Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma

Area of Science:

• Hepatobiliary surgery
• Transplant oncology
• Gastroenterology

Background:

• Cholangiocarcinoma (CCA) is a contraindication for liver transplantation (LT) in the UK.
• Incidental CCA, diagnosed post-transplant, presents a unique clinical scenario.
• Understanding outcomes is crucial for refining transplant eligibility criteria.

Purpose of the Study:

• To retrospectively analyze outcomes of patients who underwent LT with incidental CCA.
• To compare survival rates based on tumor characteristics and anatomical location.
• To evaluate the potential role of LT in selected CCA cases.

Main Methods:

• Retrospective analysis of 95 patients undergoing LT between 1988-2020 across six UK LT centers.
• Data collected included tumor characteristics (TNM staging, anatomical location) and post-transplant survival.
• Survival analysis stratified by tumor site (intrahepatic vs. perihilar) and stage (pT1 vs. pT2-4).

Main Results:

• Overall median survival after LT for incidental CCA was 4.4 years.
• Intrahepatic CCA showed better survival (5-year survival 57.1%) compared to perihilar CCA (5-year survival 30.2%).
• Early-stage (pT1) incidental CCA had significantly better survival (5-year survival 80.6%) than advanced stages (pT2-4, 5-year survival 31.1%).

Conclusions:

• Survival after LT for incidental CCA is generally inferior to standard LT outcomes.
• Early-stage and intrahepatic CCA subtypes demonstrate promising survival rates post-LT, comparable to hepatocellular cancer.
• These findings suggest that LT may be a viable option for carefully selected patients with early-stage CCA.