Orthotopic liver transplantation for patients with Klatskin tumor

It is not certain whether Klatskin tumor should be a routine indication for orthotopic liver transplantation (OLT). This study was to summarize the indication and value of orthotopic liver transplantation for patients with Klatskin tumor.

Forty patients with Klatskin tumors including 5 patients who had had liver transplantation (LTx) and 35 patients who had not undergone LTx (WLTx) from January 1992 to December 2003 were analyzed retrospectively. Their TNM stages were comparable in both groups. In the LTx group, 4 patients had Klatskin tumor including recurrent tumor after resection(1), and 1 cancerization from Carolis disease. Biliary duct anastomosis was made by Roux-en-Y choledochojejunostomy in 2, and end-to-end choledochocholedochostomy (C-C) in 3.

In the LTx group, the total resection rate and radical resection rate were both 100%. Four patients have been surviving for 48, 38, 21 and 5 months, respectively, except one died from bile leakage at day 40 after transplantation. All 4 survivors enjoyed good life without tumors at local and distant sites, even though 2 of these patients developed biliary stricture, which was soon resolved by radiological intervention. The 1-,3-year survival rates were both 80% in this group. The total resection rate and radical resection rate in the WLTx group were 63.0%(17/27)and 40.7%(11/27)and, the 1-, 3-, 5-year survival rates were 32.2%, 8.0%, 0%, respectively. There were significant differences between the two groups in radical resection rates and survival rates(P=0.016).

OLT is a good choice for patients with unresectable Klatskin tumor by routine modalities. The prognosis of patients undergoing OLT is encouraging.