Transplantation Within 6 Months of Registration Does not Enhance Survival for Patients With Perihilar Cholangiocarcinoma.

Abstract

Determine whether the timing of transplantation affects patient mortality. Neoadjuvant therapy and liver transplantation have emerged as an excellent treatment option for select patients with perihilar cholangiocarcinoma (pCCA). However, the optimal timing of transplantation is not known. We reviewed all patients registered for a standardized pCCA protocol between 1996 and 2020 at our center. After adjusting for confounders, we examined the association of waiting time with patient mortality in an intention-to-treat cohort (n=392) and those who received a liver transplant (n=256). The median (interquartile range) time from registration to transplant or dropout was 5.74 (3.25-7.06) months. Compared with a short wait time (0-3 mo), longer waiting times did not affect all-cause mortality: (3-6 mo) hazard ratio (HR) 0.98; 95% CI: 0.52-1.84; (6-9 mo) HR: 0.80; 95% CI: 0.39-1.65; (9-12 mo) HR: 0.56; 95% CI: 0.26-1.22. Subgroups with a shorter waiting time had similar survival to those with long waiting times: living donor available HR: 0.97; 95% CI: 0.67-1.42; AB or B blood group HR: 0.93; 95% CI: 0.62-1.39. Longer waiting times were associated with decreased all-cause mortality after transplantation (HR: 0.92; 95% CI: 0.87-0.97). This benefit began after a 6-month waiting time minimum (HR: 0.53; 95% CI: 0.26-1.10) and increased further after 9 months (HR: 0.43 95% CI: 0.20-0.93). Waiting time was not associated with residual adenocarcinoma in the explant (odds ratio 0.99; 95% CI: 0.98-1.00). A waiting time of at least 6 months will optimize results with transplantation without affecting overall (intention-to-treat) patient survival.