Transplant Trial Watch

Meta-analysis and Meta-regression of Survival After Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma.

Cambridge, W. A., et al.

Annals of Surgery 2020 [record in progress]


Aims
The systematic review aimed to summarise the reported survival and recurrence rate after neoadjuvant chemoradiation and orthotopic liver transplantation (NCR-OLT) for unresectable perihilar cholangiocarcinoma (pCC).

Interventions
Neoadjuvant chemoradiation and orthotopic liver transplantation

Participants
Patients with unresectable pCC undergoing NCR-OLT

Outcomes
The primary outcome was overall survival at 1, 3 and 5 years and the secondary outcome was the recurrence rate at 3 years.

Follow-up
5 year

CET Conclusions
The systematic review evaluated survival after liver transplantation for unresectable perihilar cholangiocarcinoma (pCC). A senior information specialist assisted to develop a comprehensive literature search from 2000-2019. Study selection was done by two independent reviewers, quality assessment using the Newcastle-Ottawa scale was conducted by three independent reviewers and data extraction was done by a single reviewer. The study included 20 observational studies of which 16 were assessed as being of poor methodological quality. The authors provided a detailed description of surgical techniques and adjunctive procedures that varied between studies. Survival for all patients after liver transplantation for pCC was 76.9% at 1 year (18 studies), 55.3% at 3 years (13 studies) and 44.9% at 5 years (10 studies). However, survival increased after undergoing a neoadjuvant protocol to 82.8%, 65.5% and 65.1 at 1, 3 and 5 year, respectively. To explore potential sources of heterogeneity meta-regression analysis investigated whether there was a correlation between the proportion of patients with PSC and survival. There was no significant correlation for the 3-year survival data but there was a positive, significant correlation for 5-year survival data. Disease recurrence was analysed for studies that followed patients for at least 3 years. The analysis showed an overall recurrence rate of 29.4% (8 studies), with a recurrence rate of 24.1% for patients who had neoadjuvant therapy (6 studies) and 51.7% for patients who did not have neoadjuvant therapy (2 studies).

Quality notes
Not applicable

Trial registration
PROSPERO - CRD42019127662

Funding source
No funding received