Benefit of early inflow exclusion during living donor liver transplantation for unresectable hepatoblastoma.
BACKGROUND
Hepatoblastoma (HB) is a highly malignant primary liver tumor in children. Although liver transplantation (LT) is an effective treatment for unresectable HB with good long-term outcomes, post-transplant survival is mainly affected by recurrence, despite adjuvant chemotherapy. Novel strategies are needed to improve the outcomes in patients undergoing LT for unresectable HB.


METHODS
Twelve children received LT for unresectable HB. In 9 patients, we applied early exclusion of hepatic inflow (hepatic artery and portal vein) and creation of a temporary portocaval shunt during LT.


RESULTS
There were differences in the duration of and the blood loss during operation as compared with previously reports. The estimated glomerular filtration rate was well preserved at 3, 6, and 12months and the latest follow-up after LT, and the recurrence-free survival was 88.9%.


CONCLUSIONS
Early inflow control during LT for unresectable HB may benefit recurrence-free survival by minimizing blood loss and tumor dissemination, preserving renal function and allowing early adjuvant chemotherapy.
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan. Electronic address: uchida-h@ncchd.go.jp.
Hajime
H
Uchida
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Akinari
A
Fukuda
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Kengo
K
Sasaki
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Yoshihiro
Y
Hirata
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Takanobu
T
Shigeta
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Hiroyuki
H
Kanazawa
Division of Clinical Pathology, National Center for Child Health and Development, Tokyo, Japan.
Atsuko
A
Nakazawa
Division of Radiology, National Center for Child Health and Development, Tokyo, Japan.
Osamu
O
Miyazaki
Division of Radiology, National Center for Child Health and Development, Tokyo, Japan.
Shunsuke
S
Nosaka
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Vidyadhar Padmakar
VP
Mali
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Seisuke
S
Sakamoto
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Mureo
M
Kasahara
D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D018197:Hepatoblastoma / Q000098:blood supply / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Hepatoblastoma; Liver transplant; Surgical technique