Current Status of Liver Transplantation
TO THE EDITOR:
In a recent article in Liver Transplantation,Goldaracena
reviewed the role of liver transplantation
(LT) for perihilar and intrahepatic cholangiocarcinoma
(ICC). Interestingly, they suggested that patients with
an unresectable tumor conﬁned to the hepatic hilum,
such as perihilar cholangiocarcinoma (Klatskin tumor),
and patients with cirrhosis with very early stage ICC
(single tumor of < 2 cm) are potential candidates who
might signiﬁcantly beneﬁt from LT. Although we agree
with the suggestion, as they concluded, further studies
regarding inclusion criteria and neoadjuvant and adju-
vant therapies are urgent in the era of “Transplant
In Eastern countries, viral hepatitis infection is one
of the most frequent etiologic factors for the devel-
opment of ICC, especially hepatitis B virus (HBV).
ICCs arising from HBV infection hold approximately
a half of all resected ICC cases in China and share
common characteristics with hepatocellular carcinoma,
including younger age and infrequent lymph node
In addition, our recent study success-
fully and precisely predicts recurrence of ICC after
hepatic resection by adding the presence of HBV
infection as a favorable prognostic factor (C-index,
0.65; 95% conﬁdence interval, 0.50-0.64).
more, we would like to point out results from our most
recent study that showed surprising overall survival (1-
year, 88.9%; 3-year, 77.8%; 5-year, 66.7%) of patients
with HBV-associated ICC who underwent hepatic
resection and postoperative transarterial chemoemboli-
Because the study reporting the most favorable out-
come that was found in patients with a single tumor of
<2 cm (1-year, 93%; 3-year, 84%; 5-year, 65%) from
Sapisochin et al.
is comparable to patients with ICC
arising from HBV infection who underwent hepatic
resection and postoperative TACE, future large-sized
clinical trials need to evaluate the role of combined LT
and postoperative TACE treatment in patients with
ICC arising from HBV infection to potentially expand
the inclusion criteria of LT for ICC.
Seogsong Jeong, M.D.
Meng Sha, M.D.
Qiang Xia, M.D., Ph.D.
Department of Liver Surgery
School of Medicine
Shanghai Jiao Tong University
1) Goldaracena N, Gorgen A, Sapisochin G. Current status of liver
transplantation for cholangiocarcinoma. Liver Transpl 2018;24:
2) Hibi T, Itano O, Shinoda M, Kitagawa Y. Liver transplantation for
hepatobiliary malignancies: a new era of “Transplant Oncology” has
begun. Surg Today 2017;47:403-415.
3) Jeong S, Tong Y, Sha M, Gu J, Xia Q. Hepatitis B virus-
associated intrahepatic cholangiocarcinoma: a malignancy of
distinctive characteristics between hepatocellular carcinoma and
intrahepatic cholangiocarcinoma. Oncotarget 2017;8:17292-17300.
4) Jeong S, Cheng Q, Huang L, Wang J, Sha M, Tong Y, et al. Risk
stratiﬁcation system to predict recurrence of intrahepatic cholangio-
carcinoma after hepatic resection. BMC Cancer 2017;17:464.
5) Jeong S, Zheng B, Wang J, Chi J, Tong Y, Xia L, et al. Transar-
terial chemoembolization: a favorable postoperative management
to improve prognosis of hepatitis B virus-associated intrahepatic
cholangiocarcinoma after surgical resection. Int J Biol Sci 2017;13:
6) Sapisochin G, Facciuto M, Rubbia-Brandt L, Marti J, Mehta N,
Yao FY, et al.; for iCCA International Consortium. Liver trans-
plantation for “very early” intrahepatic cholangiocarcinoma: inter-
national retrospective study supporting a prospective assessment.
Address reprint requests to Qiang Xia, M.D., Ph.D., Renji Hospital,
School of Medicine, Shanghai Jiao Tong University, Dongfang Road No.
1630, Shanghai 200127, China. Telephone: 186 21 68383775; FAX:
186 21 58737232; E-mail: email@example.com
Received October 22, 2017; accepted November 7, 2017.
2017 by the American Association for the Study of Liver
View this article online at wileyonlinelibrary.com.
Potential conflict of interest: Nothing to report.
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