The future direction of liver transplantation for intrahepatic cholangiocarcinoma

Abstract

Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic cholangiocarcinoma (iCCA) who are not amenable to curative resection. Recent studies have challenged the traditional notion that liver transplantation is contraindicated for iCCA, leading to a paradigm shift in its management. This review provides a comprehensive synthesis of the evidence regarding the role of liver transplantation in the treatment of very early or advanced iCCA and discusses the key challenges and future directions in this rapidly evolving field. For patients with cirrhosis and very early iCCA, liver transplantation has demonstrated excellent long-term survival rates, rivaling those of patients with hepatocellular carcinoma. However, the current transplantation criteria based on tumor size and number may be overly restrictive, excluding potential candidates who could benefit from this treatment. The incorporation of tumor markers into selection criteria may improve prognostic prediction and patient outcomes. In advanced iCCA, liver transplantation remains controversial but holds promise, especially when combined with neoadjuvant and adjuvant therapies. Donor organ scarcity necessitates the consideration of living donor liver transplantation as an alternative, while strategies such as utilizing marginal donors and exploring xenotransplantation offer potential solutions to address the shortage of donor livers. Overall, the evolving understanding of iCCA and the development of novel treatment strategies promise to refine and enhance the role of liver transplantation in the management of this challenging malignancy.