Successful liver transplantation for hilar cholangiocarcinoma

PURPOSE OF REVIEW: The purpose of this review is to present recent data demonstrating the success of neoadjuvant therapy followed by liver transplantation for hilar cholangiocarcinoma. RECENT FINDINGS: The most recent outcomes of a protocol involving neoadjuvant therapy followed by liver transplant for hilar cholangiocarcinoma, placed in context with the most recent data regarding outcomes for surgical resection, are discussed. Data involving the observation and management of an increased rate of vascular complications following this aggressive protocol are described. Additionally, factors which may predict disease recurrence along with the implications of these data on organ allocation policy are reviewed. SUMMARY: For patients with early stage hilar cholangiocarcinoma which is unresectable or arising in the setting of primary sclerosing cholangitis, neoadjuvant chemoradiotherapy followed by liver transplantation provides excellent survival benefit. Outcomes are notably superior to other treatment options, including resection. The protocol, however, requires extensive involvement and expertise from multiple specialties to ensure success.