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Akabane et al. Hepatoma Res 2023;9:29 Hepatoma Research
DOI: 10.20517/2394-5079.2023.45

Review Open Access

The future direction of liver transplantation for

intrahepatic cholangiocarcinoma

Miho Akabane, Yuki Imaoka, Kazunari Sasaki
Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.

Correspondence to: Dr. Kazunari Sasaki, MD, Division of Abdominal Transplant, Department of General Surgery,
Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA 94305, USA. E-mail: sasakik@stanford.edu

How to cite this article: Akabane M, Imaoka Y, Sasaki K. The future direction of liver transplantation for intrahepatic
cholangiocarcinoma. Hepatoma Res 2023;9:29. https://dx.doi.org/10.20517/2394-5079.2023.45

Received: 13 May 2023 First Decision: 14 Jun 2023 Revised: 28 Jun 2023 Accepted: 4 Jul 2023 Published: 7 Jul 2023

Academic Editor: Georgios Tsoulfas Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic
cholangiocarcinoma (iCCA) who are not amenable to curative resection. Recent studies have challenged the
traditional notion that liver transplantation is contraindicated for iCCA, leading to a paradigm shift in its
management. This review provides a comprehensive synthesis of the evidence regarding the role of liver
transplantation in the treatment of very early or advanced iCCA and discusses the key challenges and future
directions in this rapidly evolving field. For patients with cirrhosis and very early iCCA, liver transplantation has
demonstrated excellent long-term survival rates, rivaling those of patients with hepatocellular carcinoma. However,
the current transplantation criteria based on tumor size and number may be overly restrictive, excluding potential
candidates who could benefit from this treatment. The incorporation of tumor markers into selection criteria may
improve prognostic prediction and patient outcomes. In advanced iCCA, liver transplantation remains controversial
but holds promise, especially when combined with neoadjuvant and adjuvant therapies. Donor organ scarcity
necessitates the consideration of living donor liver transplantation as an alternative, while strategies such as
utilizing marginal donors and exploring xenotransplantation offer potential solutions to address the shortage of
donor livers. Overall, the evolving understanding of iCCA and the development of novel treatment strategies
promise to refine and enhance the role of liver transplantation in the management of this challenging malignancy.

Keywords: Intrahepatic cholangiocarcinoma (ICCA), liver transplantation, Cirrhosis, liver resection, prognosis

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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