Researchers from Washington University School of Medicine in St. Louis, Missouri discovered that liver transplantation can confer a 52% 5-year survival rate for appropriately selected patients with unresectable perihilar cholangiocarcinoma (CCA), according to a study published in HPB (Oxford). 

The authors of the study wrote that “surgery remains one of the central tenets of oncologic management for patients with perihilar cholangiocarcinoma and advances in neoadjuvant strategies have produced significant improvements for patients treated with curative intent.”

However, for patients in whom surgery is not possible (around 60%), most succumb to their illness within the first year of diagnosis, and the 5-year survival rate remains poor, at only 20%. 

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Therefore, liver transplantation has been proposed as a last-resort lifeline for patients with unresectable perihilar CCA. A study from the Mayo Clinic found that liver transplantation, when combined with a multimodal strategy that includes chemotherapy and radiation, can provide promising survival outcomes. The authors of this study thus decided to investigate if this was indeed the case. 

The researchers initially recruited 58 patients with perihilar CCA who were treated with multimodal therapy between 2007 and 2009. Twenty-four patients were later delisted due to the findings of advanced disease or worsening health prohibiting surgery. An additional 5 patients were recruited after completing neoadjuvant chemoradiation at their local centers. Overall, 38 patients managed to undergo liver transplantation after completing neoadjuvant chemoradiation, with a mean waiting time of 3.7 months. Fourteen (37%) transplant patients had underlying primary sclerosing cholangitis. 

The results showed that post-transplantation, the 1-year survival rate was 91%, the 3-year survival rate was 58%, and the 5-year survival rate was 52%. Thirteen (34%) patients developed malignant recurrence.

The authors of the study concluded, “The principal finding in this study is that careful patient selection and inclusion can provide satisfactory short and long-term oncologic outcomes following liver transplantation for perihilar cholangiocarcinoma.”


Ahmed O, Vachharajani N, Chang SH, et al. Single-center experience of liver transplantation for perihilar cholangiocarcinoma. HPB (Oxford). Published online August 18, 2021. doi:10.1016/j.hpb.2021.08.940