• liver;
  • surgery;
  • hepatectomy;
  • transplantation;
  • hepatocellular carcinoma;
  • cholangiocarcinoma


Background and Objectives

Although transplantation has demonstrated survival benefit for patients with hepatocellular carcinoma (HCC), there is limited data to support or refute transplantation for combined hepatocellular-cholangiocarcinoma (cHCC–CC). We hypothesized that cHCC–CC patients had poorer overall survival (OS) than HCC patients after liver transplantation.


Patients with localized HCC and cHCC–CC treated with surgical resection or transplant were identified using the Surveillance, Epidemiology, and End Results (SEER) Database (1973–2007). Cox proportional hazards models were used to examine survival.


We identified 3,378 (1,447 [43%] transplant, 1,931 [57%] resection) patients with HCC, and 54 (19 [35%] transplant, 35 [65%] resection) patients with cHCC–CC. Patients undergoing resection of HCC and cHCC–CC had similar 3-year OS (55% vs. 46%, P = 0.4). Three-year OS of patients undergoing transplant was significantly greater for HCC (78%) than for cHCC–CC (48%, P = 0.01). In adjusted models, patients transplanted for cHCC–CC had higher hazard of death compared to HCC patients (HR 2.5, 95% CI: 1.2–5.1, P = 0.01).


Transplantation for localized cHCC–CC confers a survival benefit similar to liver resection for cHCC–CC, but inferior to transplantation for HCC. With survival data that mimics historic reports of transplant for intrahepatic cholangiocarcinoma, this study questions the benefit of transplantation for patients with cHCC–CC. J. Surg. Oncol. 2013;107:608–612. © 2013 Wiley Periodicals, Inc.