title: Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: new trends and future opportunities.
abstract: BACKGROUND
  Liver transplantation (LTx) for hepatoblastoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes.
  
  
  METHODS
  To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35).
  
  
  RESULTS
  In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P = .049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P = .016), and tumor necrosis <50% (P = .013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P = .0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy.
  
  
  CONCLUSIONS
  Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.
authors: Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Ruy J
authors: RJ
authors: Cruz
authors: Sarangarajan
authors: S
authors: Ranganathan
authors: George
authors: G
authors: Mazariegos
authors: Kyle
authors: K
authors: Soltys
authors: Navdeep
authors: N
authors: Nayyar
authors: Qing
authors: Q
authors: Sun
authors: Geoffrey
authors: G
authors: Bond
authors: Peter H
authors: PH
authors: Shaw
authors: Kimberly
authors: K
authors: Haberman
authors: Lakshmanan
authors: L
authors: Krishnamurti
authors: J Wallis
authors: JW
authors: Marsh
authors: Abhinav
authors: A
authors: Humar
authors: Rakesh
authors: R
authors: Sindhi
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D018197:Hepatoblastoma / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology