Liver transplantation for intra- and extrahepatic cholangiocarcinoma

Cholangiocarcinoma (CCA) is the second most frequent primary liver malignancy. Despite extensive surgical approaches and recently developed perioperative chemotherapeutic protocols the 5-year-survival rates range from 20-60%. Especially for central intrahepatic CCA resection is often impossible due to bilobar vascular and biliary invasion; patients with primary sclerosing cholangitis often present with small central tumors and significantly impaired liver function. For these patients liver transplantation (LT) has been discussed as a potential curative option. After a series of LT for CCA in the 1990s with high quotas of early tumor recurrence and very limited long-term survival CCA has widely been agreed upon as a contraindication for LT in times of universal organ shortage. However, in selected cases of patients with PSC and small CCA as well as irresectable Klatskin tumor without extrahepatic disease LT has been performed with acceptable recurrence-free survival rates. Modern, aggressive protocols of perioperative treatment have been established with promising results. This article provides an update and overview on the current status of LT as a potential option for patients with irresectable CCA.