Liver Transplantation for Peri-hilar Cholangiocarcinoma.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Ek Khoon TanCharles B Rosen

Abstract

Liver transplantation for peri-hilar cholangiocarcinoma (pCCA) following neoadjuvant chemoradiation achieves excellent long-term survival in carefully selected patients with early-stage unresectable pCCA and patients with primary sclerosing cholangitis (PSC)-associated pCCA. Strict adherence to selection criteria, aggressive neoadjuvant therapy, operative staging prior to transplantation, and several technical accommodations during the transplant operation are necessary for success. In this review, we provide a contemporaneous overview of liver transplantation for pCCA, including selection criteria, neoadjuvant therapy, operative staging, and technical aspects of liver transplantation unique to patients with pCCA and an irradiated operative field. We also discuss several evolving trends intended to improve patient outcomes. Intention-to-treat and patient outcomes after liver transplantation for PSC-associated pCCA are superior to de novo pCCA. Outcomes between living donor liver transplantation (LDLT) and deceased donor liver transplantation are similar for patients with PSC-associated pCCA. However, LDLT for de novo pCCA shows a trend toward more disease recurrence and worse patient survival. A period of waiting time before tr...Continue Reading

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Citations

Dec 6, 2020·Current Opinion in Organ Transplantation·Michael Kriss, Scott W Biggins
Feb 13, 2021·Expert Review of Gastroenterology & Hepatology·Alexandra W AcherTimothy M Pawlik
Mar 3, 2021·Current Opinion in Organ Transplantation·Chandrashekhar KubalJohn Holden
Mar 24, 2021·Cancer Treatment and Research Communications·Alessandro Rizzo, Giovanni Brandi
Nov 6, 2021·Journal of Gastrointestinal Cancer·Sezai YilmazSami Akbulut

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