TO THE EDITOR:
We thank Jeong et al. for their thoughtful comments
on our recent review article.
As discussed, we agree
that in selected patients with hilar and intrahepatic
cholangiocarcinoma (CCA), liver transplantation (LT)
represents an excellent treatment option, achieving
good longterm results. However, we would like to
emphasize some remarks.
So far, the favorable reported outcomes strongly
support LT as an interesting strategy to successfully
treat patients with very early (2 cm) unresectable
intrahepatic CCA. Still, as mentioned in their letter, it
is important to stress that there is a worldwide need for
prospective trials that challenge this theory. This
approach also extends to their reported good outcome
of HBV-associated ICC treated with resection and
study shows interesting results, it exceeds the scope of
our review and as previously discussed, prospective
clinical trials comparing this to a more deﬁnitive treat-
ment option such as LT would better assess the best
approach for this patient population.
As we enter a new era where the role of LT as a
treatment option for other unresectable liver tumors
expands beyond hepatocellular carcinoma, further re-
search focusing on inclusion criteria and neoadjuvant
and adjuvant treatments is desperately needed. In this
manner, the best treatment option for each type of
tumor in the different speciﬁc scenarios (ie, ICC aris-
ing in HBV patients) will potentially be identiﬁed.
Nicolas Goldaracena, M.D.
Andre Gorgen, M.D.
Gonzalo Sapisochin, M.D.
Multi-Organ Transplant Program
Division of General Surgery
Department of Surgery
Toronto General Hospital
University Health Network
University of Toronto
Toronto, Ontario, Canada
1) Goldaracena N, Gorgen A, Sapisochin G. Current status of liver
transplantation for cholangiocarcinoma. Liver Transpl 2018;24:294-
2) 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:
Address reprint requests to Gonzalo Sapisochin, M.D., Multi-Organ
Transplant Program, Division of General Surgery, Department of Sur-
gery, Toronto General Hospital, University Health Network, University
of Toronto, 585 University Avenue, 11PMB184, Toronto, M5G 2N2,
ON, Canada. Telephone: 11 416 340 5230; FAX: 11 416 340 5242;
Received November 7, 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.
LETTERS TO THE EDITOR
LETTERS TO THE EDITOR