Liver Transplant for Perihilar Cholangiocarcinoma (Klatskin Tumor): The Essential Role of Patient Selection

Dondorf, Felix; Uteβ, Frank; Fahrner, René; Felgendreff, Philipp; Ardelt, Michael; Tautenhahn, Hans‐Michael; Settmacher, Utz; Rauchfuβ, Falk

doi:10.6002/ect.2018.0024

Cited by 14 publications

(6 citation statements)

References 34 publications

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“…This is especially true in the case of LDLT, which poses a risk to healthy donors. Going forward, further studies are thus called for concerning case selection criteria, selection of immunosuppressive therapy, and combined use with adjuvant therapy 38‐40 …”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Eguchi

Hidaka

Hara

et al. 2022

Annals of Gastroent Surgery

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According to the national registration in Japan, reported by the Japanese Liver Transplantation Society, 14 cholangiocellular carcinoma (CCC) were performed in Japan from 1992 to the end of 2019 because of out-of-pocket health insurance coverage and relative contraindication. 1 However, in recent years, relatively good prognoses in patients receiving liver transplantation (LT) for hilar CCC (hCCC) have been reported after intensive pretransplant chemoradiotherapy and by carefully selecting cases using deceased donor livers. [2][3][4] In general, it is not easy to distribute deceased donor organs to patients in Japan, where the number of brain-dead donors is significantly limited compared to other countries. As a result, living-donor LT is often the only option, despite not being covered by health insurance. Intrahepatic CCC (IHCCC) had been considered a contraindication for LT because of poorer outcomes. However, with recent advances in chemotherapy, an indication for LT for IHCCC is becoming an important topic, but no definitive results have yet been shown. This paper introduces updated results and progress of LT for CCC stratified by intrahepatic and hilar methods.

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Section: Discussionmentioning

confidence: 99%

“…Going forward, further studies are thus called for concerning case selection criteria, selection of immunosuppressive therapy, and combined use with adjuvant therapy. [38][39][40] D I SCLOS U R E S…”

Section: Con Clus Ionsmentioning

confidence: 99%

Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Eguchi

Hidaka

Hara

et al. 2022

Annals of Gastroent Surgery

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“…After one year, the survival rate of all tumor patients was 35%, which is low and much lower than in hepatocellular carcinoma patients[ 39 - 41 ] or selected surgical treated cholangiocarcinoma patients[ 42 - 45 ]. At least 32% had tumor recurrence during the observation period, but five studies did not report any data about recurrence.…”

Section: Discussionmentioning

confidence: 99%

Risk of malignancy in Caroli disease and syndrome: A systematic review

Fahrner¹,

Dennler²,

Inderbitzin³

2020

WJG

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BACKGROUND Congenital intrahepatic bile duct dilatation without fibrosis is called Caroli disease (CD), and is called Caroli syndrome (CS) when it has fibrotic and cirrhotic liver morphology. The development of intrahepatic carcinoma is described in both conditions, but the reported incidence varies extensively. Potential risk factors for the malignant transformation were not described. Furthermore, conservative or surgical treatment is performed depending on the extent of cystic malformation, hepatic dysfunction and structural hepatic changes, but little is known about which treatment should be offered to patients with CD or CS and cancer. AIM To further investigate the malignant transformation in these conditions. METHODS A systematic review of the current literature until January 2019 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A search using Medline (PubMed) was performed using a combination of Medical Subject Headings terms “caroli disease”, “caroli syndrome”, “tumor”, “malignant”, and “cholangiocarcinoma”. Only human studies published in English were used for this systematic review. The following parameters were extracted from each article: year of publication, type of study, number of patients, incidence of malignant tumor, duration of symptoms, age, sex, diagnostics, identification of tumor, surgical therapy, survival and tumor recurrence. RESULTS Twelve retrospective studies reporting the courses of 561 patients (53% females) were included in this systematic review. With a mean age of 41.6 years old (range 23 to 56 years old), patients were younger than other populations undergoing liver surgery. Depending on the size of the study population the incidence of cholangiocarcinoma varied from 2.7% to 37.5% with an overall incidence of 6.6%. There were only few detailed reports about preoperative diagnostic work-up, but a multimodal work-up including ultrasound of the liver, computed tomography, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography was used in most studies. Disease duration was variable with up to several years. Most patients had episodes of cholangitis, sepsis, fever or abdominal pain. Tumor detection was an incidental finding of the surgical specimen in most cases because it is currently often impossible to detect tumor manifestation during preoperative diagnostics. Liver resection or liver transplantation was performed depending on the extent of the biliary pathology and additional alterations of the liver structure or function. No postoperative adjuvant chemotherapy was reported, but chemotherapy was administered in selected cases of tumor recurrence. Overall survival rates after one year were low at 36% and a high recurrence rate of up to 75% during the observation period. CONCLUSION Only few retrospective studies reported a low tumor incidence. Despite the high rate of...

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“…pCCA is a rare disease and strict selection criteria make LT applicable only in a minority of patients. Difficulties in applying the Mayo protocol, especially with regards to brachytherapy, have discouraged many centers [85] or have led to replace brachytherapy by external stereotactic beam radiotherapy [86]. Preoperative chemoradiation associated with the need to perform lymphadenectomy of the hepatoduodenal ligament may increase technical difficulty and the rate of postoperative complications.…”

Section: Perihilar Cholangiocarcinomamentioning

confidence: 99%

Liver transplantation for tumor entities

Patrono,

De Stefano,

Romagnoli

2024

Current Opinion in Organ Transplantation

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Purpose of review Tumor entities represent an increasing indication for liver transplantation (LT). This review addresses the most contentious indications of LT in transplant oncology. Recent findings Patient selection based on tumor biology in LT for colorectal cancer liver metastases (CRLM) demonstrated promising long-term outcomes and preserved quality of life despite high recurrence rates. In selected cases, LT for intrahepatic cholangiocarcinoma (iCCA) is feasible, with acceptable survival even in high-burden cases responsive to chemotherapy. LT following a strict neoadjuvant protocol for perihilar cholangiocarcinoma (pCCA) resulted in long-term outcomes consistently surpassing benchmark values, and potentially outperforming liver resection. Summary While preliminary results are promising, prospective trials are crucial to define applications in routine clinical practice. Molecular profiling and targeted therapies pave the way for personalized approaches, requiring evolving allocation systems for equitable LT access.

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Liver Transplant for Perihilar Cholangiocarcinoma (Klatskin Tumor): The Essential Role of Patient Selection

Abstract: Liver transplant is a curative therapy for selected patients with irresectable Klatskin tumors, but further prospective studies are urgently needed.

Cited by 14 publications

References 34 publications

Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Risk of malignancy in Caroli disease and syndrome: A systematic review

Liver transplantation for tumor entities

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