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Liver Transplant for Posthepatectomy Liver Failure in Hepatoblastoma
Yuta Hirata1, Yukihiro Sanada, Takahiko Omameuda
1>From the Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan.
Insights
Predicting posthepatectomy liver failure in pediatric hepatoblastoma is crucial. A remnant liver volume under 40% after surgery indicates a high risk, necessitating careful evaluation.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Surgery
- Liver Transplantation
Background:
- Posthepatectomy liver failure is a significant risk in extended hepatectomy, especially in pediatric hepatoblastoma.
- Current methods for evaluating liver function and improving it preoperatively in children are limited.
Observation:
- This study examined four pediatric hepatoblastoma patients with Pretreatment Extent of Disease III who developed posthepatectomy liver failure.
- Surgical procedures included right trisegmentectomy and extended left hepatectomy.
- All patients experienced cholangitis and subsequent liver failure, requiring living donor liver transplantation.
Findings:
- The median remnant liver volume after hepatectomy was 33.3%.
- Peak serum total bilirubin levels reached 11.4 mg/dL.
- All four patients successfully underwent living donor liver transplant without recurrence.
Implications:
- A predictive remnant liver volume below 40% via computed tomography-volumetry before extended hepatectomy for hepatoblastoma suggests a significant risk of posthepatectomy liver failure.
- This finding aids in preoperative risk stratification and management planning for pediatric hepatoblastoma patients undergoing major liver resection.
Objectives:
Predicting the risk of posthepatectomy liver failure is important when performing extended hepatectomy. However, there is no established method to evaluate liver function and improve preoperative liver function in pediatric patients.
Materials And Methods:
We show the clinical features of pediatric patients who underwent living donor liver transplant for posthepatectomy liver failure in hepatoblastoma. The subjects were 4 patients with hepatoblastoma who were classified as Pretreatment Extent of Disease III, 2 of whom had distal metastasis (chest wall and lung).
Results:
Hepatic right trisegmentectomy was performed in 3 patients and extended left hepatectomy in 1 patient. The median alpha-fetoprotein level at the diagnosis of hepatoblastoma was 986300 ng/mL (range, 22500-2726350 ng/mL), and the median alpha-fetoprotein level before hepatectomy was 8489 ng/mL (range, 23-22500 ng/mL). The remnant liver volume after hepatectomy was 33.3% (range, 20% to 34.9%). Four patients had cholangitis after hepatectomy and progressed to posthepatectomy liver failure. The peak serum total bilirubin after hepatectomy was 11.4 mg/dL (range, 8.7-14.6 mg/dL). Living donor liver transplant was performed for these 4 patients with posthepatectomy liver failure, and they did not have a recurrence.
Conclusions:
When the predictive remnant liver volume by computed tomography-volumetry before extended hepatectomy for patients with hepatoblastoma is less than 40%, the possibility of posthepatectomy liver failure should be recognized.
