Liver transplantation for intrahepatic cholangiocarcinoma: From contraindication to biology-driven selection

Le résumé fourni par la source

Intrahepatic cholangiocarcinoma (iCCA) has historically been considered a contraindication to liver transplantation (LT) because early outcomes in unselected patients were marked by high recurrence and poor survival.Liver resection remains the standard curative-intent treatment when technically feasible and oncologically appropriate.Contemporary evidence challenges this binary view, suggesting that transplant benefit depends less on diagnosis or anatomy alone than on careful candidate selection and disease behavior over time.This narrative review examines LT for iCCA within current transplant oncology practice.Current evidence supports cautious LT consideration in two distinct settings.The first is very early iCCA in cirrhotic patients, particularly solitary tumors ≤ 2 cm, for which explant-based retrospective studies have shown better outcomes than those observed in larger or multifocal disease.This setting is supported mainly by incidental or explant-based series.Selected solitary tumors ≤ 3 cm may be considered within consensus-, guidance-based, trial-based, or registry-based frameworks after documented stability and exclusion of nodal or extrahepatic disease, although this threshold is less well validated than the 2-cm threshold.The second is unresectable, liver-limited iCCA controlled by neoadjuvant systemic therapy with or without locoregional treatment, where durable radiologic response or stability, usually for at least 6 months, serves as a dynamic test of disease behavior.This setting is based on highly selected neoadjuvant cohorts and remains more clearly investigational.In both settings, histological confirmation when feasible, careful staging, and exclusion of nodal or extrahepatic spread are essential.LT should be framed not as routine indication expansion, but as a highly selective treatment strategy for patients with liver-limited disease and sustained disease control.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.