Safety of minimal immunosuppression in liver transplantation for hepatoblastoma.
BACKGROUND
Despite aggressive chemotherapy, recurrence of disease remains the leading cause of death after liver transplantation (LTx) for hepatoblastoma (HB). Unfortunately, little is known about the effects of immunosuppression on recurrence and posttransplant outcomes. We hypothesized that minimal immunosuppression can be safely used in these recipients.


METHODS
In 2004, we adopted a minimal immunosuppression regimen using daclizumab induction and tacrolimus monotherapy. Kaplan-Meier survival curves were generated.


RESULTS
From 2004 to 2006, 6 children underwent primary LTx for HB with neoadjuvant and adjuvant chemotherapy. Patient survival was 100% at 12 months and at 24 months, without graft loss. One patient died 28 months after transplantation. Recurrence-free survival was 83% at 12 months and at 24 months. Despite minimal immunosuppression (IS), 4 of 6 HB recipients remained rejection-free. When compared to other LTx recipients receiving minimal IS, HB recipients trended to have better rejection-free survival (HB, 83% at 12 months and 62.5% at 24 months vs all others, 36% and 36%, respectively; P = .19).


CONCLUSIONS
Our short-term patient and graft survival rates are comparable to those reported for all HB recipients in the United Network for Organ Sharing database. Although not statistically significant, our rejection-free survival data suggest that HB recipients may be less likely to reject than other recipients.
Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
Matthew Y
MY
Suh
Kathleen
K
Wang
Jordan R
JR
Gutweiler
Meghna V
MV
Misra
Laura E
LE
Krawczuk
Roger L
RL
Jenkins
Craig W
CW
Lillehei
Maureen M
MM
Jonas
Heung Bae
HB
Kim
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D002675:Child, Preschool; D000077561:Daclizumab; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy; D006085:Graft Survival / Q000187:drug effects; D018197:Hepatoblastoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality*; D008297:Male; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D000077561:Daclizumab; D016559:Tacrolimus