Liver Transplantation for Intrahepatic Cholangiocarcinoma

"Liver Transplantation for Intrahepatic Cholangiocarcinoma: A Nationwide Analysis of Outcomes."
Presented by: Kamil Hanna

*Introduction*
Intrahepatic cholangiocarcinoma (ICC) remains a challenging indication for liver transplantation (LT) due to aggressive tumor biology and difficulty in selecting appropriate candidates. We evaluated nationwide outcomes of LT for ICC.

*Methods*
We performed a retrospective cohort study using the 2015–2017 Nationwide Readmission Database. Adults with ICC without extrahepatic disease (EHD) or macrovascular involvement were included. Use of liver resection (LR), neoadjuvant chemotherapy (NAT), and locoregional therapy (LRT) was captured. Primary endpoints were 6-month overall survival (OS) and recurrence-free survival (RFS) after LT (Kaplan–Meier). Secondary outcomes included 6-month readmission and postoperative complications. Predictors of 6-month OS were assessed with regression analysis.

*Results*
Among 22,557 ICC patients, 7,069 (31.3%) with extrahepatic disease and 1,120 (5.0%) with macrovascular involvement were excluded. Mean age was 68.5±12.1 years. Cirrhosis was present in 8.8%. Of eligible patients, 161 underwent LT after a median 17 days (median post-LT follow-up 182 days). Pre-LT treatments included NAT (74.6%), LR (44.5%), and LRT (21.9%). Six-month OS was 90.7% (Figure 1) and 6-month RFS was 74%. Recurrence was predominantly extrahepatic, most commonly gastrointestinal (14.8%); 9.3% recurred in the allograft. The 6-month readmission rate was 75%, most often for sepsis (14.1%) and anastomotic strictures (11.9%). Postoperative complications occurred in 42.4%, most frequently acute kidney injury (21.2%), anastomotic strictures (16.7%), hepatic artery thrombosis (16.7%), and sepsis (15.2%). Predictors of 6-month OS included cirrhosis-associated ICC, absence of lymphadenopathy, time to LT, and 6-month RFS.

*Conclusions*
LT may be a viable option for carefully selected ICC patients demonstrating pre-LT disease stability and favorable biology.
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