Liver Transplantation in Children with Advanced Hepatoblastoma: a Systematic Review and Meta-Analysis

Surgery is a key factor for the curative treatment of hepatoblastoma. Recent evidence suggests that liver transplantation has a strong effect in treating advanced hepatoblastoma. However, there is no consensus on the effects of liver transplantation. This meta-analysis aims to identify the efficacy and safety of liver transplantation for advanced hepatoblastoma, compared with those of conventional liver resection. Electronic databases were searched for relevant studies published prior to June 2022 to evaluate the survival benefit and safety in patients with advanced hepatoblastoma. The primary outcomes were the overall survival and disease-free survival rates, and the secondary outcomes were the complication and tumor recurrence rates. Five relevant clinical studies with a total of 134 participants were included in this meta-analysis. Compared with aggressive liver resection, liver transplantation had similar overall survival rates and disease-free survival rates after 1 year, 3 years, and 5 years (odds ratio (OR) 1 year = 0.89, 95% CI 0.21–3.79, P = 0.88; OR 3 years = 0.54, 95% CI 0.16–1.81, P = 0.32; OR 5 years = 1.24, 95% CI 0.22–6.82, P = 0.81; OR disease-free 1 year = 2.17, 95% CI 0.56–8.42, P = 0.26; OR disease-free 3 years = 1.42, 95% CI 0.48–4.17, P = 0.53; OR disease-free 5 years = 2.91, 95% CI 0.56–8.52, P = 0.26), tumor recurrence rates (OR = 0.62, 95% CI 0.24–1.60, P = 0.32), and complication rates (OR = 1.46, 95% CI 0.48–4.49, P = 0.51). Sensitivity analysis also demonstrated the same outcomes in terms of the tumor recurrence rate, complication rate, and overall and disease-free survival rates after 1 year, 3 years, and 5 years. The funnel plot indicated a low publication bias. Liver transplantation is an excellent option for advanced hepatoblastoma in children with acceptable perioperative complications, which is not inferior to liver resection. And liver transplantation should be considered the primary curative option when liver resection is not possible.