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. 2024 Nov;76(7):2505-2513.
doi: 10.1007/s13304-024-01889-1. Epub 2024 Aug 29.

The Italian experience on liver transplantation for unresectable peri-hilar cholangiocarcinoma: a national survey and future perspectives

Enrico Gringeri  1   2 , Alessandro Furlanetto  3   4 , Ilaria Billato  3 , Matteo Cescon  5 , Luciano De Carlis  6 , Vincenzo Mazzaferro  7 , Renato Romagnoli  8 , Paolo De Simone  9 , Marco Vivarelli  10 , Fabrizio Di Benedetto  11 , Matteo Ravaioli  5 , Andrea Lauterio  6 , Carlo Sposito  7 , Damiano Patrono  8 , Davide Ghinolfi  9 , Federico Moccheggiani  10 , Stefano Di Sandro  11 , Francesco Enrico D'Amico  3   4 , Jacopo Lanari  3   4 , Martina Gambato  12 , Silvia Trapani  13 , Francesca Bergamo  14 , Massimo Cardillo  13 , Patrizia Burra  12   4 , Umberto Cillo  3   4
Affiliations

The Italian experience on liver transplantation for unresectable peri-hilar cholangiocarcinoma: a national survey and future perspectives

Enrico Gringeri et al. Updates Surg. 2024 Nov.

Abstract

Liver transplantation (LT) was considered an ineffective treatment for perihilar cholangiocarcinoma (pCCA) until the successful experience of the Mayo Clinic, proposing a protocol with strict inclusion criteria and neoadjuvant radio-chemotherapy. Since 2015, pCCA is considered an indication for LT in Italy only in the context of controlled prospective studies. We performed a survey among the 22 Italian Liver Transplant Centers to assess the results of LT for pCCA. Eight centers reported 53 cases from 1986 to 2021 (Bologna 12, Padova 10, Niguarda 10, Milano Tumori 8, Torino 5, Pisa 4, Ancona 2, Modena 2). Patients were divided according to whether they recieved neoadjuvant radio-chemotherapy (Group 1, 25 cases) or not (Group 2, 28 cases). Eleven patients were transplanted without neoadjuvant treatment after 2015. Overall survival at 1, 3 and 5 years was 83.8%, 56.6% and 50.6% in Group 1 and 72.4%, 41.4% and 35.5% in Gropu 2 (p = 0.13). Recurrence-free survival at 1, 3, and 5 years was 91.2%, 61.1% and 47.2% in Group 1 and 58.2%, 42.2%, and 36.1% in Group 2 (p = 0.16). A competing risk regression analysis showed a 5-year risk of cancer-related death of 19% for patients in Group 1 against 62.3% in Group 2, with a hazard ratio of 0.31 (95%CI [0.10-0.98], p 0.047). This survey promoted a discussion about the limitations of the Mayo protocol and set the basis for the adoption of a new nationwide protocol (LITHALICA-NCT06125769), having the same inclusion criteria but proposing standard of care chemotherapy as neoadjuvant regimen.

Keywords: Biliary tumors; Liver; Liver transplantation; Neoadjuvant therapy; Perihilar cholangiocarcinoma.

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Conflict of interest statement

Declarations. Conflict of interest: The authors of this manuscript have no financial or non-financial conflict of interest to disclose. VM, UC, LDC, FDB, RR, MV are members of the editorial board or advisory boards of Updates in Surgery. Human and animal rights: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained for the surgical procedure prior to their participation.

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