title: Vascular complications after orthotopic liver transplantation after neoadjuvant therapy for hilar cholangiocarcinoma.
abstract: Liver transplantation after neoadjuvant chemoradiotherapy has emerged as an effective treatment for patients with localized, node-negative, unresectable hilar cholangiocarcinoma (CCA) or CCA arising in the setting of primary sclerosing cholangitis (PSC). However, concern has arisen regarding the potential for vascular complications due to high-dose neoadjuvant therapy before transplantation. We reviewed our experience with specific aims to determine the incidences of arterial, portal, and hepatic venous complications in patients transplanted for CCA compared with patients who undergo transplantation for other indications, and to describe patient outcome as a result of these vascular complications. We reviewed data for all patients who underwent liver transplantation for CCA between January 1993 and April 2006 and compared the incidences of vascular complications to whole organ and living donor recipient control groups. Sixty-eight patients underwent neoadjuvant therapy and subsequent liver transplantation. Arterial complications arose in 21%; portal venous complications arose in 22%; and overall, 40% developed vascular complications. Late hepatic artery complications occurred more often in living donor recipients transplanted for CCA compared with the living donor control group (P=0.047). Late portal vein complications occurred more often in both whole organ and living donor recipients transplanted for CCA compared with the control groups (P=0.01 and P=0.009). Hepatic venous complications were rare. Patient and graft survival were not different between CCA and control patients. Liver transplantation with neoadjuvant therapy is associated with far higher rates of late arterial and portal venous complications, but these complications do not adversely affect patient and graft survival.
authors.affiliation: William J. von Liebig Transplant Center, Department of Radiology, Mayo Clinic Rochester and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Hendrik T J
authors.initials: HT
authors.lastname: Mantel
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: Scott L
authors.initials: SL
authors.lastname: Nyberg
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
authors.forename: James C
authors.initials: JC
authors.lastname: Andrews
authors.forename: Michael A
authors.initials: MA
authors.lastname: McKusick
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alberts
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D000970:Antineoplastic Agents