Outcomes after living donor liver transplant for intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive liver cancer with limited curative options. Deceased donor liver transplant is associated with survival benefit in select patients with unresectable iCCA, although outcomes are limited by high waitlist mortality and use of expanded criteria grafts, given ongoing deceased donor scarcity. This retrospective, single-center study investigated outcomes for 7 patients who underwent living donor liver transplant for unresectable but liver-confined iCCA, managed under a transplant oncology protocol. The patients were selected for disease stability and otherwise met criteria for liver transplant. Six patients received pretransplant systemic chemotherapy, and 4 underwent locoregional therapy. Median listing model for end-stage liver disease score was 8 (interquartile range [IQR], 8-11), and patients spent a median of 38 days (IQR, 15-70 days) on the waitlist. Two patients experienced Clavien-Dindo grade III complications in the first 6 months. During a median follow-up of 5.1 years (IQR, 2.8-5.2 years), 2 patients experienced recurrence, and 1 died. Five-year Kaplan-Meier estimates for overall and recurrence-free survival were 85.7% (95% confidence interval, 33.4%-97.9%) and 71.4% (95% confidence interval, 25.8%-92.0%), respectively. All donors were alive at last follow-up. For selected patients with unresectable iCCA, living donor liver transplant may serve as a useful modality to provide oncologic benefit in the era of deceased donor liver scarcity.