Strict Selection Alone of Patients Undergoing Liver Transplantation for Hilar Cholangiocarcinoma Is Associated with Improved Survival

Abstract

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five–year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience.

2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation

“…A sample of these studies is cited in the references of the manuscript. With reports concerning LT for specific hepatic diseases [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], analysis of the impact of the type of preservation solution [25], and of the immunosuppressive regimen on the patient outcome [26], ELTR has helped develop risk models for mortality following liver-transplantation [27,28]. Owing to the large cohort of patients, the exhaustiveness, and quality of the data, and the long follow-up provided by the ELTR, the results are really representative of LT in Europe.…”

Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma

“…Studies showed improved 5‑year survival rates of over 70% when OLT was combined with neoadjuvant chemoradiotherapy in selected patients (the “Mayo protocol”) [ 66 , 109 , 110 ]. However, a multicentre analysis of the European Liver Transplant Registry in 2016 revealed comparably promising results without chemoradiation when the same strict selection criteria (hECC <3 cm, negative lymph nodes, no metastasis) were applied as in the Mayo study, therefore questioning the true contribution of pre-transplant therapy to overall survival [ 111 ]. A very recent multicentre study from the USA further challenged resection as the gold standard for hECC within these criteria, by showing that OLT (with preoperative treatment) results in substantially improved 5‑year OS of 54% versus 29% after resection [ 112 ].…”

Liver Transplantation for Perihilar Cholangiocarcinoma in the Era of Transplant Oncology: Urgent Need for a Common Definition of Resectability, Transplantability, and Curability

“…In this retrospective study, patients who complied with the Mayo Clinic criteria (group A) showed a significantly better survival compared to patients who did not meet the criteria (group B). The 5-year survival rate was 59% for group A versus 21% for group B (P = 0.001) (9). The ongoing French phase III TRANSPHIL trial should help determine whether this treatment should be the standard treatment for cholangiocarcinoma.…”