Liver Transplant for Cholangiocarcinoma

Mayo Clinic is one of the few centers in the United States that performs liver transplantation for cholangiocarcinoma (CCA). CCA is a cancer that forms in the slender tubes (bile ducts) that carry bile from the liver to the intestine. Cholangiocarcinoma obstructs the bile ducts and causes symptoms such as jaundice (yellow skin and eyes), abdominal pain, weight loss, generalized itching, and fever.

Doctors divide cholangiocarcinoma into different types based on where the cancer occurs in the bile ducts:

• Intrahepatic cholangiocarcinoma arises in the small bile ducts within the liver and is classified as a type of liver cancer.
• Hilar cholangiocarcinoma occurs where the major bile ducts combine in the central portion of the liver and form the main bile duct that drains the liver.  Cancers arising in this location are treated with resection when possible. When resection is not possible, these cancers can now be treated with transplantation using the Mayo Clinic protocol.
• Distal cholangiocarcinoma occurs in the portion of the bile duct that is nearest the small intestine. These cancers are best treated by surgical resection.

Your treatment options for your CCA will depend on the specifics of your cancer, such as the size, location and extent, as well as your health and personal preferences. At Mayo Clinic, your expert team works with you to find a treatment that meets your needs.

The 30 year risk of developing CCA is about 20% in patients with primary sclerosing cholangitis (PSC). Not everyone with PSC will get CCA and not everyone with CCA will qualify for liver transplantation. To be eligible for liver transplantation, patients with CCA must have the cancer diagnosis before the disease spreads beyond the liver. Once the disease is elsewhere in the body, a cure is not possible, and the immunosuppressive medications that patients need after transplantation could speed up the spread of the cancer cells.

Once a patient has been diagnosed with CCA and imaging shows that it has not spread outside the liver, the first step of the treatment process is three weeks of radiation treatment with concurrent and continuous infusion of chemotherapy medications. Patients then receive brachytherapy. This procedure involves placing radioactive material inside your body, also called “internal radiation”.  Patients are then treated with oral medications while they await transplantation.

All patients require a staging operation to rule-out spread of cancer prior to transplantation. During this operation, doctors will check the patient for cancer elsewhere in the body. Transplantation can be accomplished with either a deceased or living liver donor.  The waiting time for a deceased liver donor is usually more than a year. This time can be difficult for patients because they can develop infections or become sick with liver failure while waiting for a donor liver. The waiting time can be avoided if the patient has a living donor which would enable them to undergo transplantation much sooner than would otherwise be possible.

Have you been diagnosed with CCA? What were your treatment options?

HELPFUL LINKS

• Learn more about cholangiocarcinoma at Mayo Clinic
• Explore Mayo’s Transplant Center.
• Request an appointment.