Liver transplant for intrahepatic cholangiocarcinoma: current evidence and clinical practice recommendations

Intrahepatic cholangiocarcinoma (iCCA) incidence is increasing worldwide and is associated with poor prognosis. Surgical resection remains the main curative treatment. However, many patients present with unresectable disease or underlying liver dysfunction, precluding resection. Liver transplantation (LT) has recently emerged as a potential therapeutic approach, offering the theoretical advantages of tumor resection with clear margins without anatomical constraints, removal of micrometastatic intrahepatic disease, and replacement of compromised hepatic tissue. Historically, iCCA was thought to be a contraindication for LT owing to dismal survival outcomes driven by high recurrence. However, recent studies suggest improved outcomes with specific patient-selection criteria and the incorporation of effective neoadjuvant therapies.

We performed a review of the current literature on this topic, highlighting the evolution of LT for iCCA, contemporary surgical considerations, patient-selection criteria, and reported clinical outcomes from major retrospective and prospective studies. Studies were identified through MEDLINE and Goodle Scholar search, with our methodology adhering to established guidelines for narrative reviews.

Our current review consolidates the current recommendations from international societies, emphasizing contemporary trends and outcomes of LT for iCCA, utilization, and surgical outcomes.

Questions remain regarding the accurate identification of suitable candidates, optimal timing and management of neoadjuvant and adjuvant therapies, and strategies to prevent and manage recurrence. Continued prospective research is underway to better refine patient-selection criteria, validate treatment protocols, and ultimately improve survival outcomes for this challenging malignancy.