Survival and Recurrence in Liver Transplant Patients With Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma

BACKGROUND Intrahepatic cholangiocarcinoma (ICC) can be an incidental finding in liver explants following liver transplantation (LT). This study aimed to evaluate the long-term post-transplant outcomes of patients with ICC. MATERIAL AND METHODS From 2003 to 2022, 25 patients with ICC were identified among 6,611 adult LT recipients through institutional database search. RESULTS The incidence of ICC among adult LT recipients was 0.4%. All cases were incidental findings in explanted livers. The mean ICC tumor size was 2.7±1.6 cm, and 22 patients had single ICC lesion. Concurrent second liver malignancies were found in 10 patients (40%): hepatocellular carcinoma (HCC) in 9 and combined HCC-cholangiocarcinoma in one. The 5-year all-type tumor recurrence (TR) and overall survival (OS) rates were 72.0% and 47.0%, respectively. The presence of second primary cancer had no significant impact on TR (P=0.832) or OS (P=0.533). Similarly, ICC tumor stage did not significantly affect TR (P=0.394) or OS (P=0.395). Among 15 patients with ICC alone, 11 (73.3%) experienced ICC recurrence. Of the 10 patients with concurrent malignancies, 7 (70.0%) experienced all-type TR: 5 with HCC and 2 with ICC. Notably, the 5-year ICC recurrence and OS rates in 5 patients with very early-stage ICC and no HCC recurrence were 20.0% and 80.0%, respectively. CONCLUSIONS ICC is a rare incidental finding in LT recipients, often coexisting with concurrent second liver malignancy. Overall prognosis following LT for ICC remains poor, except for those with very early-stage disease. Because all incidences of TR occurred within 5 years after transplant, rigorous surveillance is essential during this period.