Liver transplantation for intrahepatic cholangiocarcinoma

David D. Lee, Kristopher P. Croome, Kaitlyn R. Musto, Jose Melendez, Ghassan Tranesh, Raouf Nakhleh, C. Burcin Taner, Justin H Nguyen, Tushar C Patel, Denise Harnois

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma–cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634–644 2018 AASLD.

Original languageEnglish (US)
Pages (from-to)634-644
Number of pages11
JournalLiver Transplantation
Volume24
Issue number5
DOIs
StatePublished - May 1 2018

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Cholangiocarcinoma
Liver Transplantation
Hepatocellular Carcinoma
Liver Neoplasms
Clinical Trials
Recurrence
Survival
Blood Vessels

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Lee, D. D., Croome, K. P., Musto, K. R., Melendez, J., Tranesh, G., Nakhleh, R., ... Harnois, D. (2018). Liver transplantation for intrahepatic cholangiocarcinoma. Liver Transplantation, 24(5), 634-644. https://doi.org/10.1002/lt.25052

Liver transplantation for intrahepatic cholangiocarcinoma. / Lee, David D.; Croome, Kristopher P.; Musto, Kaitlyn R.; Melendez, Jose; Tranesh, Ghassan; Nakhleh, Raouf; Taner, C. Burcin; Nguyen, Justin H; Patel, Tushar C; Harnois, Denise.

In: Liver Transplantation, Vol. 24, No. 5, 01.05.2018, p. 634-644.

Research output: Contribution to journalArticle

Lee, DD, Croome, KP, Musto, KR, Melendez, J, Tranesh, G, Nakhleh, R, Taner, CB, Nguyen, JH, Patel, TC & Harnois, D 2018, 'Liver transplantation for intrahepatic cholangiocarcinoma', Liver Transplantation, vol. 24, no. 5, pp. 634-644. https://doi.org/10.1002/lt.25052
Lee DD, Croome KP, Musto KR, Melendez J, Tranesh G, Nakhleh R et al. Liver transplantation for intrahepatic cholangiocarcinoma. Liver Transplantation. 2018 May 1;24(5):634-644. https://doi.org/10.1002/lt.25052
Lee, David D. ; Croome, Kristopher P. ; Musto, Kaitlyn R. ; Melendez, Jose ; Tranesh, Ghassan ; Nakhleh, Raouf ; Taner, C. Burcin ; Nguyen, Justin H ; Patel, Tushar C ; Harnois, Denise. / Liver transplantation for intrahepatic cholangiocarcinoma. In: Liver Transplantation. 2018 ; Vol. 24, No. 5. pp. 634-644.
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abstract = "Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma–cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6{\%} versus 90.0{\%} and 63.6{\%} versus 70.3{\%} (log-rank, P = 0.25), respectively. Overall recurrence was 33.3{\%} for early CCA versus 11{\%} for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634–644 2018 AASLD.",
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