Liver transplantation as an alternative for the treatment of intrahepatic cholangiocarcinoma: Past, present, and future directions
Sudha Kodali a , b , c , # , Ashton A Connor a , b , d , e , # , Souhail Thabet f , Elizabeth W Brombosz e , R Mark Ghobrial a , b , d , e , ∗
a Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
b JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX 77030, USA
c Department of Medicine, Weill Cornell Medical College, New York, NY, USA
d Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
e Department of Surgery, Weill Cornell Medical College, New York, NY, USA
f School of Medicine, New Giza University, Giza, Egypt
∗Corresponding author at: Department of Surgery, Houston Methodist Hospital, 6550 Fannin St, SM 1661, Houston, TX 77030, USA.
E-mail address: rmghobrial@houstonmethodist.org (R.M. Ghobrial).
# Contributed equally.
Abstract：Intrahepatic cholangiocarcinoma (iCCA) is a rare biliary tract cancer with high mortality rate. Complete resection of the iCCA lesion is the first choice of treatment, with good prognosis after margin-negative resection. Unfortunately, only 12%-40% of patients are eligible for resection at presentation due to cirrhosis, portal hypertension, or large tumor size. Liver transplantation (LT) offers margin-negative iCCA extirpation for patients with unresectable tumors. Initially, iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT outcomes. Recent studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced iCCA. Another selection criterion is the tumor response to neoadjuvant therapy. Patients with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor re- sponse to neoadjuvant therapy. Another index that helps predict the treatment outcome is the biomarker. Improved survival outcomes have also opened the door for living donor LT for iCCA. Patients undergoing LT for iCCA now have statistically similar survival rates as patients undergoing resection. The combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.
2024, Vol. 23 
