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. 2022 Nov 2:35:10802.
doi: 10.3389/ti.2022.10802. eCollection 2022.

Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma

Nawaz Z Safdar  1   2 , Abdul R Hakeem  2 , Rosemary Faulkes  3 , Fiona James  2 , Lisa Mason  4 , Steven Masson  5 , James Powell  4 , Ian Rowe  2 , Shishir Shetty  3 , Rebecca Jones  2 , Harry V M Spiers  6 , Neil Halliday  7 , Jack Baker  7 , Douglas Thorburn  7 , Raj Prasad  2 , Richard Parker  2
Affiliations

Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma

Nawaz Z Safdar et al. Transpl Int. .

Abstract

Cholangiocarcinoma (CCA) is currently a contraindication to liver transplantation (LT) in the United Kingdom (UK). Incidental CCA occurs rarely in some patients undergoing LT. We report on retrospective outcomes of patients with incidental CCA from six UK LT centres. Cases were identified from pathology records. Data regarding tumour characteristics and post-transplant survival were collected. CCA was classified by TNM staging and anatomical location. 95 patients who underwent LT between 1988-2020 were identified. Median follow-up after LT was 2.1 years (14 days-18.6 years). Most patients were male (68.4%), median age at LT was 53 (IQR 46-62), and the majority had underlying PSC (61%). Overall median survival after LT was 4.4 years. Survival differed by tumour site: 1-, 3-, and 5-year estimated survival was 82.1%, 68.7%, and 57.1%, respectively, in intrahepatic CCA (n = 40) and 58.5%, 42.6%, and 30.2% in perihilar CCA (n = 42; p = 0.06). 1-, 3-, and 5-year estimated survival was 95.8%, 86.5%, and 80.6%, respectively, in pT1 tumours (28.2% of cohort), and 65.8%, 44.7%, and 31.1%, respectively, in pT2-4 (p = 0.018). Survival after LT for recipients with incidental CCA is inferior compared to usual outcomes for LT in the United Kingdom. LT for earlier stage CCA has similar survival to LT for hepatocellular cancer, and intrahepatic CCAs have better survival compared to perihilar CCAs. These observations may support LT for CCA in selected cases.

Keywords: distal; hepatocellular; hilar; indication; intrahepatic; survival; transplant; tumor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan-Meier curve detailing the overall survival of all 95 patients.
FIGURE 2
FIGURE 2
Kaplan-Meier curve detailing the survival of patients grouped by site of tumour. Log‐rank test.
FIGURE 3
FIGURE 3
(A) Kaplan-Meier curve detailing the survival of patients grouped by size of tumour using pTNM staging. (B) Kaplan-Meier curve detailing the survival of pT1 vs. pT2-4. Log‐rank test.
FIGURE 4
FIGURE 4
(A) Kaplan-Meier curve detailing the survival of patients with PSC versus all the other indications for LT. (B) Kaplan-Meier curve detailing the survival of patients with PSC grouped by site (iCCA v pCCA). Log‐rank test.
See this image and copyright information in PMC

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