Digestive Diseases and Sciences

, Volume 59, Issue 5, pp 1048–1054 | Cite as

Improved Post-Transplant Survival in the United States for Patients with Cholangiocarcinoma After 2000

  • Reena J. Salgia
  • Amit G. Singal
  • Sherry Fu
  • Shawn Pelletier
  • Jorge A. Marrero
Original Article

Abstract

Background

The incidence of cholangiocarcinoma (CCA) continues to rise. Orthotopic liver transplantation (OLT) can be used for selected patients with localized but unresectable hilar CCA. Although initial post-OLT survival rates were poor, outcomes after introduction of the Mayo Clinic protocol have been more promising and there has been increased interest in OLT for CCA nationally.

Aims

The aim of this study is to determine post-transplant survival and prognostic factors for patients undergoing OLT for CCA.

Methods

A retrospective analysis of all patients with CCA listed nationwide for OLT between October 1987 and May 2008 was performed using the Scientific Registry of Transplant Recipients database. Survival curves were generated using the Kaplan–Meier method and compared using log-rank test.

Results

Of 595 patients with CCA listed for OLT, 359 (60.3 %) underwent OLT. Median age at OLT was 49 years, 66 % were male and 91 % were Caucasian. The median follow-up time was 2 years. There has been an increasing number of liver transplants performed for CCA since 2000. The 1- and 5-year probability of survival was 85.8 and 51.4 %, respectively. On multivariate analysis, significant prognostic factors for decreased post-OLT survival included transplant before 2000 (HR 11.25, 95 % CI 1.28–98.7) and acute cellular rejection (HR 5.64, 95 % CI 1.14–27.8).

Conclusions

Survival after transplant for CCA has improved over time, and OLT is being used more frequently in the treatment of CCA. Significant predictors of post-OLT survival include a history of acute rejection and date of transplant in relation to the publication of Mayo protocol results.

Keywords

Cholangiocarcinoma Liver transplant Outcomes Survival 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Reena J. Salgia
    • 1
  • Amit G. Singal
    • 2
  • Sherry Fu
    • 1
    • 4
  • Shawn Pelletier
    • 3
  • Jorge A. Marrero
    • 2
    • 5
  1. 1.Department of Internal Medicine, Taubman Medical CenterUniversity of MichiganAnn ArborUSA
  2. 2.Department of Internal MedicineUniversity of Texas SouthwesternDallasUSA
  3. 3.Department of General SurgeryUniversity of VirginiaCharlottesvilleUSA
  4. 4.Simpson Memorial InstituteAnn ArborUSA
  5. 5.University of Texas Southwestern Medical CenterDallasUSA

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