title: Outcomes and diagnostic challenges posed by incidental cholangiocarcinoma after liver transplantation.
abstract: BACKGROUND
  Liver transplantation in the presence of cholangiocarcinoma (CCA) generally carries a poor prognosis. However, the outcome of patients found to have incidental CCA (iCCA) on explanted liver histology is less clear. We have evaluated the outcomes of iCCA in our liver transplant population.
  
  
  METHODS
  A retrospective search was made of the transplantation and histopathology databases for patients fulfilling our definition for iCCA. All records, including archived histopathologic slides were retrieved and analyzed.
  
  
  RESULTS
  Of 1288 patients undergoing liver transplantation over the 20-year period 1988-2008, nine were found to have iCCA (0.70%). Seven of the nine patients underwent liver transplantation for primary sclerosing cholangitis. Three additional patients who were transplanted for presumed hepatocellular carcinoma that subsequently turned out to be CCA were identified, but excluded from survival analysis. The majority of tumors were early stage (T2 or below), but five (55.6%) had positive biliary transection margins. Median follow-up was 51 months. Five patients (55.6%) developed recurrence of CCA after a median interval of 25.8 months, giving a disease-free survival of 100% at 1 year and 66.7% at 3 years. Three patients have died of recurrence, with a median interval from transplantation of 25 months. The overall 3-year survival was 66.7%.
  
  
  CONCLUSIONS
  Patients found to have iCCA after liver transplantation have a relatively poor prognosis. Prospective liver transplant recipients, especially those with primary sclerosing cholangitis, should be investigated rigorously to exclude CCA.
authors.affiliation: Department of Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, United Kingdom.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Ali
authors.forename: Luca
authors.initials: L
authors.lastname: Bonomo
authors.forename: Rebecca
authors.initials: R
authors.lastname: Brais
authors.forename: William J H
authors.initials: WJ
authors.lastname: Griffiths
authors.forename: David J
authors.initials: DJ
authors.lastname: Lomas
authors.forename: Emmanuel L
authors.initials: EL
authors.lastname: Huguet
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Praseedom
authors.forename: Neville V
authors.initials: NV
authors.lastname: Jamieson
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
mesh_terms: D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome