Living Donor Liver Transplantation for Intrahepatic Cholangiocarcinoma

Rauchfuß, F.; Deeb, Aladdin Ali; Rohland, Oliver; Dondorf, Felix; Ardelt, Michael; Settmacher, Utz

doi:10.3390/curroncol29030157

Cited by 7 publications

(5 citation statements)

References 15 publications

(19 reference statements)

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“…Given this background, LDLT appears to be an excellent procedure from an organizational view, as surgical exploration and lymphadenectomy can be performed prior to donor surgery as demonstrated in our case. With 7 % of all liver transplantations, LDLT represents the minority of transplantations in the Eurotransplant area, but provides a useful addition to the organ pool especially in cases of missing options within the standard allocation system [22]. Nevertheless, iCCA appears to be a rare indication for LDLT.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Living donor liver transplantation in irresectable intrahepatic cholangiocarcinoma in primary sclerosing cholangitis associated liver cirrhosis

Bednarsch,

Lang,

Heise

et al. 2024

Z Gastroenterol

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Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor and usually associated with a poor oncological prognosis. The current gold standard is the surgical resection of the tumor with subsequent adjuvant therapy. However, in case of irresectability e.g. in case of liver cirrhosis, a palliative treatment regime is conducted.This report demonstrates the case of an irresectable iCCA in liver cirrhosis due to primary sclerosing cholangitis (PSC) treated by living-donor liver transplantation (LDLT) facilitated by minimal invasive donor hepatectomy. No postoperative complications were observed in the donor and the donor was released on the 6th postoperative day. Further, after a follow-up of 1.5 years, no disease recurrence was detected in the recipient.According to the recent international literature, liver transplantation can be evaluated in case of small solitary iCCA (< 3 cm) in cirrhosis. Less evidence is provided for transplantation in advanced tumors which are surgically not resectable due to advanced liver disease or infiltration of major vessels, however some reports display adequate long-term survival after strict patient selection. The selection criteria comprise the absence of distant metastases and locoregional lymph node metastases as well as partial remission or stable disease after neoadjuvant chemotherapy. Due to no established graft allocation for iCCA in Germany, LDLT is currently the best option to realize transplantation in these patients. Developments in the last decade indicate that LDLT should preferentially be performed in minimal invasive manner (laparoscopic or robotic) as this approach is associated with less overall complications and a shorter hospitalization. The presented case illustrates the possibilities of modern surgery and the introduction of transplant oncology in the modern therapy of patients combining systemic therapy, surgical resection and transplantation to achieve optimal long-term results in patients which were initially indicated for palliative treatment.

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, iCCA appears to be a rare indication for LDLT. In a recent report from 2022, Rauchfuß et al identified only 6 case reports of patients who underwent LDLT for iCCA [22].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Living donor liver transplantation in irresectable intrahepatic cholangiocarcinoma in primary sclerosing cholangitis associated liver cirrhosis

Bednarsch,

Lang,

Heise

et al. 2024

Z Gastroenterol

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“…Their study revealed a three-year survival rate of 63% ( 32 ). We resume the cases series in Table 1 , including our first reported case ( 33 – 37 ).…”

Section: Ldlt For Iccmentioning

confidence: 99%

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

Andraus,

Ochoa,

de Martino

et al. 2024

Front. Oncol.

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IntroductionIntrahepatic cholangiocarcinoma (iCC) is the liver’s second most common neoplasm. Until now, surgery is the only curative option, but only 35% of the cases are considered resectable at the diagnosis, with a post-resection survival of around 30%. Advancements in surgical techniques and perioperative care related to liver transplantation (LT) have facilitated the expansion of indications for hepatic neoplasms.MethodThis study is a comprehensive review of the global experience in living donor LT (LDLT) for treating iCC and describes our first case of LDLT for an unresectable iCC.ResultsWhile exploring LT for intrahepatic cholangiocarcinoma dates to the 1990s, the initial outcomes were discouraging, marked by poor survival and high recurrence rates. Nevertheless, contemporary perspectives underscore a reinvigorated emphasis on extending the frontiers of LT indications within the context of the “oncologic era.” The insights gleaned from examining explants, wherein incidental iCC was categorized as hepatocellular carcinoma in the preoperative period, have demonstrated comparable survival rates to small hepatocellular carcinoma. These findings substantiate the potential viability of LT as a curative alternative for iCC. Another investigated scenario pertains to “unresectable tumors with favorable biological behavior,” LT presents a theoretical advantage by providing free margins without the concern of a small future liver remnant. The constraint of organ shortage persists, particularly in nations with low donation rates. LDLT emerges as a viable and secure alternative for treating iCC.ConclusionLDLT is an excellent option for augmenting the graft pool, particularly in carefully selected patients.

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“…ICC has been considered an absolute contraindication to liver transplantation in the past [19] , but recent studies have shown that liver transplantation can achieve acceptable survival outcomes in patients ICC patients with proper selection criteria such as very early stage, small tumor volume (≤ 2cm), and single tumor [20] . Additionally, neoadjuvant chemotherapy enables patients with locally advanced and unresectable ICC to bene t from liver transplantation with favorable long-term outcomes [21,22] .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, neoadjuvant chemotherapy enables patients with locally advanced and unresectable ICC to bene t from liver transplantation with favorable long-term outcomes [21,22] . However, liver transplantation is greatly limited by the severe shortage of donors and the associated postoperative immunosuppression, which is an ordeal for patients and is capable of promoting tumor recurrence or metastasis [19] . Data on survival after neoadjuvant chemotherapy and subsequent liver transplantation are currently limited, necessitating the establishment of large sample studies to further evaluate the signi cance of this treatment strategy [23] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety comparison of neoadjuvant chemotherapy followed by surgery and upfront surgery for treating intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Yang

Jiang

2023

Preprint

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Background and Aims Currently, surgical resection is the most commonly performed and effective treatment for intrahepatic cholangiocarcinoma (ICC) worldwide. However, the prognosis of ICC is unsatisfactory. This study aimed to compare the efficacy and safety of neoadjuvant chemotherapy followed by surgery and upfront surgery in treating intrahepatic cholangiocarcinoma (ICC). The study also intends to explore whether chemotherapy should be introduced before surgery and which populations should be considered for neoadjuvant chemotherapy. Method Four databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched from their inception dates to January 2022 for relevant articles. The statistical analysis was performed using the Review Manager Software (version5.3). The non-randomized interventions (ROBINS-I) was used to assess the methodological quality of included studies and the overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Moreover, the primary outcomes included 1-year, 3-year and 5-year overall survival (OS), while the secondary outcomes were R0 resection, 1-year, 3-year and 5-year recurrence-free survival (RFS) and mortality in 90 days. Results Five studies involving 2412 patients were included in this meta-analysis. There was no significant difference in 1-year OS, 3-year OS, 1-year, 3-year and 5-year RFS between the two groups. However, the meta-analysis showed that the neoadjuvant chemotherapy group had a better 5-year OS benefit in ICC patients than the upfront surgery group (OR = 1.27, 95% CI: 1.02–1.58), while the R0 resection rate was lower in neoadjuvant chemotherapy group than that in the upfront surgery group (OR = 0.49, 95% CI: 0.26–0.91). Conclusion Compared with the upfront surgery, neoadjuvant chemotherapy followed by surgery could prolong the 5-year OS in ICC patients. Considering that the patients in the neoadjuvant chemotherapy followed by surgery group had more advanced ICC cases, the benefits of neoadjuvant chemotherapy may be more significant in patients with locally advanced (stage II-III) ICC.

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Living Donor Liver Transplantation for Intrahepatic Cholangiocarcinoma

Cited by 7 publications

References 15 publications

Laparoscopic Living donor liver transplantation in irresectable intrahepatic cholangiocarcinoma in primary sclerosing cholangitis associated liver cirrhosis

Laparoscopic Living donor liver transplantation in irresectable intrahepatic cholangiocarcinoma in primary sclerosing cholangitis associated liver cirrhosis

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

Efficacy and safety comparison of neoadjuvant chemotherapy followed by surgery and upfront surgery for treating intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

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