METHODS
A total of 28 primary pediatric LDLT for HB were performed in patients under 18 years of age at Hospital Sírio-Libanês and A. C. Camargo Cancer Center, São Paulo, Brazil, from 1996 to 2019. The clinical variables collected were gender, age, PELD score (Pediatric End-Stage Liver Disease scoring system), type of neoadjuvant Qtx (PLADO versus other regimens), pre- and post-Qtx AFP levels, %AFP reduction post Qtx (AFP pre-Qtx – AFP post-Qtx/AFP pre-Qtx), PRETEXT stage, primary versus rescue LDLT, time between diagnosis and LDLT, presence of metastases at diagnosis, follow-up time. These variables were used for determining the factors associated with event-free and overall survival in this cohort. An event was defined as HB recurrence or patient death, whichever came first. The patients were then divided in two groups: Event-No and Event-Yes. Rescue transplant was defined as transplant after a previous liver resection for HB.
Pulmonary metastasis at the time of diagnosis was not considered a contra-indication for transplantation as long as it was treated either with surgery or achieved complete remission after chemotherapy.
The same medical team was responsible for the clinical and surgical transplantation procedures in both hospitals. All patients were referred to our center by different pediatric oncology centers in the country and had received pre-transplant chemotherapy regimen as determined by each center. In this retrospective study, data was acquired through review of medical records and from a prospectively collected database. The hospitals’ ethics committee approved this study. Vascular invasion was studied only in liver explant analysis.