Abstract Background In carefully selected patients, liver transplantation (LT) has provided encouraging outcomes for unresectable biliary tract cancers (BTC), including biphenotypic (cHCC-CC), perihilar (pCC), and intrahepatic cholangiocarcinoma (iCCA). This study aimed to characterize diagnostic discrepancies, recurrence patterns, and oncologic metrics in this unique LT population. Patients and Methods Patients with BTC receiving LT within a single academic transplant center were included ( n = 98 from 2007 to 2025). Survival and recurrence outcomes were analyzed by tumor histotype using Kaplan–Meier and log-rank tests. Univariate and multivariate Cox proportional hazards regression was performed. Results The most common transplanted subtype was pCC ( n = 54, 55.1%), followed by cHCC-CC ( n = 28, 28.6%) and iCCA ( n = 16, 16.3%). Pretransplant diagnoses frequently differed from final explant pathology in 26 patients (26.5%). Recurrence occurred in 40 (40.8%) patients with a median time to recurrence of 16 months (interquartile range 1–160 months). Estimated 1-, 3-, and 5-year overall survival rates for the entire cohort were 88%, 68%, and 58%, respectively. On multivariate analysis, lymph node positivity (hazard ratio [3.27, p = 0.010), iCCA subtype (HR 2.94, p = 0.030), and explant tumor size (HR 1.22 per cm, p = 0.005) were independent predictors of recurrence. Conclusions This is, to our knowledge, the largest single-center analysis of liver transplant recipients with BTC. Lymph node positivity, iCCA subtype, and tumor size are independent predictors of recurrence following LT for BTC. Despite the diagnostic challenges and high disease recurrence, LT is a promising option for unresectable BTC when no other surgical option exists.
Campbell et al. (Sat,) studied this question.