Outcomes of Liver Transplantation for Combined Hepatocellular Cholangiocarcinoma: A Single-center Experience

Y. Liu¹, C. Hanlon¹, S. Zhou¹, D. Toy¹, K. King², K. Zhou³, J. Kahn³, L. Yuan³

¹Internal Medicine, USC Keck School of Medicine, Los Angeles, CA, ²Radiology, USC Keck School of Medicine, Los Angeles, CA, ³Internal Medicine - Gastrointestinal and Liver Disease, USC Keck School of Medicine, Los Angeles, CA

Meeting: 2021 American Transplant Congress

Abstract number: 90

Keywords: Liver transplantation, Post-transplant malignancy, Survival, Tumor recurrence

Topic: Clinical Science » Liver » Liver: Hepatocellular Carcinoma and Other Malignancies

Session Information

Session Name: Liver Transplant Oncology

Session Type: Rapid Fire Oral Abstract

Date: Saturday, June 5, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:35pm-6:40pm

Location: Virtual

*Purpose: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a hepatic tumor that exhibits histological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). cHCC-CCA is often diagnosed incidentally on explant. Clinical traits associated with cHCC-CCA and predictors of transplant outcomes should be identified to best allocate organs.

*Methods: 308 patients who underwent OLT for the indication of HCC as well as those with cHCC-CCA found on explant at Keck Hospital from 2002 to 2020 were reviewed. A cohort of patients with cHCC-CCA on explant was identified, and features/outcomes were compared to patients with HCC alone on explant.

*Results: 15 patients were identified to have cHCC-CCA or both HCC and CCA; 1 patient had isolated CCAs on explant. HCV was the major etiology of cirrhosis in both cohorts. Three cHCC-CCA phenotypes were identified: cHCC-CCA with other HCC or CCA nodules (n=6), cHCC-CCA alone (n=5), and concurrent discrete HCC and CCA nodules (n=4). Microvascular invasion on explant was present in 31% of the cHCC-CCA cohort compared to 7% in pure HCC (p=<0.001). 3-year survival was 62% in the cHCC-CCA cohort compared to 88% for HCC (p=0.02).

*Conclusions: Demographic and clinical features between HCC and cHCC-CCA are nearly identical, necessitating further modalities such as biomarkers to be developed to identify cHCC-CCA to aid transplant evaluation. Three unique phenotypes of cHCC-CCA were identified, and further identification/long-term follow up of cases should be pursued to characterize survival respectively to revise exclusion/inclusion criteria for cHCC-CCA.

Demographics (%/median)
	HCC (N=270)	cHCC-CCA or CCA (N=16)	p-value
Age	60 (54-64)	59 (51-66)	0.97
Male Sex	76%	75%	0.96
Race			0.89
-Hispanic	49%	63%
-White	28%	25%
-Asian	20%	13%
MELD-Na at transplant	13 (9-18)	12 (9-16)	0.81

Clinical, Imaging, and Explant Features (%/median)
	HCC (N=270)	cHCC-CCA or CCA (N=16)	p-value
Total tumor size at OLT imaging, cm	2.9 (1.5-4.2)	3.2 (2.0-4.7)	0.6
AFP at OLT	5.7 (3.3-13.2)	6.1 (3.3-23.6)	0.82
# of Tumors	1 (1-3)	2 (1-3)	0.09
Well differentiated	17%	6%
Moderately differentiated	61%	63%
Poorly differentiated	5%	19%
Microvascular Invasion	6.5%	31.3%	<0.001

To cite this abstract in AMA style:

Liu Y, Hanlon C, Zhou S, Toy D, King K, Zhou K, Kahn J, Yuan L. Outcomes of Liver Transplantation for Combined Hepatocellular Cholangiocarcinoma: A Single-center Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-liver-transplantation-for-combined-hepatocellular-cholangiocarcinoma-a-single-center-experience/. Accessed May 11, 2025.

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