Liver transplantation in unresectable intrahepatic cholangiocarcinoma following neoadjuvant chemotherapy and SIRT

Liver transplantation is not currently considered a standard therapeutic option for patients with unresectable, liver-limited intrahepatic cholangiocarcinoma due to historically poor outcomes. This study provides a scientific rationale for reconsidering transplantation in a highly selected subgroup of patients who achieve sustained disease control after neoadjuvant chemotherapy combined with selective internal radiation therapy. The results are particularly relevant for transplant hepatologists, oncologists, and surgeons, as they suggest that treatment response and prolonged disease stability may better predict post-transplant outcomes than tumor size alone. Clinically, these findings support a multidisciplinary, response-based selection strategy with a "test-of-time" approach, while acknowledging the small sample size and retrospective design, and highlight the need for prospective studies and structured allocation frameworks to safely expand this approach.