Dados do Trabalho

Título

Cholangiocarcinoma and liver transplantation: A systematic review of the criteria and prognosis of these patients

Introdução

Cholangiocarcinoma (CCA) is a highly lethal adenocarcinoma of the hepatobiliary system, which can be classified as intrahepatic, perihilar and distal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with Intrahepatic Cholangiocarcinoma (iCCA) will require a major hepatectomy for complete resection of the tumor. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. In patients with unresectable, advanced tumors, confined to the liver who achieve sustained response to neoadjuvant treatment, Liver transplantation (LT) may be considered an option within prospective protocols.

Objetivo

Demonstrate the indications of liver transplantation in patients with cholangiocarcinoma.

Método

This systematic review of published literature was carried out according to a predefined protocol, studies published in the last 10 years were identified through an electronic search of the US National Library of Medicine (MEDLINE), strategy used: (transplantation OR transplant) AND (cholangiocarcinoma). The title and abstract of each study was examined for relevance with full text being obtained for all potentially relevant studies. Studies were included regardless of design, with both trials and observational studies being eligible for inclusion.

Resultados

Because of the very poor initial results, CCA has been a contraindication for LT in most centers, however emerging data suggest that LT should be an option for patients with iCCA with cirrhosis and small tumors (<2 cm) and patients with unresectable liver-only disease due to vascular/biliary structures invasion or to inadequate liver remnant, these cases preceded by neoadjuvant protocols and following careful patient selection. Other criterias should be evaluated prior to patient selection, such as: Age < 65 years, histological and molecular aspects, presence of nodal disease, sclerosing cholangitis and location.

Conclusão

Based on prognostic information already available, liver transplant is an alternative for selected patients with Perihilar CCA, however owing to the shortage of available organs, it still remains unknown whether liver transplantation and neoadjuvant chemoradiotherapy should be increasingly considered for other classifications of CCA.