Outcome after liver transplantation for hilar cholangiocarcinoma in the Netherlands after implementation of a nationwide protocol

F.J.H. Hoogwater, V.E. de Meijer, B. van Hoek, W.G. Polak, I.P.J. Alwayn, A.P. van den Berg, S. Darwish Murad, R.J. Porte

Wednesday 13 march 2019

14:22 - 14:24h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: The introduction of the Mayo Clinic protocol (i.e., neoadjuvant chemoradiation therapy followed by liver transplantation) has achieved 5-year survival rates of 68% for patients with unresectable hilar cholangiocarcinoma (hCCA). The question remains if the favorable results could be attributed to the neoadjuvant therapy or to the adherence to the strict selection criteria. The aim of this study was to evaluate whether liver transplantation for hCCA after implementation of a national protocol solely based on strict selection criteria, could have equivalent results.

Methods: Prospective, multicenter national cohort study from 2011-2018. All patients with unresectable hCCA who fulfilled the inclusion criteria for the Dutch protocol for liver transplantation for hCCA were included. All potential eligible patients underwent a multidisciplinary evaluation by all three transplant centers. Patients received non-standard exception (NSE) points only after approval by all three transplant centers.

Results: A total of 19 patients with unresectable hCCA were enrolled in the transplant screening protocol. After approval by all three centers, 10 patients (53%) received NSE points and underwent orthotopic liver transplantation. In 7 (70%) patients the pathology specimen confirmed cholangiocarcinoma; the other 3 patients were diagnosed with atypical cells or no dysplasia. After a median time of 30 months four patients are still alive and a 57% survival rate is reached.

Conclusions: The survival rate of 57% as reached with the Dutch protocol based on strict selection criteria alone closely approaches the survival rates reported for patients with upfront pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic (68%). Although the power of our study is limited by a small number of patients, it does suggest that with strict selection alone a favorable survival after transplantation for hCCA can be achieved.