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Liver Transplantation for Cholangiocarcinoma

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Diagnosis and Management of Cholangiocarcinoma

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Abstract

Liver transplantation (LT) has been the gold standard treatment for patients with unresectable hepatocellular carcinoma for nearly three decades. More recently, a new era of “transplant oncology” has been ushered in with the recognition that LT is also a viable curative therapy for patients with cholangiocarcinoma (CCA). Initial success of LT for CCA was outlined by the Mayo Clinic experience for patients with unresectable hilar CCA (hCCA) measuring <3 cm managed on a strict pre-transplant protocol including neoadjuvant chemoradiotherapy and staging laparotomy to exclude lymph node metastases. More recently, numerous single-center and multicenter studies have identified excellent outcomes following LT for intrahepatic cholangiocarcinoma (iCCA) as well. While appropriateness of LT for patients with resectable hCCA or larger iCCA is debated, it’s increasingly clear that multimodal neoadjuvant therapy and appropriate patient selection are of paramount importance. Given the relative scarcity of available donor liver allografts, rigorous patient selection must be applied to mitigate oncologic risk and ensure meaningful organ utilization.

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Abbreviations

CCA:

Cholangiocarcinoma

ERCP:

Endoscopic retrograde cholangiopancreatography

hCCA:

Hilar cholangiocarcinoma

iCCA:

Intrahepatic cholangiocarcinoma

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

PSC:

Primary sclerosing cholangitis

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Author information

Authors and Affiliations

  1. Division of Liver and Pancreas Transplantation, Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA, USA

    James R. Butler & Vatche G. Agopian

  2. Liver Transplantation and Hepatobiliary Surgery, General Surgery Residency Program, Department of Surgery, David Geffen School of Medicine at UCLA, Ronald Reagan Medical Center, Los Angeles, CA, USA

    Vatche G. Agopian

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  1. James R. Butler
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  2. Vatche G. Agopian
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Correspondence to Vatche G. Agopian .

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Editors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA

    James H. Tabibian

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Butler, J.R., Agopian, V.G. (2021). Liver Transplantation for Cholangiocarcinoma. In: Tabibian, J.H. (eds) Diagnosis and Management of Cholangiocarcinoma. Springer, Cham. https://doi.org/10.1007/978-3-030-70936-5_15

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  • DOI: https://doi.org/10.1007/978-3-030-70936-5_15

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