E-Mail karger@karger.com Original Paper Digestion 2014;89:165–173 DOI: 10.1159/000357445 Trends in Pre-Liver Transplant Screening for Cholangiocarcinoma among Patients with Primary Sclerosing Cholangitis Panagiotis Trilianos Florin Selaru Zhiping Li Ahmet Gurakar Division of Gastroenterology and Hepatology, Transplant Hepatology Section, The Johns Hopkins School of Medicine, Baltimore, Md., USA OLT varies greatly among centers. Serum carbohydrate anti- gen 19-9 and magnetic resonance cholangiopancreatogra- phy are widely used. HGD warrants surveillance rather than intervention among most experts. Protocolized chemoradi- ation followed by OLT has yet to become a widely accepted approach. The very poor survival of PSC patients who de- velop CCA underlines the importance of an effective and uni- versally accepted screening process that will aid in its earlier detection. © 2014 S. Karger AG, Basel Introduction Cholangiocarcinoma (CCA), a malignant tumor arising from the bile duct epithelium, will afflict 20% [1] of pa- tients with primary sclerosing cholangitis (PSC). In about half of those cases, CCA will be detected within a year of the diagnosis of PSC, while in an additional 10%, the pre- sentation of both diagnoses will be simultaneous [2]. The tumor may manifest with physical and biochemical dete- rioration that is virtually indistinguishable from progres- sion of the underlying PSC, thus necessitating radiologic and/or histological confirmation. This scenario poses well- Key Words Cholangiocarcinoma · Cholangitis · Biliary dysplasia · Liver transplantation Abstract Background: Cholangiocarcinoma (CCA) is the most com- mon hepatobiliary malignancy complicating primary scle- rosing cholangitis (PSC). Unfortunately, timely diagnosis of CCA in PSC patients remains challenging. Aim: To investi- gate the strategies among liver centers regarding pre-trans- plant screening for CCA in patients with PSC. Methods: An online survey was returned from 46 US transplant centers, inquiring on the frequency of screening, the use of specific tests, or tactical approaches to high-grade dysplasia (HGD) or CCA. Results: Most centers screen their PSC patients for CCA prior to orthotopic liver transplantation (OLT) (89%). Se- rum carbohydrate antigen 19-9 and magnetic resonance cholangiopancreatography are first-line screening tools (93 and 84% respectively). Endoscopic retrograde cholangio- pancreatography with biliary brushings is routinely per- formed in only 30% of the centers. In the case of HGD, 61% would choose close monitoring. In the event of non-resect- able CCA, 37% have an OLT protocol, 33% resort to palliative treatment and the remaining 30% make an outside referral. Finally, half the participating centers perform CCA surveil- lance among their listed PSC patients every 6 months. Conclusion: Screening for CCA among PSC patients prior to Received: September 10, 2013 Accepted: November 12, 2013 Published online: February 22, 2014 Panagiotis Trilianos Division of Gastroenterology and Hepatology, Transplant Hepatology Section The Johns Hopkins School of Medicine, 720 Rutland Ave Ross Research Building, #918, Baltimore, MD 21205 (USA) E-Mail ptrilianos  @  yahoo.com © 2014 S. Karger AG, Basel 0012–2823/14/0892–0165$39.50/0 www.karger.com/dig This work has been presented as a poster during International Liver Transplant Society Annual Meeting, May 2012, San Francisco, Calif., USA. Downloaded by: JHU John Hopkins University 162.129.251.17 - 3/7/2014 1:16:56 AM