Present and future of liver transplantation for cholangiocellular carcinoma: moving toward personalized...

Liver transplantation for cholangiocarcinoma (CCA) shifted from a contraindication to a promising therapeutic option for selected patients. Advances in neoadjuvant therapy and refined selection criteria resulted in long-term outcomes comparable to other accepted oncologic indications, particularly in perihilar CCA managed with standardized protocols and in intrahepatic CCA with favorable tumor biology. The future challenge is to develop a multiparametric biological selection, blending clinical, functional, histopathologic, molecular, and radiologic parameters to identify candidates with indolent disease behavior, thus maximizing oncologic benefit while ensuring appropriate use of limited graft resources.