed.

Results: Of the 76 children with hepatoblastoma, 25(33%) underwent LDLT from our unit. All children received protocoled neoadjuvant chemotherapy before LT. On POST TEXT assessment 21 children for nonresectable tumor, two for tumor recurrence following hepatectomy, one for Beckwith-wiedemann syndrome and two for associated Abernathy malformation underwent LT. Hepatocellular carcinoma like foci has been identified in 20%(n=5) of the explant liver. Tumor recurrence has been seen in 24%(n=6) children post LT. Two children with rising AFP after neoadjuvant chemotherapy, two children with tumor recurrence post hepatectomy and four children with HCC like features in explant liver developed tumor recurrence post LT.  The median follow-up period for the study was 95 months. The overall survival rate at 1 year, 3 year and 5 year following LT was 88%, 72%, 72% respectively.

Conclusion: Our post LT outcomes for hepatoblastoma is comparable with SIOPEL studies. This experience shows that excellent post LT outcomes can be achieved for hepatoblastoma, even in a resource-challenged setting with careful selection of patients through multi disciplinary meeting.