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Multicenter Study
. 2022 Nov 1;276(5):846-853.
doi: 10.1097/SLA.0000000000005641. Epub 2022 Jul 27.

Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study

Eva Breuer  1 , Matteo Mueller  1 , Majella B Doyle  2 , Liu Yang  3 , Sarwa Darwish Murad  4 , Imran J Anwar  5 , Shaheed Merani  6 , Ashley Limkemann  7 , Heithem Jeddou  8 , Steven C Kim  9 , Victor López-López  10 , Ahmed Nassar  11 , Frederik J H Hoogwater  12 , Eric Vibert  13 , Michelle L De Oliveira  1 , Daniel Cherqui  13 , Robert J Porte  12 , Joseph F Magliocca  11 , Lutz Fischer  14 , Constantino Fondevila  15 , Krzysztof Zieniewicz  16 , Pablo Ramírez  10 , David P Foley  9 , Karim Boudjema  8 , Austin D Schenk  7 , Alan N Langnas  6 , Stuart Knechtle  5 , Wojciech G Polak  17 , C Burcin Taner  3 , William C Chapman  2 , Charles B Rosen  18 , Gregory J Gores  19 , Philipp Dutkowski  1 , Julie K Heimbach  18 , Pierre-Alain Clavien  1
Affiliations
Multicenter Study

Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study

Eva Breuer et al. Ann Surg. .

Abstract

Objective: To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons.

Background: Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC.

Methods: PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014-2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers.

Results: One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P <0.001).

Conclusion: This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Comparison of survival data from matched resected and transplanted cohorts. A, OS of resected Bismuth Type IV benchmark cases (solid line) versus transplanted (dashed line) unresectable PHC cases: 5-year survival is 56.3% versus 39.9%, P=0.07. B, Five-year DFS of 50.2% versus 17.4%, P<0.001. C, OS after exclusion of all cases with underlying PSC. D, DFS after exclusion of all cases with underlying PSC.
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