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

Abstract

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.

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

“…There have been many reports of LT for PHC, mainly in Europe and the United States. 75 Initially, due to its unfavorable prognosis, LT was mainly performed for selected patients with a favorable prognosis, such as PHC derived from primary sclerosing cholangitis. Recently, new treatment programs combining neoadjuvant chemoradiation and liver transplantation (NCR-OLT) and others have reported better outcomes with an overall survival after liver transplantation of 51%-74% and expanded indications for transplantation have been reported.…”

“…There have been many reports of LT for PHC, mainly in Europe and the United States 75 . Initially, due to its unfavorable prognosis, LT was mainly performed for selected patients with a favorable prognosis, such as PHC derived from primary sclerosing cholangitis.…”

“…LT might have an advantage over resection with respect to liver volume. Clinical issues surrounding donor shortage, immunosuppressive drugs, and patient selection are hurdles to the widespread use of LT 75. …”

Liver transplantation in primary liver tumors

“…For years intrahepatic cholangiocellular carcinoma has been associated with extremely poor outcomes and considered as a contraindication for LT. Progress in chemotherapy and observational data of incidental transplantations in patients with IH CCA have recently intrahepatic HCC to another indications for LT. However, based on the first metaanalysis from 2021, the indications for LT in IH CCA are limited to a single tumor sized <2 cm and carefully selected patients with advanced IH CCA after neoadjuvant therapy [44,45].…”