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World J Hepatol. Oct 8, 2015; 7(22): 2396-2403
Published online Oct 8, 2015. doi: 10.4254/wjh.v7.i22.2396
Liver transplantation for cholangiocarcinoma: Current status and new insights
Gonzalo Sapisochín, Elena Fernández de Sevilla, Juan Echeverri, Ramón Charco
Gonzalo Sapisochín, Elena Fernández de Sevilla, Juan Echeverri, Ramón Charco, Department of HBP Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, 08037 Barcelona, Spain
Author contributions: Sapisochín G, Fernández de Sevilla E, Echeverri J and Charco R contributed equally to the development and writing of this work.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the current work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gonzalo Sapisochín, MD, PhD, Department of HBP Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Passeig Vall d’Hebron 119-129, 08037 Barcelona, Spain. sapisochin@me.com
Telephone: +34-93-2746113 Fax: +34-93-2746112
Received: July 14, 2015
Peer-review started: July 14, 2015
First decision: July 17, 2015
Revised: August 14, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: October 8, 2015
Abstract

Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic (iCCA), perihiliar (phCCA) and distal. Initial experiences with orthotopic liver transplantation (OLT) for patients with iCCA and phCCA had very poor results and this treatment strategy was abandoned. In the last decade, thanks to a strict selection process and a neoadjuvant chemoradiation protocol, the results of OLT for patients with non-resectable phCCA have been shown to be excellent and this strategy has been extended worldwide in selected transplant centers. Intrahepatic cholangiocarcinoma is a growing disease in most countries and can be diagnosed both in cirrhotic and in non-cirrhotic livers. Even though OLT is contraindicated in most centers, recent investigations analyzing patients that were transplanted with a misdiagnosis of HCC and were found to have an iCCA have shown encouraging results. There is some information suggesting that patients with early stages of the disease could benefit from OLT. In this review we analyze the current state-of-the-art of OLT for cholangiocarcinoma as well as the new insights and future perspectives.

Keywords: Orthotopic liver transplantation, Perihiliar cholangiocarcinoma, Intrahepatic cholangiocarcinoma

Core tip: Cholangiocarcinoma is a malignant tumor of the biliary system. Perihilar cholangiocarcinoma is an accepted indication for orthotopic liver transplantation (OLT) in some centers under a strict selection process and after neoadjuvant chemoradiation. Intrahepatic cholangiocarcinoma is a formal contraindication for LT in most centers worldwide due to the poor reported results. Nevertheless, there is some novel research showing that the results of OLT in early stages of this disease may not be as bad and could potentially be accepted as an indication for transplant. In this review we will analyze the current state-of-the-art of liver transplantation for cholangiocarcinoma.