Effectiveness and safety of liver transplantation for surgically unresectable hilar cholangiocarcinoma: a meta-analysis

Surgical resection (SR) was the standard of care for hilar cholangiocarcinoma (HCCA). But there have been no standard research results as to whether liver transplantation (LT) was an option for the treatment of unresectable HCCA patients nowadays. For that reason, a meta-analysis was performed in order to evaluate the effectiveness and safety of LT when compared to conventional SR. Of 578 studies from MEDLINE, EMBASE, and the Cochrane Library until 2015, 8 were included in the present study. The R0 resection rate, overall survival (OS) and mortality were evaluated. Subgroup analysis was performed according to the use of neoadjuvant therapy in LT patients (subgroup I: no neoadjuvant therapy; subgroup II: neoadjuvant therapy). No significant differences were noted in the 1-, 3-, and 5-year OS and mortality between the LT patients and SR patients. However, the R0 resection rate were significantly higher in the LT group (odds ratio (OR) =4.92, 95% confidence interval (CI) =2.57-9.44, P<0.001). In the subgroup analysis, LT achieved significantly higher rates of 1-year OS (OR=2.45, 95% CI=1.035.84, P=0.043), 3-year OS (OR=2.73, 95% CI=1.51-4.96, P=0.001), 5-year OS (OR=6.86, 95% CI=1.15-41.06, P=0.035), R0 resection (OR=7.22, 95% CI=1.17-44.48, P<0.001) and equivalent mortality from subgroup II. The results from subgroup I were in accord with overall analyses. In conclusion, there is no convincing evidence for the effectiveness and safety of LT in patients with surgically unresectable HCCAs when compared to conventional SR. However, LT combined with neoadjuvant therapy should be applied in patients with surgically unresectable HCCAs if a liver was available for transplantation.