Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma.
OBJECTIVE
To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival.


BACKGROUND
Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs.


METHODS
We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival.


RESULTS
The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P < 0.01) and IUAC classification stages III-IVA (P < 0.01) for hilar cholangiocarcinoma and perineural invasion (P < 0.05) and stages III-IVA (P < 0.05) for peripheral cholangiocarcinoma.


CONCLUSIONS
OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.
Robles
Ricardo
R
Virgen de la Arrixaca University Hospital, Murcia. rirocam@um.es
Figueras
Joan
J
Turrión
Victor S
VS
Margarit
Carlos
C
Moya
Angel
A
Varo
Evaristo
E
Calleja
Javier
J
Valdivieso
Andres
A
Valdecasas
Juan Carlos G
JC
López
Pedro
P
Gómez
Manuel
M
de Vicente
Emilio
E
Loinaz
Carmelo
C
Santoyo
Julio
J
Fleitas
Manuel
M
Bernardos
Angel
A
Lladó
Laura
L
Ramírez
Pablo
P
Bueno
F S
FS
Jaurrieta
Eduardo
E
Parrilla
Pascual
P
D000328:Adult; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate