• Navine Nasser-Ghodsi, John E Eaton, Byron H Smith, Sudhakar K Venkatesh, Julie K Heimbach, Timucin Taner, Christopher L Welle, Sumera I Ilyas, Gregory J Gores, and Charles B Rosen.
• Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.
• Ann. Surg. 2024 Jul 4.

ObjectivesDetermine if timing of transplantation affects patient mortality.BackgroundNeoadjuvant therapy and liver transplantation has emerged as an excellent treatment option for select patients with perihilar cholangiocarcinoma (pCCA). However, the optimal timing of transplantation is not known.MethodsWe reviewed all patients registered for a standardized pCCA protocol between 1996 - 2020 at our center. After adjusting for confounders, we examined the association of waiting time with patient mortality in an intention-to-treat cohort (n=392) and those who received a liver transplant (n=256).ResultsThe median (interquartile range) time from registration to transplant or drop out was 5.74 (3.25-7.06) months. Compared to a short wait time (0-3 months), longer waiting times did not affect all-cause mortality: (3-6 months) hazard ratio (HR) 0.98; 95% CI 0.52-1.84; (6-9 months) HR 0.80; 95% CI 0.39-1.65; (9-12 months) HR 0.56; 95% CI 0.26-1.22. Subgroups with a shorter waiting time had similar survival to those with long waiting times: living donor available HR 0.97; 95% CI 0.67-1.42; AB or B blood group HR 0.93; 95% CI 0.62-1.39. Longer waiting times were associated with decreased all-cause mortality after transplantation (HR 0.92; 95% CI 0.87-0.97). This benefit began after a 6 month waiting time minimum (HR 0.53; 95% CI 0.26-1.10) and increased further after 9 months (HR; 0.43 95% CI 0.20-0.93). Waiting time was not associated with residual adenocarcinoma in the explant (odds ratio 0.99; 95% CI 0.98-1.00).ConclusionsA waiting time of at least 6 months will optimize results with transplantation without affecting overall (intention-to-treat) patient survival.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

8 keywords...

hide…