Rare Malignant Indications for Liver Transplantation: A Collaborative Transplant Study Report

Area of Science:

• Hepatobiliary surgery
• Transplant oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) is the primary malignant indication for liver transplantation (LT).
• Other rare malignant indications for LT include cholangiocarcinoma (CCC), neuroendocrine tumors (NET), and liver sarcomas (LSAR).
• Limited data exists on post-LT outcomes for these rare malignancies.

Purpose of the Study:

• To compare graft and patient survival after LT among patients with HCC, CCC, NET, and LSAR.
• To identify differences in outcomes for rare malignant indications for LT.

Main Methods:

• Analysis of 14,623 LTs performed between 1988 and 2017.
• Data from patients with HCC, CCC, NET, and LSAR reported to the Collaborative Transplant Study.
• Graft and patient survival rates were analyzed using multivariable Cox regression.

Main Results:

• Cholangiocarcinoma (CCC) patients exhibited a 5-year graft survival rate of 32.1%, significantly lower than HCC (63.2%), NET (51.6%), and LSAR (64.5%) patients.
• CCC patients had a significantly higher risk of graft loss and cancer-related death within five years post-LT compared to HCC patients.
• Increased risks were observed for NET and LSAR patients but did not reach statistical significance.

Conclusions:

• Cholangiocarcinoma (CCC) patients demonstrate significantly poorer graft and patient survival following liver transplantation (LT) compared to hepatocellular carcinoma (HCC) patients.
• These survival disparities may necessitate re-evaluation of current LT indication criteria and palliative care strategies for specific liver malignancies.