AUTHOR=Safdar Nawaz Z. , Hakeem Abdul R. , Faulkes Rosemary , James Fiona , Mason Lisa , Masson Steven , Powell James , Rowe Ian , Shetty Shishir , Jones Rebecca , Spiers Harry V. M. , Halliday Neil , Baker Jack , Thorburn Douglas , Prasad Raj , Parker Richard 

TITLE=Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10802

DOI=10.3389/ti.2022.10802

ISSN=1432-2277

ABSTRACT=Cholangiocarcinoma (CCA) is currently a contraindication to liver transplantation (LT) in the UK. Incidental diagnosis of CCA at explant is rare, but occurs in some patients undergoing LT. We retrospectively report on the outcomes of patients with incidental CCA from six UK liver transplant centres. 
Cases were identified from pathology records. Data regarding tumour characteristics and post-transplant survival was collected. CCA was classified by TNM staging and anatomical location. The log-rank test was used for significance (p<0.05).
Ninety-five patients who underwent LT between 1988 and 2020 were identified. Median follow-up after LT was 2.1 years (range 14 days to 18.6 years). Most patients were male (68.4%), median age at LT was 53 (IQR 46-62) and the majority had underlying PSC (61%). Overall median survival after LT was 4.4 years. Survival differed by tumour site: 1-, 3- and 5-year estimated survival was 82.1%, 68.7% and 57.1%, respectively, in intrahepatic CCA (n=40) and 58.5%, 42.6% and 30.2% in perihilar CCA (n=42; p=0.06). 1-, 3- and 5-year estimated survival was 95.8%, 86.5% and 80.6%, respectively, in pT1 tumours (28.2% of cohort), and 65.8%, 44.7% and 31.1%, respectively, in pT2-4 (p=0.018). 
Survival after LT for recipients with incidental CCA is inferior compared to usual outcomes for LT in the UK. LT for earlier stage CCA has similar survival to LT for hepatocellular cancer and, intrahepatic CCAs have better survival compared to perihilar CCAs. These observations may support liver transplantation for CCA in selected cases.