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

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1048-1054
Number of pages7
JournalDigestive Diseases and Sciences
Volume59
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Cholangiocarcinoma
Liver Transplantation
Transplants
Survival
Klatskin Tumor
Graft Rejection
Registries
Publications
Multivariate Analysis
Survival Rate
Databases

Keywords

  • Cholangiocarcinoma
  • Liver transplant
  • Outcomes
  • Survival

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Improved post-transplant survival in the United States for patients with cholangiocarcinoma after 2000. / Salgia, Reena J.; Singal, Amit G.; Fu, Sherry; Pelletier, Shawn; Marrero, Jorge A.

In: Digestive Diseases and Sciences, Vol. 59, No. 5, 2014, p. 1048-1054.

Research output: Contribution to journalArticle

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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.",
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AU - Marrero, Jorge A.

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N2 - 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.

AB - 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.

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