Liver transplantation for cholangiocarcinoma

Perihilar cholangiocarcinoma (pCCA) has become a new evidence-supported indication for the liver transplantation with outcomes comparable to other traditional indications for liver transplantation. This state of the art procedure complemented by neoadjuvant chemoradiation can be curative for a selected group of patients with pCCA. Indications for transplantation are rather restricted and directed on minimizing the risk of tumor recurrence. The 5-year post-transplant survival rate for patients with perihilar CCA is 69 +/- 4%. Feasibility of the procedure was recently enhanced by improvement in diagnostic modalities including the fluorescence in situ hybridization and MRCP techniques, utilization of pancreatoduodenectomy in patients with microscopic disease extending below the cystic duct, perfection of vascular reconstruction techniques, and expansion of the donor pool by living donor transplantation. There are also emerging data suggesting adjuvant chemotherapy may be effective for patients at a high risk for disease recurrence. While liver transplantation for perihilar CCA is associated with the best outcome, liver transplantation for intrahepatic CCA and mixed hepatocellular-cholangiocellular carcinoma is still controversial due to high rate of disease recurrence. There are recent data suggesting liver transplantation for small intrahepatic CCA ≤ 3 cm is associated with acceptable outcome. This chapter will focus on outcomes, indications, selection criteria, the procedure, and recent advances in transplantation for pCCA.