Long-Term Outcomes of Liver Transplantation in Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Comparison with Portal Vein Tumor Thrombus

SIMPLE SUMMARY: Liver transplantation is the last chance for patients with hepatocellular carcinoma (HCC) who can no longer be treated. However, not all HCC patients are eligible for a liver transplant. There are several conditions that are eligible for liver transplantation. Among them, portal vein tumor thrombus (PVTT) is treated as a contraindication and bile duct tumor thrombus (BDTT) as an implicit contraindication. However, recently, a study has been published that performed liver transplantation after locoregional treatment in HCC patients with PVTT. We evaluated the long-term clinical significance of liver transplantation in HCC patients with BDTT. We found that BDTT had as poor a disease-free and overall survival after liver transplantation as PVTT. Liver transplantation in HCC patients with BDTT requires a cautious approach and exploration. ABSTRACT: Liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) remains controversial. This study analyzed the recurrence and overall survival rates through long-term results after LT in HCC patients with BDTT and compared the results after LT in HCC patients with portal vein tumor thrombus (PVTT). We performed a retrospective study of 45 patients with PVTT, 16 patients with BDTT, and 11 patients with coexisting PVTT and BDTT among HCC patients who underwent LT at a single center from 1999 to 2020. The HCC recurrence rates were 40.4% at 1 year, 30.3.3% at 2 years, and 27.6% at 3 years in the PVTT group; 66.7%, 53.3%, and 46.7% in the BDTT group; and 22.2%, 22.2%, and 0% in the coexisting group (p = 0.183). Overall patient survival rates were 68.4% at 1 year, 54.3% at 2 years, and 41.7% at 3 years in the PVTT group; 81.3%, 62.5%, and 48.2% in the BDTT group; and 63.6%, 27.3%, and 0% in the coexisting group (p = 0.157). In the multivariate analysis, the pre-transplantation model for tumor recurrence after liver transplantation (MoRAL) score and model for end-stage liver disease (MELD) score were found to be independent risk factors for recurrence and survival in all groups. HCC patients with BDTT showed no difference in recurrence and survival compared with HCC patients with PVTT at the long-term follow-up after LT.