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Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience

BACKGROUND. While liver transplantation (LT) with neoadjuvant chemoradiation is increasingly utilized for the management of unresectable cholangiocarcinoma (CCA), data on post-LT survival are limited. METHODS. We identified 844 patients who underwent LT (2002–2019) for nonincidental (CCA listing) or...

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Autores principales: Ziogas, Ioannis A., Rauf, Muhammad A., Matsuoka, Lea K., Izzy, Manhal, Rega, Scott A., Feurer, Irene D., Alexopoulos, Sophoclis P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440016/
https://www.ncbi.nlm.nih.gov/pubmed/34549084
http://dx.doi.org/10.1097/TXD.0000000000001133
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author Ziogas, Ioannis A.
Rauf, Muhammad A.
Matsuoka, Lea K.
Izzy, Manhal
Rega, Scott A.
Feurer, Irene D.
Alexopoulos, Sophoclis P.
author_facet Ziogas, Ioannis A.
Rauf, Muhammad A.
Matsuoka, Lea K.
Izzy, Manhal
Rega, Scott A.
Feurer, Irene D.
Alexopoulos, Sophoclis P.
author_sort Ziogas, Ioannis A.
collection PubMed
description BACKGROUND. While liver transplantation (LT) with neoadjuvant chemoradiation is increasingly utilized for the management of unresectable cholangiocarcinoma (CCA), data on post-LT survival are limited. METHODS. We identified 844 patients who underwent LT (2002–2019) for nonincidental (CCA listing) or incidental (CCA on explant, not at listing) CCA in the Scientific Registry of Transplant Recipients. Kaplan–Meier and multivariable proportional hazards regression methods evaluated the effects of patient characteristics, donor type, transplant era (before/after 2010), and center volume (center-level CCALTs/active year) on the risk of graft failure and patient mortality. RESULTS. One center performed >12 CCALTs/y, and the rest performed ≤4. Five-year graft survival was 50.6%. Multivariable models demonstrated laboratory model of end-stage liver disease ≥40 versus <15 and center volumes of 1, >1 to ≤2, and >2 to ≤4 CCALTs/y compared to >12 were associated with increased risk of graft failure and mortality (all P ≤ 0.002). Extra vessel use was associated with center volume. Among all recipients, extra vessel use occurred in 55.4% of CCALTs performed at the highest volume center and in 14.0% of cases at centers having ≤4 CCAs/y (P < 0.05). CONCLUSIONS. Center volume-related differences in outcomes and extra vessel use highlight the importance of establishing a unified, effective treatment protocol and the potential utility of regionalization of LT for CCA.
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spelling pubmed-84400162021-09-20 Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience Ziogas, Ioannis A. Rauf, Muhammad A. Matsuoka, Lea K. Izzy, Manhal Rega, Scott A. Feurer, Irene D. Alexopoulos, Sophoclis P. Transplant Direct Liver Transplantation BACKGROUND. While liver transplantation (LT) with neoadjuvant chemoradiation is increasingly utilized for the management of unresectable cholangiocarcinoma (CCA), data on post-LT survival are limited. METHODS. We identified 844 patients who underwent LT (2002–2019) for nonincidental (CCA listing) or incidental (CCA on explant, not at listing) CCA in the Scientific Registry of Transplant Recipients. Kaplan–Meier and multivariable proportional hazards regression methods evaluated the effects of patient characteristics, donor type, transplant era (before/after 2010), and center volume (center-level CCALTs/active year) on the risk of graft failure and patient mortality. RESULTS. One center performed >12 CCALTs/y, and the rest performed ≤4. Five-year graft survival was 50.6%. Multivariable models demonstrated laboratory model of end-stage liver disease ≥40 versus <15 and center volumes of 1, >1 to ≤2, and >2 to ≤4 CCALTs/y compared to >12 were associated with increased risk of graft failure and mortality (all P ≤ 0.002). Extra vessel use was associated with center volume. Among all recipients, extra vessel use occurred in 55.4% of CCALTs performed at the highest volume center and in 14.0% of cases at centers having ≤4 CCAs/y (P < 0.05). CONCLUSIONS. Center volume-related differences in outcomes and extra vessel use highlight the importance of establishing a unified, effective treatment protocol and the potential utility of regionalization of LT for CCA. Lippincott Williams & Wilkins 2021-03-22 /pmc/articles/PMC8440016/ /pubmed/34549084 http://dx.doi.org/10.1097/TXD.0000000000001133 Text en Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Liver Transplantation
Ziogas, Ioannis A.
Rauf, Muhammad A.
Matsuoka, Lea K.
Izzy, Manhal
Rega, Scott A.
Feurer, Irene D.
Alexopoulos, Sophoclis P.
Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title_full Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title_fullStr Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title_full_unstemmed Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title_short Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
title_sort liver transplantation for cholangiocarcinoma: charting a path with lessons learned from center experience
topic Liver Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440016/
https://www.ncbi.nlm.nih.gov/pubmed/34549084
http://dx.doi.org/10.1097/TXD.0000000000001133
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