Liver Transplantation for Non-resectable Perihilar Cholangiocarcinoma

Prior treatment

• Prior history of solid organ or bone marrow transplantation
• Prior extrahepatic metastatic disease

Other illness

• Perforation of the visceral peritoneum
• Other malignancies, except curatively treated more than 5 years ago without relapse
• Known history of human immunodeficiency virus (HIV) infection
• Substance abuse, medical, psychological, or social conditions that may interfere with the patient's participation in the study or evaluation of the study results
• Known hypersensitivity to rapamycin

Other

• Tumor involving common hepatic artery, celiac trunck or superior mesenteric artery the tumor
• Tumor involving main portal vein
• Tumor involving inferior vena cava
• Weight loss \>15% the last 6 months
• Patient BMI \> 30
• Women who are pregnant or breast feeding
• Any reason why, in the opinion of the investigator, the patient should not participate

• Radiologically strong suspicion of pCCA
• Tumor can involve intrahepatic portal vein without thrombosis of extrahepatic portal vein
• Tumor can involve hepatic artery distal to gastroduodenal artery or involve replaced hepatic artery
• First time pCCA
• Disease deemed not eligible for liver resection based on tumor location or underlying liver dysfunction
• No extrahepatic disease, or lymph node involvement detected on imaging
• No signs of extrahepatic metastatic disease according to PET-CT scan
• No signs of extrahepatic metastatic disease according to CT or MR (chest/abdomen/pelvis) scan within 4 weeks prior to the faculty meeting at the transplant unit
• At least 18 years of age
• Good performance status, Eastern Cooperative Oncology Group (ECOG) score: 0 or 1
• Satisfactory blood tests Hb \>10g/dl, neutrophiles \>1.0 (after any G-CSF), TRC \>50, Bilirubin\<3 x upper normal level, ASAT, ALAT\<5 x upper normal level, Creatinine \<1.5 x upper normal level. Albumin above lower normal level, Normal IgG4 levels
• Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to GCP, and national/local regulations
• Received chemotherapy for at least 6 months with at least 10% response according ti RECIST criteria and with no progression of disease at time of Lt
• At least 10 months from diagnosis
• Patient must be accepted for transplantation before progressive disease
• Twelve months or more time span from the diagnosis of pCCA and date of being listed for liver transplantation