Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

• Published in: Hepatobiliary & pancreatic diseases international Vol. 16; no. 3; pp. 264 - 270
• Main Authors: Elshamy, Mohammed, Presser, Naftali, Hammad, Abdulrahman Y, Firl, Daniel J, Coppa, Christopher, Fung, John, Aucejo, Federico N
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.06.2017; Hepatobiliary and Transplant Surgery,Digestive Disease and Surgery Institute Cleveland Clinic,Cleveland,OH,USA%Imaging Institute Cleveland Clinic,Cleveland,OH,USA
• Subjects: Aged; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Biopsy; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cholangiocarcinoma - diagnostic imaging; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Databases, Factual; Disease Progression; Disease-Free Survival; Early Detection of Cancer; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; Kaplan-Meier Estimate; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; mixed hepatocellular carcinoma/cholangiocarcinoma; Neoplasm Recurrence, Local; Neoplasms, Complex and Mixed - diagnostic imaging; Neoplasms, Complex and Mixed - mortality; Neoplasms, Complex and Mixed - pathology; Neoplasms, Complex and Mixed - surgery; Ohio; Risk Factors; survival outcomes; Time Factors; Treatment Outcome; mixed hepatocellular carcinoma/cholangiocarcinoma; survival outcomes; liver transplantation
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(17)60016-X

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.