{
  "abstract": "Introduction Patients with a chronic cholangiopathy have an increased risk of cholangiocarcinoma, particularly perihilar type. In those with primary sclerosing cholangitis (PSC), this equates to a 20% lifetime risk and cholangiocarcinoma development is the leading cause of death on the liver transplant waiting liver. The presence of cholangiocarcinoma currently precludes liver transplant outside of a trial setting. Recently our centre has observed an anecdotal increase in incidental perihilar cholangiocarcinoma incidence in chronic cholangiopathy explants, which this study explored further.Methods This was a retrospective single-centre study. All first-time liver-only transplants for any indication undertaken 2023–2024 were identified. The histopathology reports were reviewed to identify the liver disease subtype and those with a perihilar cholangiocarcinoma. This was compared to first-time liver-only transplants undertaken 2015–2022.Results Between 2023–2024 five incidental perihilar cholangiocarcinomas were identified in 191 liver explants, incidence 2.6%. In all cases the background liver disease was a cholangiopathy (three PSC, one biliary atresia, one unknown aetiology) resulting in a perihilar cholangiocarcinoma incidence of 13% (5/38) in cholangiopathy explants. This is significantly higher than 2015–2022 where one perihilar cholangiocarcinoma and one gallbladder adenocarcinoma were identified, both on a background of PSC, incidence of 1.2% (2/167) in cholangiopathy explants, p=0.003, and 0.3% (2/729) in all explants, p=0.005. Three further cholangiopathy explants between 2023–24 had high grade dysplasia (HGD) including two with papillary neoplasms of the gallbladder and/or bile ducts without invasive disease, incidence 7.9% (3/38); which was greater than 2015–2022 where two had HGD of the bile ducts and one of the gallbladder, incidence 1.8% (3/167), p=0.08. No explants for non-cholangiopathic liver disease (n=714) had either HGD or perihilar cholangiocarcinoma between 2015–2024.When considering the six explants with perihilar cholangiocarcinoma, patients had a median age of 45 years (range 26–60) and had been listed for a median of 67 days (range 7–94), table 1. In all cases the tumour was at least stage pT2 with perineural invasion, lymphovascular space invasion and a probable positive surgical resection margin; five had associated large duct HGD. All patients were alive at the time of data collection, median follow up 348 days (range 121–3306), one had radiological recurrence within 12 months post-transplant.Abstract P149 Table 1Discussion Our centre has observed a recent significant increase in incidental perihilar cholangiocarcinomas in patients undergoing liver transplant for a chronic cholangiopathy. The cause is currently unclear. Discussion with other liver transplant centres is warranted to determine if this is a national trend.",
  "authors": [
    {
      "affiliations": [
        "Cambridge University Hospitals, Cambridge, UK"
      ],
      "name": "Anna Paterson"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals, Cambridge, UK"
      ],
      "name": "Sarah Al-Dujaili"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals, Cambridge, UK"
      ],
      "name": "William Griffiths"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals, Cambridge, UK"
      ],
      "name": "Gwilym Webb"
    }
  ],
  "title": "P149 Increasing incidence of perihilar cholangiocarcinoma in first-time liver transplants for chronic cholangiopathy",
  "uid": "d9bf632e-4c73-54db-9f3f-f891b9101426"
}