Liver transplantation for hilar cholangiocarcinoma: Spanish experience

• Published in: Transplantation proceedings Vol. 35; no. 5; pp. 1821 - 1822
• Main Authors: Robles, R, Figueras, J, Turrión, V.S, Margarit, C, Moya, A, Varo, E, Calleja, J, Valdivieso, A, Garcia-Valdelcasas, J.C, López, P, Gómez, M, de Vicente, E, Loinaz, C, Santoyo, J, Casanova, D, Bernardos, A, Fernández, J.A, Marín, C, Ramírez, P, Bueno, F.S, Jaurrieta, E, Parrilla, P
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2003; Elsevier Science
• Subjects: Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic; Biological and medical sciences; Cholangiocarcinoma - surgery; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Neoplasm Staging; Palliative Care; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Time Factors; Tumors; Europe; Spain; Human; Site; Digestive system; Hepatic disease; Transplantation; Malignant tumor; Biliary tract disease; Homotransplantation; Experience; Treatment; Porta hepatis; Malignant cholangioma; Surgery; Digestive diseases; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/S0041-1345(03)00724-3

Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival. We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years. The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion ( P < .001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA ( P < .05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion ( P < .01) and stages III to IVA ( P < .01). OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.