Outcomes of Liver Transplantation in Patients With Incidental Combined Hepatocellular–Cholangiocarcinoma: A Follow-Up Study

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INTRODUCTION: Surgical resection is the standard treatment for combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC). However, recent studies suggest that liver transplantation (LT) may be a viable alternative for selected patients, with encouraging survival outcomes. The objective of this study is to report the outcomes of LT in patients with incidental cHCC-CC. METHODS: This single-center retrospective study included adult patients who underwent LT for hepatocellular carcinoma (HCC) and were found to have an incidental histopathological diagnosis of cHCC-CC between January 2015 and December 2024. RESULTS: During the study period, 1321 LT were performed, of which 24 patients (2.57%) had a histopathological diagnosis of cHCC-CC. The mean age was 58.5 years (range: 31-71), and 75% of patients were male. Regarding radiological findings, 16 patients had a LI-RADS 5 classification. On explant analysis, 3 patients (12.5%) had a single nodule confirmed as cHCC-CC on histopathology. In the remaining cases, the disease was multifocal (ranging from 2 to 25 nodules), with HCC as the predominant lesion and at least one nodule identified as cHCC-CC. During follow-up, 2 patients developed pulmonary recurrence of HCC, with a mean time between LT and recurrence of 314 days. CONCLUSIONS: Liver transplantation may represent a therapeutic option for selected patients with cHCC-CC. However, these results should be interpreted with caution due to the retrospective design of the study and the limited number of cases analyzed.