Outcomes of Living-Donor Liver Transplantation for Cholangiocarcinoma Versus Hepatocellular Carcinoma in the United States

<b>Objectives:</b> Cholangiocarcinoma (CCA) is a malignancy of the biliary epithelium associated with high mortality. Hepatocellular carcinoma (HCC) is the most common primary liver tumor and has an established indication for liver transplant (LT). Living-donor LT (LDLT) may offer a curative and timely option for selected CCA patients. <b>Methods:</b> The United Network of Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) data was reviewed from January 2010 to December 2022 for patients who underwent LDLT with HCC or CCA diagnostic codes. Post-LDLT survival for CCA was compared to HCC and non-HCC/CCA patients using Kaplan-Meier analysis. Stepwise multivariate analysis adjusted for recipient age, gender, race, and underlying etiology. <b>Results:</b> LDLT for CCA was most commonly performed in UNOS region 7 (54.9%) and region 2 (12.7%). Among 3993 LDLT recipients, 102 (2.6%) had CCA, 774 (19.4%) had HCC, and 3117 (78%) had neither HCC nor CCA. The 1-, 3- and 5-year post-LDLT survival of patients with CCA were 84.6%, 70.4%, and 62.2% versus 93.1%, 85.2%, and 78.2% for HCC, respectively. <b>Conclusions:</b> CCA accounts for 2.6% of LDLTs compared to 19.4% for HCC in the United States. At 5 years post-LDLT, patients with CCA have significantly lower survival compared to HCC.