Research advances in liver transplantation in treatment of perihilar cholangiocarcinoma

Perihilar cholangiocarcinoma （pCCA） originates from the biliary epithelium at the confluence of the left and right hepatic ducts， and most patients are in the advanced stage at the time of confirmed diagnosis due to complex anatomy， insidious early symptoms， and highly aggressive tumor biology. Although radical resection remains the preferred treatment method， there is still a low 5-year survival rate after surgery. Since Mayo Clinic proposed a protocol combining neoadjuvant chemoradiotherapy with strict screening criteria， long-term outcomes of pCCA have been significantly improved after liver transplantation. With the expansion of donor liver sources， the maturation of living-donor liver transplantation techniques， and the optimization of immunosuppression strategies， liver transplantation has gradually become a standardized treatment regimen for specific patients with pCCA. This article systematically reviews the current status of liver transplantation for the treatment of pCCA， the criteria for indications， the strategies for neoadjuvant therapy before surgery， postoperative management， and recurrence prevention and control， as well as the directions for future development such as precise molecular subtyping， combined immunotherapy， and the optimization of donor organ resources.