To explore the therapeutic efficacy of liver transplantation(LT) in patients with biliary tract cancer (BTC).

A retrospective analysis was conducted on the clinicopathological data and survival outcomes of BTC patients who underwent LT at Beijing Tsinghua Changgung Hospital between January 1, 2018, and June 30, 2024, with regular follow-up. The cohort included 6 cases of perihilar cholangiocarcinoma (pHCC), 8 cases of intrahepatic cholangiocarcinoma (ICC), 13 cases of combined hepatocellular-cholangiocarcinoma (cHCC-CCA), and 1 case of gallbladder carcinoma (GC). Survival rates were calculated and survival curves were plotted using the Kaplan-Meier method. Survival analysis was performed using the log-rank test. P value <0.05 was considered statistically significant.

As of the follow-up deadline of June 30, 2025, the median follow-up time for the 28 recipients was 19 (5-80) months. 19 patients experienced tumor recurrence, and 18 patients died (17 from end-stage tumor disease and 1 from myocardial infarction without recurrence). The 1-year overall survival and 1-year recurrence-free survival rates for all 28 recipients were 71.4% and 50.0%, respectively. The single GC recipient survived 53 months without recurrence by the end of follow-up. For recipients with pHCC, ICC, and cHCC-CCA, the 1-year overall survival rates were 50.0%, 87.5%, and 69.2%, respectively; the 1-year recurrence-free survival rates were 33.3%, 37.5%, and 61.5%, respectively; and the median survival times were 15.5 (8-20), 29 (8-80), and 44 (5-80) months, respectively. The difference in overall survival among the three primary disease groups was statistically significant (χ²=4.822, P<0.05), whereas the difference in recurrence-free survival was not statistically significant (χ²=3.287, P>0.05). Recipients with T1-stage cHCC-CCA had significantly better overall survival and recurrence-free survival than those with non-T1-stage disease (χ²=8.170 and 5.232, P all <0.05).

The efficacy of LT for BTC is unsatisfactory due to the high rate of tumor recurrence and relatively short post-transplant survival. Exploring appropriate recipient selection criteria and targeted downstaging/conversion strategies may help optimize long-term outcomes.