Liver transplantation for hilar cholangiocarcinoma: a German survey.
BACKGROUND
The present study reports a German survey addressing outcomes in nonselected historical series of liver transplantation (OLT) for hilar cholangiocarcinoma (HL).


METHODS
We sent to all 25 German transplant centers performing OLT a survey that addressed (1) the number of OLTs for HL and the period during which they were performed; (2) the incidence of HL diagnosed prior to OLT/rate of incidental HL (for example, in primary sclerosing cholangitis); (3) tumor stages according to Union Internationale Centre le Cancer; (4) patient survival; and (5) tumor recurrence rate.


RESULTS
Eighty percent of centers responded, reporting 47 patients who were transplanted for HL. Tumors were classified as pT2 (25%), pT3 (73%), or pT4 (2%). HL was diagnosed incidentally in 10% of cases. A primary diagnosis of PSC was observed in 16% of patients. Overall median survival was 35.5 months. When in-hospital mortality (n = 12) was excluded, the median survival was 45.4 months, corresponding to 3- and 5-year survival rates of 42% and 31%, versus 31% and 22% when in-hospital mortality was included. HL recurred in 34% of cases. Three- and 5-year survivals for the 15 patients transplanted since 1998 was 57% and 48%, respectively. Median survival ranged from 20 to 42 months based on the time period (P = .014).


CONCLUSIONS
The acceptable overall survival, the improved results after careful patient selection since 1998, and the encouraging outcomes from recent studies all suggest that OLT may be a potential treatment for selected cases of HL. Prospective multicenter randomized studies with strict selection criteria and multimodal treatments seem necessary.
Kaiser
G M
GM
Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Universitätsklinikum Essen, Germany.
Sotiropoulos
G C
GC
Jauch
K W
KW
Löhe
F
F
Hirner
A
A
Kalff
J C
JC
Königsrainer
A
A
Steurer
W
W
Senninger
N
N
Brockmann
J G
JG
Schlitt
H J
HJ
Zülke
C
C
Büchler
M W
MW
Schemmer
P
P
Settmacher
U
U
Hauss
J
J
Lippert
H
H
Hopt
U T
UT
Otto
G
G
Heiss
M M
MM
Bechstein
W O
WO
Timm
S
S
Klar
E
E
Hölscher
A H
AH
Rogiers
X
X
Stangl
M
M
Hohenberger
W
W
Müller
V
V
Molmenti
E P
EP
Fouzas
I
I
Erhard
J
J
Malagó
M
M
Paul
A
A
Broelsch
C E
CE
Lang
H
H
D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors