Outcomes Analysis for 280 Patients with Cholangiocarcinoma Treated with Liver Transplantation Over an 18-year Period

Abstract

Cholangiocarcinoma is an aggressive malignancy with 5-year survival rates<15%. Selected patients present with localized but unresectable disease and are candidates for orthotopic liver transplantation (OLT). The purpose of this study was to evaluate a multi-institutional experience with liver transplantation for this malignancy. Two hundred eighty patients with cholangiocarcinoma treated with OLT from 1987 to 2005 were identified in The United Network for Organ Sharing database. Patient and allograft survivals were calculated and the potential prognostic value of multiple clinicopathologic variables was assessed. At a median follow-up interval of 452 days (range: 0-6,166 days), 1- and 5-year patient survivals were 74 and 38%, respectively, with 49 actual 5-year survivors and 21 actual 10-year survivors. Posttransplant 1- and 5-year allograft survivals were 69 and 36%, respectively. Study variables associated with improved survivals included diagnosis of cholangiocarcinoma pre-OLT [5-year overall survival (OS): 68 vs. 20% for patients with incidental diagnoses at the time of OLT, p<0.001] and OLT after 1993 (5-year OS: 45 vs. 30% pre-1994, p<0.01). In contrast, the diagnosis of concomitant primary sclerosing cholangitis did not impact survivals (5-year OS: 41 vs. 50% without primary sclerosing cholangitis, p=0.402). Selected cholangiocarcinoma patients treated with OLT experience a survival benefit. Diagnosis of cancer prior to OLT allows for better staging and pre-OLT therapy that may translate into improved outcomes. These data support the continued development of multimodality cholangiocarcinoma treatment protocols that include OLT.

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

“…In 2002, Sudan et al [229] reported a series of 11 patients transplanted for CC after neoadjuvant chemoradiation with 45% tumor free survival and median follow up of 7.5 years. Similar reports have been reported by Becker et al [230] who observed a 45% 5-year survival for patients who were diagnosed as being affected by CC prior to undergoing transplantation, and a 33% 5-year survival was observed by Sotiropoulos et al [231] in Germany. At the Mayo Clinic, Rosen et al [232,233] have developed a liver transplantation protocol for HCC that provides a disease-free 5-year survival of 82%.…”

Surgical strategy for bile duct cancer: Advances and current limitations

“…Patients requiring a total hepatectomy to achieve a negative margin and those with underlying liver failure precluding hepatic resection are possible candidates for OLT, but early experience with OLT for hilar cholangiocarcinoma was disappointing with early recurrence rates of more than 50% and a 5-year survival rate of 10% to 20% [161][162][163][164] . Recently, in highly selected patients undergoing neoadjuvant protocols, improved survivals were reported with a 5-year survival rate of 30% to 45% [165][166][167] . More recently, the socalled "Mayo protocol" was reported with the intent of treating a highly selected group of patients with cholangiocarcinoma with a strict regimen of preoperative staging and neoadjuvant chemoradiation followed by OLT [168][169][170] .…”

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

“…Recent findings, however, have lead to a resurgence in orthotopic liver transplantation for unresectable, albeit locally contained cholangiocarcinoma. Becker et al [75] reported a series of 280 patients with cholangiocarcinoma who received orthotopic liver transplantation. After a median follow-up of 452 d, the survival rates at 1 and 5 years were 74% and 38%, respectively.…”