AB042. SOH25_AB_218. Liver transplantation following neoadjuvant chemoradiotherapy: a long-term experience with Mayo Protocol
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AB042. SOH25_AB_218. Liver transplantation following neoadjuvant chemoradiotherapy: a long-term experience with Mayo Protocol

Riccardo Nasto1, Gianluca Rompianesi1,2, Robert O’Connell2, Emir Hoti1, Tom Gallagher1, Fiona Hand1

1Department of Hepatobiliary and Transplant Surgery, St Vincent’s University Hospital, Dublin, Ireland; 2Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy

Background: Hilar cholangiocarcinoma (hCCA) is a rare but aggressive malignancy. The Mayo Protocol with orthotopic liver transplantation (OLT) offers a curative option for unresectable hCCA. This study evaluates long-term outcomes from our centre.

Methods: A retrospective analysis of patients with unresectable hCCA treated between 2004 and 2024 was performed. Overall survival (OS), recurrence-free survival (RFS), and predictors of survival and recurrence were analysed.

Results: Among 32 patients, OS at 1, 3, 5, and 10 years was 78%, 55%, 45%, and 32%, respectively, while RFS was 89%, 61%, and 57% at 1, 3, and 5 years. Patients achieving pathological complete response (pCR) had significantly better OS (89%, 77%, 71%, and 58%) and RFS (93%, 90%, 80%, and 72%) compared to non-pCR patients (OS: 77%, 27%, 0%; RFS: 55%, 36%, 0%; P<0.001). For patients with primary sclerosing cholangitis (PSC), OS was 75%, 65%, 58%, and 41%, compared to 88%, 27%, and 0% in non PSC patients (P=0.045). RFS in PSC patients was 95%, 83%, and 72%, compared to 75%, 27%, and 0% in non-PSC patients (P=0.001). Cox regression confirmed pCR as an independent predictor of improved OS (HR 0.111; P=0.007) and RFS (HR 0.024; P=0.018).

Conclusions: This is one of the largest single-centre European cohorts of hCCA patients treated with the Mayo Protocol. Liver transplantation is a feasible and effective treatment for well-selected patients. Achieving pCR significantly reduces death and recurrence, highlighting its importance as a target for future research.

Keywords: Hilar cholangiocarcinoma (hCCA); liver transplantation; long-term outcome; Mayo Protocol; transplant oncology

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab042
Cite this abstract as: Nasto R, Rompianesi G, O’Connell R, Hoti E, Gallagher T, Hand F. AB042. SOH25_AB_218. Liver transplantation following neoadjuvant chemoradiotherapy: a long-term experience with Mayo Protocol. Mesentery Peritoneum 2025;9:AB042.

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