The results of liver transplantation in patients with cholangiocarcinoma have been poor. It has been suggested that elevated serum CA19-9 levels predict cholangiocarcinoma in patients with primary sclerosing cholangitis. We analyzed the predictive value of CAl9-9 antigen as a marker of cholangiocarcinoma in patients with primary sclerosing cholangitis evaluated for liver transplantation. We reviewed the charts of 26 patients with primary sclerosing cholangitis (stage IV) in whom preoperative serum CA19-9 levels were determined; 22 of 26 underwent liver transplant. Explant specimens were serially sectioned and examined for tumor. In 3 of the 26 patients, cholangiocarcinoma was diagnosed during pretransplantation evaluation; exploratory laparotomy on the last patient showed no evidence of cholangiocarcinoma, and this patient is awaiting transholangiocarcinoma (CCA) has a well-docu-C mented association with primary sclerosing cholangitis (PSC); 5% to 15% of patients with PSC are found to have CCA as well.' Accurate and timely diagnosis of cholangiocarcinoma in the presence of PSC can be difficult because of the lack of pathognomonic signs, laboratory data, or radiological findings. Detection of CCA is frequently delayed until an advanced stage, when a patient with previously stable disease begins to deteriorate rapidly.2 Earlier diagnosis via a sensitive and specific serum marker may allow surgical therapy and improved long-term survival.
Liver transplantation in patients with cholangiocar-From the