Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

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Background Liver transplantation has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (PHC) in the Mayo Clinic with a reported 5-year survival of 53% on intention-to-treat analysis. The majority of these patients (63%) had PSC-associated PHC. The objective of this study was to estimate eligibility for such a protocol in a cohort of PHC patients in two tertiary referral centers. Methods: Consecutive patients diagnosed with PHC were included from two high volume hepatobiliary academic centers in the Netherlands. The selection criteria used by the Mayo Clinic were applied to determine the proportion of patients eligible for transplantation. Results: A total of 732 patients with PHC were identified, of whom 24 (4.0%) had PSC-associated PHC. 154 patients were primarily eligible for resection. 335 patients were excluded because of lymph node or distant metastases. After applying the Mayo Clinic inclusion and exclusion criteria, 35 patients were found to be eligible out of a total cohort of 732 patients (4.8%; figure). Median survival from diagnosis for patients eligible for transplantation was 1.1 years (95%CI: 0.4-1.8), and no patient reached 5-year survival. Finally, the strict age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible based on performance and oncological considerations (figure). Conclusion: At two major tertiary referral centers, 5% of patients with perihilar cholangiocarcinoma were eligible for liver transplantation under the Mayo criteria. Without liver transplantation these patients had a median survival of 1 year.