Lurie Children’s

Lurie Children’s Case Study: Pediatric Hepatoblastoma & Liver Transplantation

This case study describes the multidisciplinary care provided by the liver transplantation specialists at Ann & Robert H. Lurie Children’s Hospital of Chicago. The patient described in the study is a 6-year-old girl who was diagnosed with hepatoblastoma.

Initial diagnosis & treatment

The 6-year-old female was diagnosed with hepatoblastoma in Dubai. Hepatoblastoma is a very rare cancerous tumor that originates in the liver. The liver consists of right and left lobes, and in some children, parts of both lobes can be involved. Hepatoblastoma cancer cells can also spread (metastasize) to other areas of the body. The most common sites of metastasis are the lungs.

The tumor lesions in her liver were in both lobes, and she also presented with metastases to her lungs. According to the PRETEXT classification of hepatoblastoma, she was classified as PRETEXT III P1V1M1, which indicated that the tumor was involved in at least three of the four major parts of the liver. It also meant that she had both portal and hepatic venous involvement and lung metastases. The portal vein and hepatic veins are major blood vessels that bring blood in and out of the liver respectively. After an initial biopsy done to confirm the diagnosis, she underwent five cycles of chemotherapy in Dubai to shrink the tumor. The chemotherapy successfully cleared the lungs of the tumor and significantly reduced its size in the liver, though it still involved both lobes. The patient’s doctors in Dubai were concerned that any surgery to remove the tumor, short of transplantation, would be hazardous.

Lurie Children’s second opinion & comprehensive evaluation

While in Dubai, the patient was referred to a center in Germany that recommended liver transplantation. The patient then traveled to our facility in Chicago for a second opinion. Our team reviewed the biopsy slides from Dubai and determined that the tumor was a transitional cell tumor that incorporated both elements of hepatoblastoma and hepatocellular carcinoma (HCC). We decided to attempt to remove the tumor without transplanting the liver.

Lurie Children’s hepatobiliary tumor specialists have done studies on the best course of treatment for primary hepatic tumors that had been referred for transplantation from other centers. We’ve found that aggressive surgical excision (removal) is often the best course of treatment. Not only does excision allow the child to avoid an unnecessary transplant and extensive follow-up care, but it also helps make scarce organs available to children with no other options.

Surgical excision

Lurie Children’s surgeon Riccardo Superina, MD, performed the procedure, which began with excision of the right sided tumor under total vascular isolation. A portion of her inferior vena cava was excised and reconstructed. She then also had tumor thrombus invading the main portal and extending up the left portal. This required excision of the vein and primary anastomosis. The left lobe lesion was then removed, making the excision of the tumor complete. The child is making a good recovery and will continue with the post-surgery chemotherapy at our center before returning to Dubai.

Lurie Children’s Transplant Surgery and Liver Transplantation Program

Many children are referred to Lurie Children’s for possible liver transplantation, though the majority of these patients undergo corrective surgery that does not require liver replacement. Over the last five years, many children have been referred from abroad for corrective surgery and have been successfully repatriated without needing a transplant.

For children who are in need of transplantation, we have one of the largest and most experienced pediatric liver transplant teams in the country. Our Pediatric Liver Transplantation Program performs more liver transplants in children than any other center in the region, and it ranks in the top 10 in the United States in the number of liver transplants performed each year. As of January 2013, the team had performed more than 300 liver transplants since the program began in 1997.

The consumerization of healthcare: Who will be our trusted advisors?

Healthcare Technology The consumerization of healthcare: Who will be our trusted advisors? Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Dubai, based on the medical scan you had in the United States. This future is far closer that you might think, due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in health care and personal wellbeing.

In just a few years, mobile technologies have led to tremendous innovation in consumer health tools. Research and development is focusing on health conditions over a person’s lifetime and on holistic care, generating constant learning through analytics and algorithms that identify patterns and behaviors. Social and digital technologies herald a new dawn of collaboration and cooperation that reach out to communities of people with similar conditions, engaging them in ways which were never before possible. We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analyzing personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time, it will not be the chronically ill but the healthy people who will invest the most in managing their health.

Digitalization and consumerization will rattle the healthcare industry. It is already revolutionizing the business models of traditional healthcare companies and providers. Innovation is not only about adding a new channel or connecting a product, it is a complete redesign of long-established practices, adjustment of systems and processes. Most importantly, it calls for a change of culture in companies to reflect the new opportunities – and challenges – presented by the digital world. There is a tremendous opportunity to consumerize healthcare, but to drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology and clinical applications and informatics.

These advances may not only open the doors wider for traditional healthcare providers – with consumerization, companies without healthcare expertise but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market and in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative health care – in many cases only limited by their imaginations. For example, we may see virtual reality technology moving from the gaming industry to healthcare for improving patients’ rehabilitation after a stroke.

While these new propositions tackle a number of the healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable and open, and the user experience needs to be harmonized.

Perhaps one of the most important challenges is related to people’s behavior and preferences. Regardless of whether these new and existing companies are analyzing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors. Consumers, patients and professionals alike will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies who know how to offer us tailored, cuttingedge solutions combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisors in health.

 Date of upload: 14th Nov 2014


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