PSC with cholangiocarcinoma: transplant timing

What is known

• Radical liver resection and liver transplantation are both potentially curative in PSC patients without metastatic or locally advanced disease. ¹
• Liver transplantation with neoadjuvant chemoradiation can be considered for selected patients with unresectable perihilar cholangiocarcinoma. ¹
• A Mayo neoadjuvant protocol before transplantation reported 5-year survival of 73% in highly selected patients; predictors of recurrence included elevated CA 19-9, portal vein encasement, and residual tumor on explant. ²
• A retrospective review found neoadjuvant chemotherapy plus transplantation superior to radical resection with adjuvant therapy for locally advanced cholangiocarcinoma. ²
• In distal cholangiocarcinoma with simultaneous perihilar tumor, pancreaticoduodenectomy could be considered simultaneous or sequential to liver transplantation. ¹

What is unknown / caveats

• Transplant benefit data rest on highly selected patients with stringent inclusion criteria and possible selection bias
• Excerpts do not directly compare simultaneous resection during the same operation versus neoadjuvant-then-transplant as framed
• The optimal sequencing for an individual patient depends on tumor resectability and location, which the excerpts do not resolve as a single rule.

References

1. Villard C, Jorns C, Bergquist A. Treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis: a comprehensive review. eGastroenterology. 2024. PMID: 39944751.

2. Valero V, Cosgrove D, Herman JM, Pawlik TM. Management of perihilar cholangiocarcinoma in the era of multimodal therapy. Expert Rev Gastroenterol Hepatol. 2012. PMID: 22928900.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.