探索胆道系统恶性肿瘤(BTC)肝移植疗效。

回顾性分析2018年1月1日至2024年6月30日在北京清华长庚医院行肝移植治疗并规律随访的28例BTC受者临床资料与生存情况，其中肝门部胆管癌(pHCC)6例、肝内胆管细胞癌(ICC)8例、混合型肝癌(cHCC-CCA)13例、胆囊癌(GC)1例。采用Kaplan-Meier法计算生存率并绘制生存曲线，并采用log-rank检验进行比较。P<0.05为差异有统计学意义。

随访截至2025年6月30日，28例受者中位随访时间为19(5~80)个月，其中肿瘤复发19例，死亡18例(17例复发受者因肿瘤终末期疾病死亡、1例未复发受者因心梗死亡)。28例受者肝移植后1年总生存率、1年无复发生存率分别为71.4%、50.0%。1例GC肝移植受者术后未复发，截至随访终点已生存53个月。pHCC、ICC及cHCC-CCA肝移植受者术后1年总生存率分别为50.0%、87.5%和69.2%，1年无复发生存率分别为33.3%、37.5%和61.5%，中位生存期分别为15.5(8~20)、29(8~80)和44(5~80)个月，三种原发病受者术后总生存(OS)差异有统计学意义(χ²＝4.822，P<0.05)，术后无复发生存(RFS)差异无统计学意义(χ²＝3.287，P>0.05)。T1与非T1分期cHCC-CCA肝移植受者术后OS和RFS差异均有统计学意义(χ²＝8.170和5.232，P均<0.05)。

由于肿瘤高复发率和术后生存期较短，肝移植治疗BTC的疗效总体而言并不理想。探索恰当的受者选择标准和有针对性的降期转化策略，有望优化长期预后。

To explore the therapeutic efficacy of liver transplantation(LT) in patients with biliary tract cancer (BTC).

A retrospective analysis was conducted on the clinicopathological data and survival outcomes of BTC patients who underwent LT at Beijing Tsinghua Changgung Hospital between January 1, 2018, and June 30, 2024, with regular follow-up. The cohort included 6 cases of perihilar cholangiocarcinoma (pHCC), 8 cases of intrahepatic cholangiocarcinoma (ICC), 13 cases of combined hepatocellular-cholangiocarcinoma (cHCC-CCA), and 1 case of gallbladder carcinoma (GC). Survival rates were calculated and survival curves were plotted using the Kaplan-Meier method. Survival analysis was performed using the log-rank test. P value <0.05 was considered statistically significant.

As of the follow-up deadline of June 30, 2025, the median follow-up time for the 28 recipients was 19 (5-80) months. 19 patients experienced tumor recurrence, and 18 patients died (17 from end-stage tumor disease and 1 from myocardial infarction without recurrence). The 1-year overall survival and 1-year recurrence-free survival rates for all 28 recipients were 71.4% and 50.0%, respectively. The single GC recipient survived 53 months without recurrence by the end of follow-up. For recipients with pHCC, ICC, and cHCC-CCA, the 1-year overall survival rates were 50.0%, 87.5%, and 69.2%, respectively; the 1-year recurrence-free survival rates were 33.3%, 37.5%, and 61.5%, respectively; and the median survival times were 15.5 (8-20), 29 (8-80), and 44 (5-80) months, respectively. The difference in overall survival among the three primary disease groups was statistically significant (χ²=4.822, P<0.05), whereas the difference in recurrence-free survival was not statistically significant (χ²=3.287, P>0.05). Recipients with T1-stage cHCC-CCA had significantly better overall survival and recurrence-free survival than those with non-T1-stage disease (χ²=8.170 and 5.232, P all <0.05).

The efficacy of LT for BTC is unsatisfactory due to the high rate of tumor recurrence and relatively short post-transplant survival. Exploring appropriate recipient selection criteria and targeted downstaging/conversion strategies may help optimize long-term outcomes.