Selected patients with unresectable perihilar cholangiocarcinoma (pCCA) derive long-term benefits from liver transplantation. Between 1993-2019, our group at Mayo Clinic performed 237 transplants for pCCA. With this experience, we note that two distinct patient populations comprise this group of pCCA patients: those with underlying primary sclerosing cholangitis (PSC) and those without identifiable risk factors termed sporadic or de novo pCCA. Long-term survival after transplant is better in PSC patients (74% five-year survival) than in those with de novo pCCA (58% five-year survival). Herein, we review the likely clinical factors contributing to the divergence in outcomes for these two patient populations. We also offer our insights on how further advances may improve patient selection and survival, focusing on the de novo pCCA patient population.
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| http://dx.doi.org/10.3390/cancers12113157 | DOI Listing |
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Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma.
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- The limited availability of organs complicates the preference for LT as a treatment, and while options like living donor transplants exist, there's ongoing debate on whether surgical resection or LT should be the standard treatment.
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View Article and Find Full Text PDFCan the Limits of Liver Transplantation Be Expanded in Perihilar Cholangiocarcinoma?
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Selected patients with unresectable perihilar cholangiocarcinoma (pCCA) derive long-term benefits from liver transplantation. Between 1993-2019, our group at Mayo Clinic performed 237 transplants for pCCA. With this experience, we note that two distinct patient populations comprise this group of pCCA patients: those with underlying primary sclerosing cholangitis (PSC) and those without identifiable risk factors termed sporadic or de novo pCCA.
View Article and Find Full Text PDFLiver Transplantation for Peri-hilar Cholangiocarcinoma.
J Gastrointest Surg
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Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA.
Background: 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.
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