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World J Gastrointest Surg. Jan 27, 2022; 14(1): 1-11
Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.1
Current status of liver transplantation for cholangiocarcinoma
Patrick Twohig, Thoetchai Bee Peeraphatdit, Sandeep Mukherjee
Patrick Twohig, Thoetchai Bee Peeraphatdit, Department of Internal Medicine, Division of Gastroenterology and Transplant Hepatology, University of Nebraska Medical Center, Omaha, NE 68198, United States
Sandeep Mukherjee, Department of Internal Medicine, Division of Gastroenterology, Creighton University, Omaha, NE 68124, United States
Author contributions: Twohig P performed a majority of the writing, prepared the figures and tables; Peeraphatdit TB assisted in writing the manuscript, preparing figures and tables, and reviewing the manuscript; Mukherjee S designed the outline of the manuscript, provided input into writing and reviewing the manuscript; all authors approved of the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sandeep Mukherjee, FRCP (C), MD, Full Professor, Department of Internal Medicine, Division of Gastroenterology, Creighton University, Suite 401, Education Building, 7710 Mercy Road, Omaha, NE 68124, United States. sandeep.mukherjee@alegent.org
Received: April 7, 2021
Peer-review started: April 7, 2021
First decision: June 23, 2021
Revised: July 12, 2022
Accepted: December 28, 2021
Article in press: December 28, 2021
Published online: January 27, 2022
Processing time: 286 Days and 23.6 Hours
Abstract

Cholangiocarcinoma (CCA) is the second most common liver cancer with a median survival of 12-24 mo without treatment. It is further classified based on its location into intrahepatic CCA (iCCA), perihilar CCA (pCCA), and distal CCA. Surgical resection is the mainstay of treatment, but up to 70% of these tumors are inoperable at the time of diagnosis. CCA was previously an absolute contraindication for liver transplantation (LT) due to poor outcomes primary due to early recurrent disease. However, improvement in patient selection criteria and neoadjuvant treatment protocols have improved outcomes for inoperable pCCA patients with recent studies reporting LT may improve survival in iCCA. Future advances in the treatment of CCA should include refining patient selection criteria and organ allocation for all subtypes of CCA, determining effective immunotherapies and the evolving role of personalized medicine in patients ineligible for surgical resection or LT. Our article reviews the current status of LT in CCA, along with future directions in managing patients with CCA.

Keywords: Intrahepatic cholangiocarcinoma; Perihilar cholangiocarcinoma; Liver transplantation; Immunotherapy; Chemotherapy; Transplant

Core Tip: Perihilar cholangiocarcinoma (pCCA) is an accepted indication for liver transplantation (LT) using a strict selection process and standardized neoadjuvant treatment protocol with pre-operative disease staging. Intrahepatic cholangiocarcinoma (iCCA) has historically been a contraindication for LT due to poor reported outcomes. With improved tumor detection, patient selection, and neoadjuvant treatment, recent studies have reported improved survival in iCCA patients with LT. No standardized protocol exists for the treatment of iCCA using LT. Our review analyzes the history and current literature on the treatment of pCCA and iCCA, along with gaps in knowledge and future perspectives.