XQuick Search
Liver Transplantation for Cholangiocarcinoma: An Update and Review
Shazil Ahmed Gangat1, N. Begum Ozturk2, Malak Elsawy1, Eda Yildiz3, Ali Emre Bardak3, O. Sila Ozgur4, Ahmet Gurakar1, Behnam Saberi5, Merve Gurakar11Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD, USA2University of St. Louis Medical School, Section of Gastroenterology and Hepatology, St. Louis, MO, USA
3Department of Medicine, Boston Medical Center - Brighton, Boston, MA, USA
4Department of Medicine, University of Pittsburg School of Medicine, Pittsburg, PA, USA
5Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Gastroenterology and Hepatology, Boston, MA, USA
Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary epithelium. Its management is significantly challenging, as most cases are diagnosed at an advanced stage and treatment options are limited. Surgical resection is the standard treatment approach. However, approximately 70% of patients are diagnosed with unresectable disease due to distant metastases, extensive local disease, or poor hepatic reserve. Liver transplantation (LT) has gained attention as an alternative for select cases of unresectable perihilar (pCCA) and intrahepatic (iCCA) CCA.
This review aims to evaluate the role of LT in the management of CCA.
Earlier studies assessing the use of LT in treating CCA reported poor outcomes. However, the development of new neoadjuvant chemoradiotherapy protocols has led to remarkable improvements in post-transplant outcomes, with five-year survival rates exceeding 80% in selected pCCA patients. As for early-stage iCCA, limited data suggest that LT combined with neoadjuvant therapy yields more favorable outcomes than surgical resection, suggesting its potential benefit.
LT combined with neoadjuvant chemoradiotherapy appears to be a promising treatment option for unresectable CCA, especially in select cases of pCCA. Yet, there is still a significant gap in the literature, and further studies are needed to address this issue.
Keywords: Cholangiocarcinoma, liver transplantation, living-donor liver transplantation, peri-hilar cholangiocarcinoma
Manuscript Language: English