Liver transplantation for intrahepatic cholangiocarcinoma

Abstract

Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634-644 2018 AASLD.

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

“…(10) Lee et al found that both early iCCA (≤2 cm) and advanced iCCA (>2 cm or multifocal tumors or involving vascular invasion) had similar outcomes after LT compared with patients with HCC T2 within the Milan criteria. (24) The 5-cm cutoff point seems clinically relevant because a tumor size between 5 and 10 cm was significantly associated with a lower survival rate in patients who underwent either LR or LT. (25) Moreover, improvements in radiological techniques, the systematic use of magnetic resonance imaging, and greater suspicion in the event of radiographic findings not typical of HCC (26) will increase the preoperative diagnosis of iCCA and cHCC-CCA, which is easier in tumors up to 5 cm. In our series, cHCC-CCA was found more frequently in LT patients, even though patients with cHCC-CCA experienced the same recurrence rate as those with iCCA in both the LR and LT groups.…”

“…When compared with the LR group, patients who underwent LT were younger (59 versus 63 [48-80] years; P = 0.03) and had a lower BMI (27 versus 29 [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] kg/m 2 ; P = 0.046; Table 1). A significantly higher rate of diabetes was seen in transplanted patients (23 [47%] versus 6 [23%]; P = 0.04), and they had a significantly higher MELD score (12 versus 7 [6][7][8][9][10][11][12][13][14]; P < 0.001).…”

“…It has been reported that cHCC-CCA has a better prognosis compared with iCCA, (27) whereas other groups found comparable recurrence and disease-free survival rates in patients with iCCA or cHCC-CCA. (10,24) The histological differentiation of tumors and their hepatocellular versus biliary components might have an influence on tumor recurrence. (28) A recent study reported that the tumor differentiation of cHCC-CCA correlated with post-LT outcomes because moderately differentiated tumors were associated with a low risk of post-LT recurrence.…”

Patients' prognosis of intrahepatic cholangiocarcinoma and combined hepatocellular‐cholangiocarcinoma after resection

“…Some studies have suggested that patients with cHCC‐CC have a poorer prognosis than those with ICC, while others have either reported the opposite or no significant difference in survival . Liver transplantation is also one of choice for ICC and cHCC‐CC . However, surgical outcomes of ICC patients after liver transplantation is quite poor due to higher recurrence and shorter survival compared to HCC patients .…”

“…Liver transplantation is also one of choice for ICC and cHCC‐CC . However, surgical outcomes of ICC patients after liver transplantation is quite poor due to higher recurrence and shorter survival compared to HCC patients . Liver transplantation also cannot contribute to better prognosis of patients with cHCC‐CC compared to those with HCC, but may improve surgical outcomes than ICC patients …”