Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

Jaynee J. A. Vugts, Marcia P. Gaspersz, Eva Roos, Lotte F. Franken, Pim B. Olthof, Robert J. S. Coelen, Jeroen L. A. van Vugt, Tim A. Labeur, Lieke Brouwer, Marc G. H. Besselink, Jan N. M. IJzermans, Sarwa Darwish Murad, Thomas M. van Gulik, Jeroen de Jonge, Wojciech G. Polak, Olivier R. C. Busch, Joris L. Erdmann, Bas Groot Koerkamp*, Stefan Buettner*

*Corresponding author for this work

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Abstract

Background: Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods: Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results: A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3–23). Conclusion: Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed.

Original languageEnglish
Pages (from-to)1483-1492
Number of pages10
JournalAnnals of Surgical Oncology
Volume28
Issue number3
Early online dateSept 2020
DOIs
Publication statusPublished - Mar 2021

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© 2020, The Author(s).

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  • EMC OR-01

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