Transplantation for Peri-Hilar and Intrahepatic Cholangiocarcinoma With mTOR Immunosuppression

Samar Semaan ¹, Ashton A Connor ², Ashish Saharia ²

¹Department of Surgery, Houston Methodist Hospital, Houston, TX.
²Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Surgery, Weill Cornell Medical College, New York, NY.
³Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX; Department of Medicine, Weill Cornell Medical College, New York, NY.
⁴Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX.
⁵Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Surgery, Weill Cornell Medical College, New York, NY; Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX.
⁶Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.
⁷Division of Medical Oncology, Department of Medicine, Houston Methodist Hospital, Houston, TX.
⁸Department of Medicine, Weill Cornell Medical College, New York, NY; Division of Medical Oncology, Department of Medicine, Houston Methodist Hospital, Houston, TX.
⁹Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
¹⁰Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.

⁰Department of Surgery, Houston Methodist Hospital, Houston, TX.

Transplantation Proceedings +

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February 12, 2025

View abstract on PubMed

Summary

Liver transplantation for cholangiocarcinoma (CCA) shows promising survival rates, especially for intrahepatic tumors without lympho-vascular invasion. Immunosuppression strategies require further investigation for optimal patient outcomes.

Area Of Science

Hepatobiliary Surgery
Transplant Oncology
Gastroenterology

Background

Cholangiocarcinoma (CCA) incidence and mortality are increasing globally.
Optimizing outcomes requires detailed data on combined therapies and patient selection for liver transplantation (LT).

Purpose Of The Study

To evaluate outcomes of LT for peri-hilar (PH) and intrahepatic (IH) CCA.
To identify factors influencing overall survival (OS) and recurrence-free survival (RFS) post-LT.
To assess the role of immunosuppression, including mTOR inhibition, in CCA LT.

Main Methods

Retrospective review of 53 patients with PH or IH CCA undergoing LT (2008-2023).
Analysis of neoadjuvant therapies, explant pathology, and post-transplant outcomes.
Cox proportional hazards models used to determine significance for OS and RFS.

Main Results

Three-year OS and RFS were 69.2% and 57.4%, respectively.
Intrahepatic CCA and absence of lympho-vascular invasion (LVI) were associated with better OS.
Age, BMI, primary sclerosing cholangitis (PSC), and locoregional therapy (LRT) impacted RFS.

Conclusions

LT offers significant survival benefits for selected CCA patients, particularly those with IH tumors and no LVI.
Current immunosuppression protocols, including mTOR inhibition, showed inconsistent associations with improved outcomes in this cohort.

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