Journal: Annals of surgical oncology
This retrospective two-center study evaluated how many patients with intrahepatic cholangiocarcinoma (iCCA) would qualify for liver transplantation under stringent criteria, and what outcomes those patients achieve without actually receiving a transplant.
From 1,407 iCCA patients (2008–2018), 327 (23%) had advanced but liver-confined disease. Applying six strict transplant-eligibility criteria—unresectability, absence of extrahepatic disease, disease control after chemotherapy, age ≤72, no major comorbidities, and no major vascular involvement—only 39 patients (12% of those with advanced liver-confined disease; 2.8% of the total cohort) qualified.
- Most patients with liver-confined advanced disease either progressed or died within 6 months, or were excluded due to later resection, age, performance status, comorbidities, or vascular involvement.
- More than half of the ultimately “eligible” group received hepatic arterial infusion pump chemotherapy.
Among these 39 transplant-eligible but non-transplanted patients, median overall survival from diagnosis was 39 months, with an estimated 3‑year survival of 46% from the time they would have been considered eligible. These outcomes surpass typical expectations for systemic therapy alone and likely reflect a combination of biologically favorable disease and the impact of hepatic arterial infusion therapy. The study underscores that only a very small fraction of iCCA patients meet stringent criteria for transplant consideration.