The role of liver transplant for intrahepatic cholangiocarcinoma: the UK NHSBT liver advisory group pilot programme

Aim: Liver transplantation (LT) offers a potential curative treatment for non-metastatic intrahepatic cholangiocarcinoma (iCCA) in patients with chronic liver disease who are not amenable to liver resection (LR). Recent evidence suggests that cirrhotic patients with "very early" iCCA (single tumour, <= 2 cm) might benefit the most from LT, with a 5-year survival as high as 73%. In view of these developments, NHS Blood and Transplant's Liver Advisory Group (LAG) established a Fixed Term Working Group (FTWG) to determine whether iCCA in patients with background cirrhosis should be considered for LT in the United Kingdom. Methods: The FTWG included cholangiocarcinoma/LT patient representatives, experts in cholangiocarcinoma surgery/oncology, LT surgery, hepatology, hepatobiliary radiology, hepatobiliary pathology, nuclear medicine, and representation from various national hepatobiliary/oncology and transplant professional bodies. The objective was to make recommendations on appropriate indications, patient selection criteria, referral criteria, radiological assessment, transplant listing pathways, data management, and overall quality assurance. Results: The FTWG recommended LT for very early iCCA in cirrhotics, who are otherwise not suitable for LR. In this paper, we summarise the selection criteria, patient pathways, referral framework, pre-transplant assessment criteria, outcome measures, and dissemination strategy for implementing this new indication for LT in the UK. Conclusion: The introduction and evaluation of this pilot programme is an important breakthrough for iCCA patients in the UK, marking a significant stride in the field of transplant oncology. The results of this service evaluation will describe the role of LT in iCCA and guide future programmes to optimise patient selection, management, and outcomes.