Liver transplantation as a new treatment option for perihilar cholangiocarcinoma and colorectal liver metastases: a review.

Liver transplantation (LT) has become widespread in recent years owing to advances in the elucidation of its pathogenesis, surgical procedures, and perioperative management. Historically, LT was only performed in patients with end-stage liver disease and certain malignancies, such as hepatocellular carcinoma, but its indications have recently been expanded to include unresectable perihilar cholangiocarcinoma (pCCA) and colorectal liver metastases (CRLM). In this review, we discuss the current status and future prospects of LT for these expanded indications. Perihilar cholangiocarcinoma and colorectal liver metastasis have poor prognoses if they cannot be surgically resected. For non-resectable pCCA, neoadjuvant chemoradiotherapy followed by LT has demonstrated improved survival, particularly under the Mayo Clinic protocol. Furthermore, LT for CRLM has received renewed interest following encouraging results from a Norwegian group showing a 5-year survival rate of > 80% with strict selection criteria. A recent randomized controlled trial further validated LT with chemotherapy as a promising option, demonstrating a significant survival advantage over chemotherapy alone. Both achieved favorable outcomes by implementing strict patient selection criteria and integrating LT as part of a multidisciplinary treatment approach that includes chemotherapy and radiation therapy. As transplant oncology continues to evolve, a multidisciplinary approach integrating transplant surgery, oncology, and hepatology is crucial for refining LT protocols for non-resectable pCCA and CRLM. Ongoing clinical trials and translational research are key to defining the role of LT in this expanding field, potentially establishing it as a standard therapy for selected cases of advanced hepatic malignancies.