title: Improved post-transplant survival in the United States for patients with cholangiocarcinoma after 2000.
abstract: BACKGROUND
  The incidence of cholangiocarcinoma (CCA) continues to rise. Orthotopic liver transplantation (OLT) can be used for selected patients with localized but unresectable hilar CCA. Although initial post-OLT survival rates were poor, outcomes after introduction of the Mayo Clinic protocol have been more promising and there has been increased interest in OLT for CCA nationally.
  
  
  OBJECTIVE
  The aim of this study is to determine post-transplant survival and prognostic factors for patients undergoing OLT for CCA.
  
  
  METHODS
  A retrospective analysis of all patients with CCA listed nationwide for OLT between October 1987 and May 2008 was performed using the Scientific Registry of Transplant Recipients database. Survival curves were generated using the Kaplan-Meier method and compared using log-rank test.
  
  
  RESULTS
  Of 595 patients with CCA listed for OLT, 359 (60.3 %) underwent OLT. Median age at OLT was 49 years, 66 % were male and 91 % were Caucasian. The median follow-up time was 2 years. There has been an increasing number of liver transplants performed for CCA since 2000. The 1- and 5-year probability of survival was 85.8 and 51.4 %, respectively. On multivariate analysis, significant prognostic factors for decreased post-OLT survival included transplant before 2000 (HR 11.25, 95 % CI 1.28-98.7) and acute cellular rejection (HR 5.64, 95 % CI 1.14-27.8).
  
  
  CONCLUSIONS
  Survival after transplant for CCA has improved over time, and OLT is being used more frequently in the treatment of CCA. Significant predictors of post-OLT survival include a history of acute rejection and date of transplant in relation to the publication of Mayo protocol results.
authors.affiliation: Department of Internal Medicine, Taubman Medical Center, University of Michigan, 1500 E. Medical Center Drive, Room 3912, SPC 5362, Ann Arbor, MI, 48109, USA, rsalgia@med.umich.edu.
authors.forename: Reena J
authors.initials: RJ
authors.lastname: Salgia
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.forename: Sherry
authors.initials: S
authors.lastname: Fu
authors.forename: Shawn
authors.initials: S
authors.lastname: Pelletier
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult