|
|
|
| Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma: a single-center experience |
| Mohammed Elshamy, Naftali Presser, Abdulrahman Y Hammad, Daniel J Firl, Christopher Coppa, John Fung and Federico N Aucejo |
Cleveland, USA
Author Affiliations: Hepatobiliary and Transplant Surgery, Digestive Disease and Surgery Institute (Elshamy M, Presser N, Hammad AY, Firl DJ, Fung J and Aucejo FN), and Imaging Institute (Coppa C), Cleveland Clinic, Cleveland, OH, USA
Corresponding Author: Federico N Aucejo, MD, Hepatobiliary and Transplant Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave. /A100, Cleveland, OH 44195, USA (Tel: +216-445-8021; Email: aucejof@ccf.org)
|
|
|
|
Abstract BACKGROUND: Reports of liver transplantation (LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma (HCC/CC) and intrahepatic cholangiocarcinoma (ICC) are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC.
METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC.
RESULTS: The observed recurrence rate post-LT was 31% (4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines.
CONCLUSIONS: Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.
|
|
|
|
|
|
|
|
|
2017, Vol. 16 
