title: Long-term outcome of liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma.
abstract: OBJECTIVE
  Combined hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC) is a rare pair of intrahepatic malignancies. Differential diagnosis among combined HCC-CCC, HCC, or CCC can be difficult; thus malignancies other than ordinary HCC are occasionally encountered unexpectedly in explanted liver specimens. The present study analyzed the long-term outcomes of liver transplantation (OLT) among patients with HCC-CCC.
  
  
  METHODS
  Between January 1999 and December 2009, we performed 2137 adult OLT at our institution including 15 cases of pathologically confirmed HCC-CCC, who all underwent OLT with a pretransplant diagnosis of HCC. We reviewed retrospectively the medical records of these 15 patients.
  
  
  RESULTS
  Their mean age was 58.9 ± 7.2 years. The median preoperative alpha-fetoprotein level was 32.6 ng/mL. Fourteen patients underwent living donor and one deceased donor OLT. The Milan criteria were met in 12 cases. A single tumor was identified in 8 and multiple lesions in 7 patients. The maximal tumor diameter was 2.9 ± 1.7 cm. Seven patients experienced tumor recurrences: including 6 within the first 12 months. All of the patients who experienced recurrences died at a median 4 months after that diagnosis. The overall patient survival rates were 66.7% at 1 year and 60.0% at 3 and 5 years. Disease-free patient survival rates were 60.0% at 1 year and 53.3% at 3 and 5 years.
  
  
  CONCLUSIONS
  Patients with combined HCC-CCC showed a high rate of early recurrences, particularly within the first year.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: C-S
authors.initials: CS
authors.lastname: Park
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.forename: S-H
authors.initials: SH
authors.lastname: Kang
authors.forename: B-H
authors.initials: BH
authors.lastname: Jung
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged