Bushara Omar, Kadakia Yash, Krupp Katharine, Friedman Jessica, Hoteit Maarouf A, Bittermann Therese, Araji Tarek, Levine Matthew H
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
Transplant Direct. 2025 Jun 27;11(7):e1822. doi: 10.1097/TXD.0000000000001822. eCollection 2025 Jul.
Hilar cholangiocarcinoma has limited treatments, with transplantation emerging as a curative option. During the era of regional patient review, it was suggested that transplant centers performing a higher volume of transplants for cholangiocarcinoma had improved outcomes. However, it is unknown whether this association persists since the national standardization of guidelines in May 2019.
Transplant candidates listed in the United Network of Organ Sharing database using cholangiocarcinoma exception points from May 2019 to December 2022 were included. Experienced centers were defined as performing at least 10 transplants during the time period. Recipient and donor characteristics, graft and patient survival, and hospital length of stay were compared between more and less experienced centers. The Wilcoxon rank-sum test, Fisher exact test, Kaplan-Meier curves, log-rank tests, and Cox hazards analyses were used where appropriate.
Between May 2019 and December 2022, 166 transplants for cholangiocarcinoma were performed at 37 centers, with "more experienced" centers accounting for 59% (n = 98). Unadjusted graft survival ( = 0.03) and patient survival ( = 0.047) were lower at less experienced centers. In addition to center experience, univariable Cox analyses recipient age (0.02), diabetes (0.18), and donor age (0.08) had a value of ≤0.2. In a covariate-adjusted model, more experienced centers were associated with a 70% lower hazard of graft failure (hazard ratio, 0.29; 95% confidence interval, 0.12-0.70; = 0.006) and 72% lower hazard of mortality (hazard ratio, 0.27; confidence interval, 0.11-0.69; = 0.007).
These data suggest that experienced centers have improved posttransplant survival. Variations in selection and postoperative care not captured by this study may underlie this association. More granular studies are warranted to elucidate the impact of center experience on outcomes in transplantation for cholangiocarcinoma.
肝门部胆管癌的治疗方法有限，肝移植逐渐成为一种治愈性选择。在区域患者评估时代，有人提出，为胆管癌进行更高移植量的移植中心其治疗效果有所改善。然而，自2019年5月指南实现全国标准化以来，这种关联是否仍然存在尚不清楚。
纳入2019年5月至2022年12月期间在美国器官共享联合网络数据库中使用胆管癌例外点列出的移植候选者。经验丰富的中心定义为在此期间至少进行10例移植手术。比较经验丰富和经验较少的中心之间的受者和供者特征、移植物和患者存活率以及住院时间。在适当情况下使用Wilcoxon秩和检验、Fisher精确检验、Kaplan-Meier曲线、对数秩检验和Cox风险分析。
2019年5月至2022年12月期间，37个中心共进行了166例胆管癌移植手术，“经验更丰富”的中心占59%（n = 98）。经验较少的中心未调整的移植物存活率（P = 0.03）和患者存活率（P = 0.047）较低。除了中心经验外，单变量Cox分析显示受者年龄（P = 0.02）、糖尿病（P = 0.18）和供者年龄（P = 0.08）的P值≤0.2。在一个协变量调整模型中，经验更丰富的中心与移植物失败风险降低70%（风险比，0.29；95%置信区间，0.12 - 0.70；P = 0.006）和死亡风险降低72%（风险比，0.27；置信区间，0.11 - 0.69；P = 0.007）相关。
这些数据表明，经验丰富的中心移植后存活率有所提高。本研究未涵盖的选择和术后护理方面的差异可能是这种关联的基础。需要更细致的研究来阐明中心经验对胆管癌移植结局的影响。
