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UNRESECTABLE HEPATOBLASTOMA, LIVING DONATION AND PRE-TRANSPLANT FACTORS ASSOCIATED WITH EVENT-FREE SURVIVAL
  • +13
  • Joao Seda-Neto,
  • Flávia Feier,
  • Renata Pugliese,
  • Helry Candido,
  • Rodrigo Vincenzi,
  • Gilda Porta,
  • Irene Miura,
  • Vera Baggio,
  • Adriana Porta,
  • Celso Rodrigues,
  • Cecilia da Costa,
  • Renato Melaragno,
  • Sidnei Epelman,
  • Ana Paula Winneschhofer,
  • Eduardo Fonseca,
  • Paulo Chapchap
Joao Seda-Neto
Hospital Sirio-Libanes
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Flávia Feier
Hospital Sirio Libanes
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Renata Pugliese
Hospital Sirio Libanes/ Hospital AC Camargo
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Helry Candido
Hospital Sirio Libanes
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Rodrigo Vincenzi
Hospital Sirio Libanes
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Gilda Porta
Hospital Sirio Libanes/ Hospital AC Camargo
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Irene Miura
Hospital Sirio Libanes/ Hospital AC Camargo
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Vera Baggio
Hospital Sirio Libanes
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Adriana Porta
Hospital Sirio Libanes/ Hospital AC Camargo
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Celso Rodrigues
Hospital Sirio Libanes
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Cecilia da Costa
Fundação Antônio Prudente
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Renato Melaragno
Hospital do Câncer AC Camargo
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Sidnei Epelman
Hospital Santa Marcelina de Sao Paulo, Brazil
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Ana Paula Winneschhofer
Hospital Infantil Joana de Gusmao
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Eduardo Fonseca
Hospital Sirio Libanes
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Paulo Chapchap
Hospital Sirio Libanes
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Abstract

Background: Hepatoblastoma (HB) treatment has improved over time with established chemotherapy (Qtx) protocols, and liver resection or liver transplantation (LT). However, the right timing for LT and adequate patient selection are key to achieve acceptable disease-free survival rates in patients with unresectable HB. Few groups have reported such factors in the setting of living donor liver transplantation (LDLT). Procedure: This single-center retrospective analysis of 28 children with HB submitted to LDLT aimed at determining the pre-transplant factors associated with worse post-transplant event-free survival. Results: Patients were divided in groups according to the occurrence of the event (recurrence/death) after LDLT – 10 patients in the event-yes and 18 patients in the event-no. Probability of 5-y event-free survival was 63.9%. Alpha-fetoprotein (AFP) reduction post-Qtx > 70% had a good performance for the occurrence of the event, with a calculated AUC of 0.8. A scoring system was derived from the pre-transplant risk factors (AFP reduction < 70%, time from diagnosis to LDLT > 12 months, rescue LT) for the probability of the event: no risk factor present (15.4%), one risk factor present (33.3%), and > 2 risk factors present (66.7%), (p=0.02). Conclusion: LDLT for HB is the preferred treatment option for unresectable HB, with no distant metastasis and adequate response to Qtx. The pre-transplant factors composing the risk score should be critically evaluated in order to move forward with the LDLT. However, due to the limited number of patients in this study, a larger number of patients is required to corroborate these findings.