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Center Effects on Post-Transplant Outcomes in Liver Transplantation for Hilar Cholangiocarcinoma

S. Nagai1, T. Kitajima1, G. Sapisochin2, D. Moonka1, T. Hibi3

1Henry Ford Hospital, Detroit, MI, 2University of Toronto, Toronto, ON, Canada, 3Kumamoto University, Kumamoto, Japan

Meeting: 2020 American Transplant Congress

Abstract number: A-138

Keywords: Allocation, Liver transplantation, Malignancy, Recurrence

Session Information

Session Name: Poster Session A: Liver: Hepatocellular Carcinoma and Other Malignancies

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Based on favorable outcomes reported by experienced centers, perihilar cholangiocarcinoma (Ph-CCA) has become an accepted indication for liver transplantation (LT). In the United States, patients with Ph-CCA can receive MELD exception scores according to OPTN/UNOS policy. What is less clear is if the reported outcomes have been reproduced nationwide. The aim of this study is to evaluate post-transplant outcomes in patients with Ph-CCA and determine prognostic factors.

*Methods: This study uses data from OPTN/UNOS. Patients who underwent LT with MELD exception scores for Ph-CCA between 2010-2017 were evaluated. To investigate center effects on outcomes, transplant centers were classified into well and less-experienced groups with a threshold number of 8 LTs (1 LT/year); Group 1 (well-experienced [8 or more LTs], 5 centers), Group 2 (less-experienced [<8LTs], 25 centers). (Figure 1) Post-transplant mortality due to all-cause and recurrence of Ph-CCA were set as endpoints. Risks of mortality were analyzed using Cox regression models.

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*Results: A total of 155 patients received primary LT with MELD exception scores for Ph-CCA. There were 92 and 63 LTs for Ph-CCA in Groups 1 and 2. Post-transplant outcomes were significantly better in Group 1 than Group 2 with 1, 3, and 5-year patient survival rates of 92.7%, 58.9%, and 48.2%, vs. 70.3%, 47.5%, and 27.4%. Group 2, compared to Group 1, showed significantly higher risk of all-cause mortality and mortality associated with Ph-CCA recurrence. (Figure 2) The largest center performed 49 LTs for Ph-CCA. The less-experienced group, compared to the largest center, showed significantly higher risks for mortality due to all-cause and recurrence of Ph-CCA, whereas other well-experienced centers showed comparable risks. Center experience was an independent risk factor for post-transplant mortality (HR 2.04, P=0.007), along with recipient performance status (Karnofsky score 10-30%) (HR 2.86, P=0.005).

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*Conclusions: Risk of recurrence of Ph-CCA and mortality was significantly higher in the less-experienced center group. Center effects on post-transplant outcomes in patients with Ph-CCA should be recognized.

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To cite this abstract in AMA style:

Nagai S, Kitajima T, Sapisochin G, Moonka D, Hibi T. Center Effects on Post-Transplant Outcomes in Liver Transplantation for Hilar Cholangiocarcinoma [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/center-effects-on-post-transplant-outcomes-in-liver-transplantation-for-hilar-cholangiocarcinoma/. Accessed May 11, 2025.

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