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Cirrhotic patients with early iCCA possible candidates for LT

Patients with cirrhosis and “very early” intrahepatic cholangiocarcinoma — defined as single tumors no greater than 2 centimeters — may become candidates for an early liver transplant, according to recent findings published in Hepatology.

“Results showed that those patients with a ‘very early’ [intrahepatic cholangiocarcinoma (iCCA)] at the explant pathology had a 5-year post-transplant survival of 65% compared with 45% in those with ‘advanced’ iCCA,” Gonzalo Sapisochin, MD, assistant professor of surgery at the University of Toronto, told Healio.com/Hepatology. “They also reported that the risk for recurrence was lower in the ‘very early’ iCCA group (21% vs. 58%). The researchers suggested that an argument could be made to include these patients in the waiting list and encourage investigators to enroll in a future prospective trial.”

Gonzalo Sapisochin

In most centers worldwide, the presence of iCCA on a cirrhotic liver is a contraindication for liver transplantation, according to Sapisochin and colleagues. However, recent studies suggest that patients with “very early” iCCA may have acceptable results after a liver transplant.

Sapisochin and colleagues sought to further evaluate those findings in a larger cohort of patients. They retrospectively assessed 81patients transplanted for hepatocellular carcinoma or decompensated cirrhosis who had iCCA at 17 centers worldwide between 2000 and 2013. The researchers group patients as having either “very early” iCCA or “advanced” disease — defined as a single tumor greater than 2 centimeters or multifocal disease.

Of the total cohort, 33 had both iCCA and HCC and 48 had only iCCA. In those with only iCCA, 15 had “very early” disease and 33 had “advanced” disease. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 vs. 1.6 cm).

Median follow-up was 35 months. The cumulative risk for recurrence was lower in the “very early” group vs. the “advanced” group (at 1 year, 7% vs. 30%; 3 years, 18% vs. 47%; 5 years 18% vs. 61%). Further, actuarial survival was also better in the “very early” group compared with the “advanced” group (at 1 year, 93% vs. 79%; 3 years, 84% vs. 50%; 5 years, 65% vs. 45%) (P = .02).

The researchers concluded that patients with cirrhosis and “very early” iCCA may become candidates for liver transplantation. However, a prospective multicenter clinical trial is needed to confirm these results.

“The most important challenge when conducting this clinical trial would be to be able to diagnose an iCCA at a very early stage preoperatively,” the researchers wrote. “Due to this difficulty in diagnosis, seven patients in the ‘very early’ iCCA group had incidentally found tumors.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.