The Study Group of the Japanese Liver Transplantation Society, Tokyo, Japan.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Hepatobiliary Pancreat Sci. 2021 Apr;28(4):346-352. doi: 10.1002/jhbp.896. Epub 2021 Feb 9.
Intrahepatic cholangiocarcinoma had been considered a contraindication for liver transplantation because of poorer outcomes. However, incidental intrahepatic cholangiocarcinoma in the explanted liver has been reported because of the difficulty of obtaining an accurate diagnosis in cirrhotic livers on preoperative imaging.
We conducted a nationwide survey to analyze the incidence of incidental intrahepatic cholangiocarcinoma and outcomes after liver transplantation, in Japan.
Forty-five of 64 institutions (70%) responded to our initial investigation. Between January 2001 and December 2015, 6627 liver transplantations were performed in these 45 institutions, with 19 cases (0.3%) of incidental intrahepatic cholangiocarcinoma reported from 12 transplant centers. Six cases were diagnosed as hepatocellular carcinoma preoperatively. The 1-, 3-, and 5-year recurrence-free survival rates were 79%, 45%, and 45%, respectively. Tumor recurrence after liver transplantation was found in 10 patients (53%). The 1-, 3-, and 5-year overall survival rates were 79%, 63%, and 46%, respectively.
Intrahepatic cholangiocarcinoma at liver transplantation is associated with a high risk of recurrence and poor prognosis, even these tumors are detected incidentally in the explanted liver.
肝内胆管细胞癌曾被认为是肝移植的禁忌证，因为其预后较差。然而，由于术前影像学检查在肝硬化肝脏中难以获得准确的诊断，因此在移植肝脏中偶然发现肝内胆管细胞癌。
我们进行了一项全国性调查，以分析日本肝移植术后偶然发现的肝内胆管细胞癌的发病率和结局。
在我们的初步调查中，64 家机构中有 45 家（70%）做出了回应。2001 年 1 月至 2015 年 12 月，这 45 家机构共进行了 6627 例肝移植，其中 12 家移植中心报告了 19 例（0.3%）偶然发现的肝内胆管细胞癌。6 例术前诊断为肝细胞癌。1、3、5 年无复发生存率分别为 79%、45%和 45%。10 例患者（53%）在肝移植后出现肿瘤复发。1、3、5 年总生存率分别为 79%、63%和 46%。
肝移植时偶然发现的肝内胆管细胞癌复发风险高，预后差，即使这些肿瘤在移植肝脏中偶然发现。
