OBJECTIVETo document the indication and value of orthotopic liver transplantation (OLT) for the patient with Klatskin tumor.

METHODSForty patients of Klatskin tumors, including 5 patients with liver transplantation (LTx) and 35 without LTx (WLTx) from Jan 1992 to Dec 2003 were enrolled for analysis retrospectively. The TNM stages were comparable in both groups. In LTx group, 4 patients were Klatskin tumor including 1 recurrence 5 months later after resection, and 1 cancerization from Caroli's disease. Biliary duct anastomosis was performed by Roux-en-Y choledochojejunostomy in two, end-to-end choledochocholedochostomy in 3 cases.

RESULTSIn LTx group, the total resection rate and radical resection rate were both 100%. Four cases survived for 48, 38, 21 and 5 months, respectively, except that the other one died from bile leakage at the 40th day after transplantation. All 4 survivors had good life quality without tumor in local or distant site, even though 3 of 4 cases developed biliary stricture, which was cured by radiological intervention therapy. The overall 1, 3-year survival rates were both 4/5 in LTx. The total resection rate and radical resection rate in the WLTx group were 63.0% (17/27) and 40.7% (11/27) and, the 1, 3, 5-year survival rates were 32.2%, 8.0% and 0, respectively. There was significant difference between the two groups in radical resection rate and survival rate (P = 0.016). In the routine radical resection group, the 1, 3-year survival rates were 54.5% (6/11) and 18.% (2/11), which were not significantly different from those in LTx.

CONCLUSIONOLT is a good choice for the patients with advanced stage of unresectable Klatskin tumor by routine modalities, and the prognosis was exciting.