title: Liver transplantation for hilar cholangiocarcinoma: Spanish experience.
abstract: BACKGROUND
  Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival.
  
  
  METHODS
  We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years.
  
  
  RESULTS
  The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion (P<.001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA (P<.05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion (P<.01) and stages III to IVA (P<.01).
  
  
  CONCLUSIONS
  OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.
authors.affiliation: Virgen de la Arrixaca University Hospital, Murcia, Spain. rirocam@um.es
authors.forename: R
authors.initials: R
authors.lastname: Robles
authors.forename: J
authors.initials: J
authors.lastname: Figueras
authors.forename: V S
authors.initials: VS
authors.lastname: Turrión
authors.forename: C
authors.initials: C
authors.lastname: Margarit
authors.forename: A
authors.initials: A
authors.lastname: Moya
authors.forename: E
authors.initials: E
authors.lastname: Varo
authors.forename: J
authors.initials: J
authors.lastname: Calleja
authors.forename: A
authors.initials: A
authors.lastname: Valdivieso
authors.forename: J C
authors.initials: JC
authors.lastname: Garcia-Valdelcasas
authors.forename: P
authors.initials: P
authors.lastname: López
authors.forename: M
authors.initials: M
authors.lastname: Gómez
authors.forename: E
authors.initials: E
authors.lastname: de Vicente
authors.forename: C
authors.initials: C
authors.lastname: Loinaz
authors.forename: J
authors.initials: J
authors.lastname: Santoyo
authors.forename: D
authors.initials: D
authors.lastname: Casanova
authors.forename: A
authors.initials: A
authors.lastname: Bernardos
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández
authors.forename: C
authors.initials: C
authors.lastname: Marín
authors.forename: P
authors.initials: P
authors.lastname: Ramírez
authors.forename: F S
authors.initials: FS
authors.lastname: Bueno
authors.forename: E
authors.initials: E
authors.lastname: Jaurrieta
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D009367:Neoplasm Staging; D010166:Palliative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors