Poor outcomes after liver transplantation in patients with incidental cholangiocarcinoma irrespective of tumor localization.
BACKGROUND
After liver transplantation for cholangiocarcinoma (CCC), patients have a poor prognosis without use of specific therapeutic strategies. Accordingly, recipients with incidental CCC might have the highest risk of recurrent disease; however, sparse data on the long-term outcome of unselected patients with incidental CCC have been published. The aim of this study was to evaluate the post-transplantation outcomes of patients with incidental CCC with special focus on tumor localization.


METHODS
There were 11 primary liver transplantations in patients with incidental CCC of 1310 liver transplantation procedures performed between December 1994 and August 2013. All patients with incidental CCC received a chemotherapy regiment including gemcitabine/5 fluorouracil, doxorubicin, and mitomycin. The patients were switched from calcineurin inhibitors to mammalian target of rapamycin inhibitor-based immunosuppression shortly after CCC diagnosis.


RESULTS
Intra- and extrahepatic tumors were found in 6 and 5 patients, respectively. At median follow-up examination of 26.3 months there were 8 CCC recurrences and 7 patient deaths. Overall survival after liver transplantation for incidental CCC was 88.9% at 1 year, 44.4% at 2 years, and 14.8% at 3 years. The corresponding rates of recurrence-free survival were 45.7%, 45.7%, and 0.0%, respectively. Post-transplantation CCC recurrences were universal with 0% 3-year recurrence-free survival both in patients with intra- and extrahepatic tumors (P = .475).


CONCLUSIONS
Incidental CCC in liver transplantation is associated with poor outcomes irrespective of tumor localization. Introduction of new adjuvant multimodal treatment concepts is necessary to improve the prognosis for this subgroup of patients.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. Electronic address: wpatek@mp.pl.
W
W
Patkowski
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
R
R
Stankiewicz
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Grąt
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Krasnodębski
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
O
O
Kornasiewicz
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Krawczyk
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D065095:Calcineurin Inhibitors / Q000008:administration & dosage; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D033162:Incidental Findings; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D020123:Sirolimus / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003841:Deoxycytidine; D016685:Mitomycin; D004317:Doxorubicin; D005472:Fluorouracil; D020123:Sirolimus; D000093542:Gemcitabine