Liver transplantation for cholangiocarcinoma: Results in 207 patients

Background. Because of the high incidence of recurrent tumor, many surgeons have become disenchanted with transplantation as a treatment for cholangio carcinoma. Methods. The Cincinnati Transplant Tumor Registry database was used to exam ine 207 patients who underwent liver transplantation for otherwise unresect able cholangiocarcinoma or cholangiohepatoma. Specific factors evaluated in cluded tumor size, presence of multiple nodules, evidence of tumor spread a t surgery, and treatment with adjuvant chemotherapy and/or radiation therap y. Incidentally found tumors were compared to tumors that were known or sus pected to be present before transplantation. Results. The 1, 2, and 5-year survival estimates using life table analysis were 72, 48, and 23%. Fifty-one percent of patients had recurrence of their tumors after transplantation and 84% of recurrences occurred within 2 year s of transplantation. Survival. after recurrence was rarely more than 1 yea r. Forty-seven percent of recurrences occurred in the allograft and 30% in the lungs. Tumor recurrence, and evidence of tumor spread at the time of su rgery, were negative prognostic variables. There were no positive prognosti c variables. Patients with incidentally found cholangiocarcinomas did not h ave improved survival over patients with known or suspected tumors. A small number of patients survived for more than 5 years without recurrence. Howe ver, this group had no variable in common that would aid in the selection o f similar patients in the future. Conclusions. Because of the high rate of recurrent tumor and lack, of posit ive prognostic variables, transplantation should seldom be used as a treatm ent for cholangiocarcinoma. For transplantation to be a viable treatment in the future, more effective adjuvant therapies are necessary.