Current status of liver transplantation for cholangiocarcinoma.

Abstract

Potential conflict of interest: Nothing to report. TO THE EDITOR: In a recent article in Liver Transplantation, Goldaracena et al.1 reviewed the role of liver transplantation (LT) for perihilar and intrahepatic cholangiocarcinoma (ICC). Interestingly, they suggested that patients with an unresectable tumor confined to the hepatic hilum, such as perihilar cholangiocarcinoma (Klatskin tumor), and patients with cirrhosis with very early stage ICC (single tumor of < 2 cm) are potential candidates who might significantly benefit from LT. Although we agree with the suggestion, as they concluded, further studies regarding inclusion criteria and neoadjuvant and adjuvant therapies are urgent in the era of “Transplant Oncology.”2 In Eastern countries, viral hepatitis infection is one of the most frequent etiologic factors for the development of ICC, especially hepatitis B virus (HBV). ICCs arising from HBV infection hold approximately a half of all resected ICC cases in China and share common characteristics with hepatocellular carcinoma, including younger age and infrequent lymph node metastasis.3 In addition, our recent study successfully and precisely predicts recurrence of ICC after hepatic resection by adding the presence of HBV infection as a favorable prognostic factor (C‐index, 0.65; 95% confidence interval, 0.50‐0.64).5 Furthermore, we would like to point out results from our most recent study that showed surprising overall survival (1‐year, 88.9%; 3‐year, 77.8%; 5‐year, 66.7%) of patients with HBV‐associated ICC who underwent hepatic resection and postoperative transarterial chemoembolization (TACE). Because the study reporting the most favorable outcome that was found in patients with a single tumor of <2 cm (1‐year, 93%; 3‐year, 84%; 5‐year, 65%) from Sapisochin et al.6 is comparable to patients with ICC arising from HBV infection who underwent hepatic resection and postoperative TACE, future large‐sized clinical trials need to evaluate the role of combined LT and postoperative TACE treatment in patients with ICC arising from HBV infection to potentially expand the inclusion criteria of LT for ICC.