Liver Transplant for Intrahepatic Cholangiocarcinoma: Current Evidence and Clinical Practice Recommendations.

Intrahepatic cholangiocarcinoma (iCCA) incidence is increasing globally 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 due to dismal survival outcomes driven by high recurrence. However, recent studies suggest improved outcomes with specific patient selection criteria and incorporation of effective neoadjuvant therapies. This review summarizes current literature, highlighting the evolution of LT for iCCA, contemporary surgical considerations, patient selection criteria, and reported clinical outcomes from major retrospective and prospective studies. Furthermore, it consolidates current recommendations from international societies. Questions remain as to the accurate identification of suitable candidates, optimal timing, and management of neoadjuvant and adjuvant therapies, as well as 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.