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Liver Transplant Outcomes in Patients with Mixed Hepatocellular-Cholangiocarcinoma: A Different Disease
*Rachel Kohn, *Madhukar S. Patel, *Johannes R. Kratz, James F. Markmann, *Parsia A Vagefi
Massachusetts General Hospital/Harvard Medical School, Boston, MA, MA
Objective: Evaluate the outcomes of liver transplantation (LT) in patients with mixed hepatocellular carcinoma- cholangiocarcinoma (HCC-CC).
Design: Single center retrospective study from 1/1/05 to 1/1/13.
Setting: Tertiary care center within UNOS Region 1.
Patients: Adult, primary, non-status 1, LT recipients at our center transplanted for presumed HCC (n=132).
Interventions: N/A
Main Outcome Measures: Demographics, LT characteristics, pre-transplant treatments received, tumor pathology characteristics, post-transplant recurrence of disease, and death.
Results: Over the eight-year study period, 5 patients had mixed HCC-CC and 127 patients had isolated HCC on explant pathology. All patients with mixed HCC-CC were male, with an average age of 61±7 years, and average MELD at listing of 12.8±7.2. Four of the five received pre-transplant treatment with either radiofrequency ablation or transarterial chemoembolization. Mean follow-up post transplant was 22.1±14.8 months with post transplant recurrence occurring in three patients and ultimately resulting in death in two of these. These two patients were unique in that they were the only two with vascular invasion on explant pathology. One patient died without evidence of metastasis, yielding an overall mortality of 60%. These outcomes are in comparison to an 8.7% recurrence of disease and 17.3% overall mortality rate in LT patients with isolated HCC. Only one patient with mixed HCC-CC survived without recurrence of disease or death, and was the only patient whose tumor was well differentiated on pathology.
Conclusions: LT in patients with mixed HCC-CC is associated with poor overall outcomes with regards to recurrence of disease and overall mortality. Given the limited number of organs available for transplantation, effort should focus on identifying these patients prior to transplant through improved histological or radiological assessment.
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