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.