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Review
. 2023 Apr 7;29(13):1969-1981.
doi: 10.3748/wjg.v29.i13.1969.

Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

Aditya Borakati  1 , Farid Froghi  1 , Ricky H Bhogal  2 , Vasileios K Mavroeidis  3
Affiliations
Review

Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

Aditya Borakati et al. World J Gastroenterol. .

Abstract

Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium. It may occur at any location along the biliary tree with the perihilar area being the most common. Prognosis is poor with 5-year overall survival at less than 10%, typically due to unresectable disease at presentation. Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours, but is frequently not possible due to locally advanced disease. On the other hand, orthotopic liver transplantation (LT) allows for a radical and potentially curative resection for these patients, but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes. In patients with perihilar CCA, within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT, excellent results have been achieved in the last decades, resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience. However, in intrahepatic CCA, the role of LT remains controversial and owing to dismal previous results it is not an accepted indication. Nevertheless, more recent studies have demonstrated favourable results with LT in early intrahepatic CCA, indicating that, under defined criteria, its role may increase in the future. This review highlights the history and contemporary advances of LT in CCA, with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.

Keywords: Cholangiocarcinoma; Klatskin tumor; Liver cancer; Liver resection; Liver transplantation; Neoadjuvant therapy.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Classification of cholangiocarcinoma[62,71]. A: Anatomical classification of cholangiocarcinoma: Intrahepatic cholangiocarcinoma-proximal to second order bile ducts; Perihilar cholangiocarcinomas-between second order branches of right and/or left hepatic ducts and cystic duct confluence; Distal cholangiocarcinoma-between cystic duct confluence and Ampulla of Vater; B: Bismuth Corlette Classification of perihilar cholangiocarcinoma, https://creativecommons.org/licenses/by-sa/4.0/deed.en. Citation: Borakati A, Froghi F, Bhogal RH, Mavroeidis VK. Stereotactic radiotherapy for intrahepatic cholangiocarcinoma. World J Gastrointest Oncol 2022; 14: 1478-1489 [PMID: 36160742 DOI: 10.4251/wjgo.v14.i8.1478] and Wikimedia Commons. File: Bismuth corlette classification for perihilar cholangiocarcinomas.svg. 2020 Oct 9 [visited 3 February 2023]. Available from: https://commons.wikimedia.org/wiki/File:Bismuth_corlette_classification_for_perihilar_cholangiocarcinomas.svg.
Figure 2
Figure 2
Mayo clinic protocol for liver transplantation in hilar cholangiocarcinoma. EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; CA-19-9: Carbohydrate antigen 19-9; FISH: Fluorescence in situ hybridization.
See this image and copyright information in PMC

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