Role of liver transplantation in the treatment of cholangiocarcinoma

Cholangiocarcinoma is a rare malignancy arising from the bile duct epithelium with a grim prognosis. Although complete resection may be curative, it is feasible only in a minority of cases owing to local extension of the tumor. Early experiences with liver transplantation were discouraging, given the high rates of tumor recurrence and poor patient survival. Trials with aggressive transplantation methods and adjuvant chemotherapy did not yield significantly better outcomes. Recently, stringent patient selection and neoadjuvant chemoradiation have yielded promising results with 5-year survival rates as high as 76%. Factors associated with recurrence after transplantation include advanced age, history of cholecystectomy, elevated serum glycoprotein cancer antigen 19-9 level, a discreet mass on imaging and an interval from enrollment to transplant greater than 100 days.