Liver transplantation for intrahepatic cholangiocarcinoma: Insights from a National Registry Study in China

This study investigates the clinical efficacy of liver transplantation (LT) for intrahepatic cholangiocarcinoma (ICC), identifies clinicopathologic factors impacting prognosis, and provides evidence-based data to support LT indications for ICC. A retrospective cohort study was conducted using data from 124 ICC patients in the Chinese Liver Transplant Registry from January 2015 to December 2020. Clinicopathologic data and survival outcomes were analyzed. Postoperative survival was assessed using Kaplan-Meier analysis and Log-rank tests, while Cox regression identified prognostic factors. The number of LT cases for ICC increased yearly from 2015 to 2019, with major centers located in Shanghai, Guangdong, Beijing, Zhejiang, and Hubei. The overall survival (OS) rates at 1, 3, and 5 years were 68.2%, 35.5%, and 32.0%, respectively, and the disease-free survival (DFS) rates were 51.0%, 29.3%, and 26.5%, respectively. Poorer prognosis was linked to male gender, poor Child-Pugh classification, and not meeting the Hangzhou criteria. A significant OS difference was found between 89 male and 35 female patients (P = .034), with female patients showing better OS than male patients, but no significant difference was observed in DFS (P = .084). Among 78 patients exceeding the Milan criteria, those with preoperative neoadjuvant therapy had better OS (P = .041), though DFS differences were not significant (P = .228). LT prognosis for ICC is influenced by multiple factors, including worse outcomes for males. Preoperative neoadjuvant therapy improves survival for patients exceeding the Milan criteria but does not significantly prevent recurrence. Optimization of recipient selection and neoadjuvant therapy application is necessary.