Liver transplantation for primary hepatic malignancies of childhood: The UNOS experience

Background/purpose: The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies. Methods: The United Network for Organ Sharing (UNOS) database was queried for all patients < 18 years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 (n = 544). Five-year patient and graft survival were determined using Kaplan–Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model. Results: The majority of patients were diagnosed with hepatoblastoma (HB) (n = 376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant. Conclusions: In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types. Type of study: Case series with no comparison group. Level of evidence: IV.