Liver Transplantation for Cholangiocarcinoma

Abstract

AbstractCholangiocarcinomas (CCAs) are highly aggressive, primary liver cancers with rising incidence and mortality rates. The current 5-year overall survival is less than 20%. There are no standardized screening protocols, and current diagnostic methods include serum biomarkers and imaging techniques with suboptimal sensitivities and specificities. The most commonly used treatment options, including combination systemic therapies, locoregional therapies, and surgical resection, offer improving but nonetheless limited progression-free and overall survival. Liver transplantation has shown promising results as a potentially curative treatment for two types of CCA, namely, perihilar and intrahepatic. However, the evidence is largely from retrospective series of small to moderate sample sizes. There is a need to define optimal types and sequencing of neoadjuvant and adjuvant peritransplant therapies, as well as criteria for CCA patient transplant eligibility. Here, we conduct a granular review of the evidence available on every step of the transplant care pathway for perihilar and intrahepatic CCA patients. We aim to inform best practices to inform future avenues of research and maximize the number of patients eligible for this potentially life-prolonging therapy.