Liver transplantation could be a treatment option for patients with cholangiocarcinoma (CCA), even those with advanced tumors, according to a study recently published in Cirugía Española.

“The results of this study, however, may suggest that in highly selected advanced tumors, [liver transplantation] could also be an alternative, considering the absence of tumoral recurrence and near equivalent survival to early-stage tumors,” the authors wrote.

This retrospective cohort study included 13 patients who underwent liver transplantation and later received an incidental diagnosis of intrahepatic CCA (54%) or hepatocellular CCA (46%) by histopathological analysis.

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The median age was 56 years, and most patients were male (84.6%). The most common cause of liver disease was hepatitis C virus infection (46.2%), followed by alcoholic liver disease (38.5%) and hepatitis B virus infection (15.3%).

The median follow-up time was 65 months. During this period, the overall survival rates were 92.3%, 76.9%, and 76.9% at the first, third, and fifth years after surgery, respectively. There were no relapses; hence, the tumor-free survival rates were the same.

Moreover, the overall survival rates among patients with early-stage CCA were 100%, 83.3%, and 83.3% at years 1, 3, and 5, respectively. Importantly, these results were not statistically different from those of patients with advanced-stage CCA.

On the other hand, patients with intrahepatic CCA achieved better overall survival rates than those with hepatocellular CCA, with 87.7% vs 66.7% survival in the fifth year, respectively. Regardless, this difference was not statistically significant.

Although these results are greatly valuable, there are still many details left to fully understand to consider liver transplantation as a feasible therapeutic alternative for patients with CCA. For example, identifying specific criteria that allow clinicians to determine which patients could be adequate candidates for liver transplantation is arguably the most important next step.

“Several multicenter international studies have suggested that tumor size correlates with recurrence and survival after [liver transplantation], as in an international retrospective analysis where 5-years survival for tumors ≤2 cm was 65% compared with 45% in tumors >2 cm,” the authors noted.


Moreno VG, Alonso IJ, Fernández CF, et al. “Long-term follow-up of liver transplantation in incidental intrahepatic cholangiocarcinoma and mixed hepatocellular-cholangiocarcinoma”. Cir Esp (Engl Ed). Published online April 28, 2023. doi:10.1016/j.cireng.2023.04.010