This large single-centre analysis evaluated whether earlier liver transplantation improves survival in patients with perihilar cholangiocarcinoma (pCCA) treated with standardised neoadjuvant therapy and transplant protocol. The key question: Does transplanting within 6 months of protocol registration improve outcomes?
This large single-centre analysis evaluated whether earlier liver transplantation improves survival in patients with perihilar cholangiocarcinoma (pCCA) treated with standardised neoadjuvant therapy and transplant protocol.
The key question:
Does transplanting within 6 months of protocol registration improve outcomes?
Study Overview
392 patients in the intention-to-treat cohort
256 underwent liver transplantation
Median time to transplant/dropout: ~5.7 months
Key Findings
Shorter wait times (0–3 months) did NOT improve overall survival.
Waiting longer (≥6 months) did not worsen intention-to-treat survival.
Importantly, among transplanted patients:
Waiting ≥6 months was associated with lower post-transplant mortality.
Survival benefit became more pronounced beyond 9 months.
Waiting time was not associated with increased residual tumour in the explant.
Clinical Interpretation
This study challenges the assumption that “earlier is better” for transplant in pCCA.
A minimum 6-month waiting period may:
Allow biological selection of favourable tumour behaviour
Reduce post-transplant mortality
Maintain overall survival in the broader cohort
Take-Home Message for Hepatobiliary & Transplant Teams
Transplantation within 6 months of registration does not enhance survival, and waiting ≥6 months may optimise outcomes without compromising overall patient survival.
This reinforces the importance of disciplined protocol adherence and biological selection in pCCA transplant programs.
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