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Primary Multivisceral Transplantation in a Child with Hepatoblastoma and Portomesenteric Thrombosis

Andres, Ane1; Hernandez, Francisco1; Sanchez-Montenegro, Carlos1; Romo, Martha1; De la Torre, Carlos1; Encinas, Jose Luis1; Martinez, Leopoldo1; Garcia-Miguel, Purificacion3; Prieto, Gerardo2; Lopez-Santamaria, Manuel1

doi: 10.1097/01.tp.0000521452.66335.fe
1a.126

1Pediatric Surgery, Hospital La Paz, Madrid, Spain; 2Pediatric Gastroenterology, Hospital La Paz, Madrid, Spain; 3Pediatric Oncohematology, Hospital La Paz, Madrid, Spain.

Unresectable hepatoblastoma can be successfully treated by liver transplantation, provided there is no extrahepatic involvement. The objective of this article is report the experience of a new indication for multivisceral transplant in a pediatric patient with diagnosis of unresectable tumor.

A 3 years old patient with diagnosis of mixed hepatoblastoma (epithelial-mesenchymal) pretreatment extent of disease IV with multiple bilateral liver tumors and involvement of mesenteric axis (complete thrombosis of the splenoportal axis and the superior mesenteric vein) that contraindicated isolated liver transplantation. At diagnosis the alpha-fetoprotein levels were 263,400 ng/ml. He was treated according to SIOPEL chemotherapy protocol prior to inclusion in multivisceral transplant list that was carried out in February 2015. A multivisceral transplantation including liver, stomach, duodenum, pancreas, small intestine and colon was performed. He has developed with a good outcome, a normally functioning graft and digestive autonomy with a survival of 24 months’ post-transplant and normal levels of alpha-fetoprotein.

Should be consider the possibility of realization of multivisceral transplantation in patients’ carriers of tumors with extensive deep thrombosis of the splenic-portal axis (StageIII-IV), that do not respond to conventional treatment or not possible to do by their extension.

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