Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVE: To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons. BACKGROUND: Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC. METHODS: PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014-2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers. RESULTS: One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P <0.001). CONCLUSION: This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.

Full Text

Duke Authors

Cited Authors

  • Breuer, E; Mueller, M; Doyle, MB; Yang, L; Darwish Murad, S; Anwar, IJ; Merani, S; Limkemann, A; Jeddou, H; Kim, SC; López-López, V; Nassar, A; Hoogwater, FJH; Vibert, E; De Oliveira, ML; Cherqui, D; Porte, RJ; Magliocca, JF; Fischer, L; Fondevila, C; Zieniewicz, K; Ramírez, P; Foley, DP; Boudjema, K; Schenk, AD; Langnas, AN; Knechtle, S; Polak, WG; Taner, CB; Chapman, WC; Rosen, CB; Gores, GJ; Dutkowski, P; Heimbach, JK; Clavien, P-A

Published Date

  • November 1, 2022

Published In

Volume / Issue

  • 276 / 5

Start / End Page

  • 846 - 853

PubMed ID

  • 35894433

Electronic International Standard Serial Number (EISSN)

  • 1528-1140

Digital Object Identifier (DOI)

  • 10.1097/SLA.0000000000005641

Language

  • eng

Conference Location

  • United States