Liver transplantation for incidental cholangiocarcinoma:... : Liver Transplantation (original) (raw)

Original Articles

Liver transplantation for incidental cholangiocarcinoma: Analysis of the Canadian experience

Ghali, Peter1; Marotta, Paul J.2; Yoshida, Eric M.3; Bain, Vincent G.4; Marleau, Denis5; Peltekian, Kevork6; Metrakos, Peter1; Deschênes, Marc1,*,†

1_Departments of Medicine and Surgery, McGill University, Montréal, Québec, Canada_

2_Department of Medicine, University of Western Ontario, London, Ontario, Canada_

3_Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada_

4_Department of Medicine, University of Alberta, Edmonton, Alberta, Canada_

5_Department of Medicine, Université de Montréal, Montréal, Québec, Canada_

6_Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada_

Published online in Wiley InterScience (www.interscience.wiley.com).

*McGill University Health Centre, Royal Victoria Hospital Site, 687 Pine Avenue W., Ross Pavilion, Room R 2.28, Montreal, Quebec, Canada H3A 1A1

Email:[email protected]

Received 16 December 2004; Accepted 3 May 2005

†Telephone: 514–843–1616; FAX: 514–843–1421

Abstract

Cholangiocarcinoma is a biliary tumor, which not infrequently complicates primary sclerosing cholangitis. It carries a poor prognosis and, with the exception of carefully selected individuals in research protocols, contraindicates orthotopic liver transplantation. There has been some suggestion that cholangiocarcinomas incidentally discovered at the time of transplantation carry a better prognosis. The goal of this retrospective study was to perform a national review of outcomes after liver transplantation in Canadian recipients found to have incidental cholangiocarcinoma in their explanted native liver. Six of the seven liver transplant centers in Canada provided clinical and follow-up information on all liver transplant recipients found to have incidental cholangiocarcinoma in their explants. The diagnosis or suspicion of cholangiocarcinoma prior to transplantation were exclusion criteria for this study. Ten individuals with cholangiocarcinoma were transplanted between 1996 and 2003. The median duration of follow-up was 28 months. Eight of the 10 had PSC. All of the tumors were stage I or II. The 3-year survival for these patients was 30%. The median time to recurrence was 26 months (95% confidence interval 13uu-uu37), and the median time to death was 30 months (95% confidence interval 28uu-uu53). In conclusion, although early survival of patients transplanted for incidental cholangiocarcinoma appears good, intermediate- and long-term survival rates are not better than for individuals historically transplanted with known cholangiocarcinoma. Aggressive investigation for cholangiocarcinoma is mandated. Incidentally found tumours remain a difficult treatment problem, and prospective adjuvant chemo-, radio-, and immunotherapies should be investigated. (Liver Transpl 2005;11:1412–1416.)