Neoadjuvant therapy and liver transplantation for hilar cholangiocarcinoma: is pretreatment pathological confirmation of diagnosis necessary?

Background: Neoadjuvant chemoradiotherapy followed by operative staging and liver transplantation is an effective treatment for patients with unresectable hilar cholangiocarcinoma (CCA) and CCA arising in the setting of primary sclerosing cholangitis (PSC). Pathologic confirmation of CCA is notoriously difficult, and many patients have been treated based on clinical criteria without pathological confirmation.

Study Design: We reviewed our experience with the specific aim of determining the need for pathological confirmation of CCA before treatment.

Current status of liver transplantation for hilar cholangiocarcinoma.

Purpose Of Review: Liver transplantation for unresectable hilar cholangiocarcinoma is a highly controversial issue. This review will summarize results with transplantation alone and a new strategy of high-dose neoadjuvant chemoradiotherapy and subsequent liver transplantation. The review will address controversies regarding this novel approach to the treatment of hilar cholangiocarcinoma, including prioritization of patients with cholangiocarcinoma awaiting scarce deceased donor livers.

Vascular complications after orthotopic liver transplantation after neoadjuvant therapy for hilar cholangiocarcinoma.

Liver transplantation after neoadjuvant chemoradiotherapy has emerged as an effective treatment for patients with localized, node-negative, unresectable hilar cholangiocarcinoma (CCA) or CCA arising in the setting of primary sclerosing cholangitis (PSC). However, concern has arisen regarding the potential for vascular complications due to high-dose neoadjuvant therapy before transplantation. We reviewed our experience with specific aims to determine the incidences of arterial, portal, and hepatic venous complications in patients transplanted for CCA compared with patients who undergo transplantation for other indications, and to describe patient outcome as a result of these vascular complications.