Outcomes After Living Donor Liver Transplant for Intrahepatic Cholangiocarcinoma.

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive liver cancer with limited curative options. Deceased donor liver transplant is associated with survival benefit in select patients with unresectable iCCA, although outcomes are limited by high waitlist mortality and use of expanded criteria grafts, given ongoing deceased donor scarcity. This retrospective, single-center study investigated outcomes for seven patients who underwent living donor liver transplant (LDLT) for unresectable but liver-confined iCCA, managed under a transplant oncology protocol. The patients were selected for disease stability and otherwise met criteria for liver transplant. Six patients received pre-transplant systemic chemotherapy and four underwent locoregional therapy. Median listing Model for End-Stage Liver Disease score was 8 (IQR, 8-11) and patients spent a median 38 days (IQR, 15-70) on waitlist. Two patients experienced Clavien-Dindo grade III complications in the first six months. During a median follow-up of 5.1 years (IQR, 2.8-5.2), two patients experienced recurrence, and one died. 5-year Kaplan-Meier estimates for overall and recurrence-free survival were 85.7% (95% CI, 33.4-97.9) and 71.4% (95% CI, 25.8-92.0), respectively. All donors were alive at last follow-up. For selected patients with unresectable iCCA, LDLT may serve as a useful modality to provide oncological benefit in the era of deceased donor liver scarcity.