# Outcomes of Liver Transplantation with Incidental Intrahepatic Cholangiocarcinoma—Own Experience and a Systematic Review

## TL;DR

This study examines liver transplant outcomes in patients with incidental intrahepatic cholangiocarcinoma and finds a significant risk of recurrence.

## Contribution

The paper contributes new clinical insights from a combined case study and systematic review on liver transplantation for incidental cholangiocarcinoma.

## Key findings

- Two patients with incidental intrahepatic cholangiocarcinoma had no recurrence or mortality after liver transplantation.
- Systematic review of 413 cases showed recurrence rates ranging from 28.6% to 80%.
- Careful screening is recommended for patients with liver cancer undergoing liver transplantation.

## Abstract

Background: Cholangiocarcinoma, the second most common primary liver cancer, is still a contraindication for performing liver transplantation in most patients. Despite various trials being performed in large clinical centers, the results are still not satisfactory. The aim of this study was to present cases from our own cohort and perform a systematic review of the results of liver transplantation in patients with incidental intrahepatic cholangiocarcinoma. Materials and methods: We retrospectively reviewed the records of all patients who underwent liver transplantation and identified two patients with incidental intrahepatic cholangiocarcinoma via histopathological examination of the explanted liver. The results of radiological and biochemical screening performed during liver transplantation, standardized histopathological examination and follow-up data are presented. Additionally, a systematic review of PubMed and Cochrane Reviews based on the PRISMA protocol was performed, yielding 413 similar cases. Results: We present two cases of incidental intrahepatic cholangiocarcinoma found after liver transplantation. The patients were managed according to a standard protocol with no consecutive modification of immunosuppression or chemotherapy. There was no recurrence or mortality. In this systematic review, the mean reported number of lesions ranged between 1 and 2 per patient. A total of 42 recurrences were reported. The percentage of recurrences ranged between 28.6% and 80%. Conclusions: Despite not being a frequent finding, follow-up and further treatment of patients with incidental iCCA should be reported and analyzed. Extra carefulness in screening is advised in patients who are already diagnosed with oncological disease of the liver. In long-term follow-up, recurrence of the disease is rather probable.