title: Living Donor Liver Transplantation for Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Experience of a Single Center.
abstract: BACKGROUND Because the outcome of liver transplantation for cholangiocarcinoma is often poor, cholangiocarcinoma is a contraindication for liver transplantation in most centers. Combined hepatocellular carcinoma and cholangiocarcinoma is a rare type of primary hepatic malignancy containing features of hepatocellular carcinoma and cholangiocarcinoma. Diagnosing combined hepatocellular carcinoma and cholangiocarcinoma pre-operatively is difficult. Because of sparse research presentations worldwide, we report our experience with living donor liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma. MATERIAL AND METHODS A total of 710 patients underwent living donor liver transplantation at our institution from April 2006 to June 2014; 377 of them received transplantation because of hepatocellular carcinoma with University of California San Francisco (UCSF) staging criteria fulfilled pre-operatively. Eleven patients (2.92%) were diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma confirmed pathologically from explant livers; we reviewed these cases retrospectively. Long-term survival was compared between patients diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma and patients diagnosed with hepatocellular carcinoma. RESULTS The mean age of the patients in our series was 60.2 years, and the median follow-up period was 23.9 months. Four patients were diagnosed with a recurrence during the follow-up period, including one intra-hepatic and three extra-hepatic recurrences. Four patients died due to tumor recurrence. Except for patients with advanced-stage cancer, disease-free survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma compared with that of patients with hepatocellular carcinoma was 80% versus 97.2% in 1 year, and 46.7% versus 92.5% in 3 years (p<0.001), and overall survival was 90% versus 97.2% in 1 year, and 61.7% versus 95.1% in 3 years (p<0.001). CONCLUSIONS Outcomes of liver transplantation for patients with combined hepatocellular carcinoma and cholangiocarcinoma were worse than those for patients with hepatocellular carcinoma in this study. Combined hepatocellular carcinoma and cholangiocarcinoma are presumed to be a relative contraindication for liver transplantation.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Cheng-Chih
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ying-Ju
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Tzu-Hao
authors.initials: TH
authors.lastname: Huang
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chun-Han
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Fang-Ying
authors.initials: FY
authors.lastname: Kuo
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Li
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Liver Transplantation Program, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome