engleski

Liver transplantation in patients with hilar cholangiocarcinoma-single center experience

Introduction: Liver transplantation (LT) in patients with hilar cholangiocarcinoma (hCC) is a controversial method of treatment. However, in selected number of patients provides acceptable results. Aims: The aim of this study is to present the outcome of liver transplantation in patients with hCC in our Center. Material and Methods: A retrospective analysis was performed on data of transplanted patients due to hCC between 2010 and 2017 in Clinical Hospital Merkur, Croatia. Data were evaluated regarding demographic, clinical, etiological, histopathologic stage, waiting time (WT) on list and outcome. Results: In total period 784 liver transplants were performed, of which 3.4% (n = 27) were made due to hCC. Mean age was 61 ± 7.98 years and majority of patients were male (51.9%). 65.2% of patients were exposed to endobiliary drainage before LT. Primary sclerosing cholangitis was present in only one patient, while the majority of patients (96.3%) did not have associated liver disease. The median time on waiting list was very short and amounted 16.22 days (0-89). The majority of patients were Bismuth type III (44%), followed by type II (24%). On the histopathological examination 65% of cases showed tumor size less than 30 mm. Comparison of tumor size greater and less than 30 mm showed equal shares of lymphovascular invasion, perineural invasion, the invasion of surrounding fatty tissue and early tumor recurrence. The Mayo Clinic protocol of neoadjuvant chemoradiation was not performed. Median follow-up after LT was 16.7 months (range from 0.2 to 73.8). Overall tumor recurrence was 26.1%. There wasn’t significant difference in tumors size, lymphovascular invasion, perineural invasion and the invasion of surrounding fatty tissue between group with or without hCC recurrence. 1- and 3-year survival rate after transplantation was 21/27 (77, 7%) and 15/27 (55, 5%), respectively ; with 55.6% of death rate due to early recurrence of hCC and 44.4% rate due to postoperative mortality. Only four patients live longer than five years. Conclusions: Orthotopic liver transplantation might be applicable for a highly selected subgroup, emphasizing the need for better adjuvant strategies. To define prognostic factors for hCC recurrence, larger cohort of patients need to be analyzed. Current high donor rate in Croatia provides hCC patients short WT on the list for LT.

cholangiocarcinoma, liver transplantation, survival

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