Liver Transplant Beats Resection for Combined HCC-CCA

Liver transplantation gave better 5-year survival than liver resection in combined hepatocellular-cholangiocarcinoma, including tumors within UCSF criteria.

• 5-year overall survival was 89.9% after transplant versus 65.6% after resection (79 transplant, 32 resection patients).
• Within UCSF criteria, 5-year recurrence-free survival was 89.8% after transplant versus 51.6% after resection.
• Macrovascular invasion and poor differentiation independently predicted recurrence after transplant.

Transplant may be justified in carefully selected patients within UCSF criteria, with macrovascular invasion and poor differentiation as exclusion signals. This retrospective, single-center comparison cannot separate selection bias from treatment effect, so it supports case selection rather than routine transplant for this tumor type.