Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study

• Type of Material: Article
• Authors: Eva Breuer, University Hospital Zurich; Matteo Mueller, University Hospital Zurich; Majella B. Doyle, Washington University in St. Louis; Liu Yang, Mayo Clin Florida; Sarwa Darwish Murad, University Medical Center Rotterdam; Imran J. Anwar, Duke University; Shaheed Merani, University of Nebraska; Ashley Limkemann, Ohio State University; Heithem Jeddou, Pontchaillou University; Steven Kim, Emory University; Victor Lopez-Lopez, Virgen de la Arrixaca Clinic; Ahmed Nassar, Emory University; Frederick J. H. Hoogwater, University of Groningen; Eric Vibert, Paul Brousse Hospital; Michelle L. De Oliveira, University Hospital Zurich; Daniel Cherqui, Paul Brousse Hospital; Robert J. Porte, University of Groningen; Joseph Magliocca, Emory University; Lutz Fischer, University Medical Center Hamburg-Eppendorf; Constantino Fondevila, Hospital Universitario La Paz; Krzysztof Zieniewicz, Medical University of Warsaw; Pablo Ramirez, Virgen de la Arrixaca Clinic; David P. Foley, University of Wisconsin; Karim Boudjema, Pontchaillou University; Austin D. Schenk, Ohio State University; Alan N. Langnas, University of Nebraska; Stuart Knechtle, Emory University; Wojciech G. Polak, University Medical Center Rotterdam; C. Burcin Taner, Mayo Clinic; William C. Chapman, Washington University; Charles B. Rosen, Mayo Clinic; Gregory J. Gores, Mayo Clinic; Philipp Dutkowski, University Hospital Zurich; Julie K. Heimbach, Mayo Clinic; Pierre-Alain Clavien, University Hospital Zurich
• Language: English
• Date: 2022-11-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/SLA.0000000000005641
• Title of Journal or Parent Work: ANNALS OF SURGERY
• Volume: 276
• Issue: 5
• Start Page: 846
• End Page: 853
• Grant/Funding Information: This study is supported by the LGID (Liver and Gastrointestinal Disease) Foundation and the Yvonne Jacob Foundation.
• Keywords: NEOADJUVANT CHEMORADIATION; Surgery; benchmarks; Science & Technology; perihilar cholangiocarcinoma; SURGICAL COMPLICATIONS; complications; RESECTION; outcomes; PREDICTORS; RECURRENCE; Life Sciences & Biomedicine; CCI (R); liver transplantation; DEFINING BENCHMARKS; Mayo-protocol; SURVIVAL; CLASSIFICATION; HILAR CHOLANGIOCARCINOMA; OUTCOMES
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Objective: To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons. Background: Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC. Methods: PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014–2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥ 50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers. Results: One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤ 5.2%; comprehensive complication index at 1 year of ≤ 33.7; grade ≥ 3 complication rates ≤ 66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n = 106) (62% vs 32%, P < 0.001). Conclusion: This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.