Reappraising Liver Transplantation for Combined Hepatocellular-cholangiocarcinoma
In brief
Combined liver cancer: transplant linked to 90% five-year survival vs 66% after resection
In a prospective database study, 79 transplant recipients had 89.9% overall survival at five years, compared with 65.6% among 32 patients who had resection; recurrence-free survival was also higher after transplant. Outcomes for selected patients meeting UCSF criteria resembled those for liver cancer patients with hepatocellular carcinoma, but tumor invasion into major vessels and poor differentiation predicted recurrence.
- Journal
- Annals of surgery (Q1)
- Published
- 30 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Sadhana Shankar, Ashwin Rammohan, Vasanthakumar Gunasekaran, Rajesh Rajalingam, Kumar Palaniappan, Komalavalli Subbiah, et al.
- PMID
- 42960453
- DOI
- 10.1097/SLA.0000000000007156
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 31 October 2026): Direct comparison of transplant versus resection and selection factors
Abstract
OBJECTIVE: To determine whether liver transplantation (LT) confers durable oncologic benefit in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and to identify predictors of recurrence that may guide transplant candidacy. BACKGROUND: cHCC-CCA is a rare primary liver malignancy with aggressive biological behavior. LT has traditionally been contraindicated due to concerns regarding recurrence. We evaluated long-term outcomes of LT versus liver resection (LR) and compared LT outcomes for cHCC-CCA with those for hepatocellular carcinoma (HCC). METHODS: Patients with cHCC-CCA who underwent LT or LR between 2010 and 2024 were identified from a prospective database. Survival outcomes, recurrence patterns, and risk factors for recurrence were analyzed. Outcomes of LT for cHCC-CCA were additionally compared with HCC. RESULTS: A total of 79 patients underwent LT (diagnosed on explant) and 32 underwent LR for cHCC-CCA. 5-year overall survival (OS) and recurrence-free survival (RFS) were superior following LT compared with LR (OS: 89.9% vs. 65.6%, P=0.007; RFS: 84.8% vs. 53.1%, P=0.001). This benefit was maintained for tumors within UCSF criteria [overall survival (88.7% LT vs. 65.6% LR, log rank P 0.014) and RFS (89.8% LT vs. 51.6% LR, P<0.001)]. Among LT recipients, OS for cHCC-CCA was comparable to HCC (89.9% vs. 86%, P=0.721). Within the LT cohort, macrovascular invasion (HR 25.01, P=0.003) and poor tumor differentiation (HR 7.29, P=0.004) independently predicted recurrence. CONCLUSION: In carefully selected patients, cHCC-CCA within UCSF criteria can achieve transplant outcomes comparable to HCC. Macrovascular invasion and poor tumor differentiation are major predictors of recurrence and may inform candidate selection for LT.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.