title: Long-term outcome of patients undergoing liver transplantation for mixed hepatocellular carcinoma and cholangiocarcinoma: an analysis of the UNOS database.
abstract: BACKGROUND
  Mixed hepatocellular and cholangiocarcinoma (HCC-CC) have been associated with a poor prognosis after liver transplantation (LT). We aimed to evaluate long-term outcomes in patients undergoing LT for HCC-CC versus patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC).
  
  
  METHODS
  Retrospective analysis of the United Network for Organ Sharing (UNOS) database from 1994-2013. Overall survival (OS) in patients with HCC-CC, HCC, and CC, were compared.
  
  
  RESULTS
  We identified 4049 patients transplanted for primary malignancy (94 HCC-CC; 3515 HCC; 440 CC). Mean age of patients with HCC-CC was 57 ± 10 years, and 77% were male. MELD score did not differ among the groups (p = 0.637). Hepatitis C virus was the most common secondary diagnosis within the HCC-CC (44%) and HCC (36%) cohorts, with primary sclerosing cholangitis in the CC (16%) cohort. OS rates at 1, 3 and 5 years for HCC-CC (82%, 47%, 40%) were similar to CC (79%, 58%, 47%), but significantly worse than HCC (86%, 72%, and 62% p = 0.002).
  
  
  CONCLUSIONS
  Patients undergoing LT for HCC had significantly better survival compared to those transplanted for HCC-CC and CC. LT for mixed HCC-CC confers a survival rate similar to selected patients with CC. Efforts should be made to identify HCC-CC patients preoperatively.
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Valery
authors.initials: V
authors.lastname: Vilchez
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Malay B
authors.initials: MB
authors.lastname: Shah
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Daily
authors.affiliation: Department of Gastroenterology, University of Kentucky, Lexington, KY, 40536, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Pena
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Davenport
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, KY, 40536, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hosein
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gedaly
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA. Electronic address: erin.maynard@uky.edu.
authors.forename: Erin
authors.initials: E
authors.lastname: Maynard
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018193:Neoplasms, Complex and Mixed / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States