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Transplantation Within 6 Months of Registration does not Enhance Survival for Patients with Perihilar Cholangiocarcinoma

  • 0Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.
Annals of Surgery +

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July 5, 2024

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July 5, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Waiting at least six months for a liver transplant optimizes outcomes for perihilar cholangiocarcinoma (pCCA) patients. This waiting period does not negatively impact overall patient survival in the intention-to-treat cohort.

Area Of Science

  • Hepatobiliary surgery
  • Transplant oncology
  • Gastroenterology

Background

  • Perihilar cholangiocarcinoma (pCCA) is a challenging diagnosis.
  • Neoadjuvant therapy followed by liver transplantation offers a viable treatment for select pCCA patients.
  • Optimal timing for liver transplantation in pCCA remains undetermined.

Purpose Of The Study

  • To determine if the timing of liver transplantation influences patient mortality in the context of pCCA treatment.
  • To analyze the association between waiting time for transplantation and patient survival outcomes.

Main Methods

  • Retrospective review of patients undergoing a standardized pCCA protocol (1996-2020).
  • Analysis of an intention-to-treat cohort (n=392) and a transplant recipient cohort (n=256).
  • Statistical adjustment for confounders to assess the impact of waiting time on mortality.

Main Results

  • Longer waiting times (3-12 months) did not increase all-cause mortality compared to short waits (0-3 months).
  • Waiting times of 6-9 months and beyond showed a trend towards decreased all-cause mortality.
  • Waiting times of at least 6 months were associated with decreased all-cause mortality post-transplantation (HR 0.92), with benefits increasing after 9 months (HR 0.43).
  • No association was found between waiting time and residual adenocarcinoma in explants.

Conclusions

  • A waiting time of at least 6 months is recommended to optimize outcomes for liver transplantation in pCCA.
  • This waiting period does not adversely affect overall intention-to-treat patient survival.
  • Longer waits may confer survival benefits post-transplantation.