*Purpose: Intrahepatic cholangiocarcinoma (ICCA) has traditionally been considered a contraindication to liver transplantation (LT). We previously reported a case series of six patients with large, unresectable ICCA tumors who underwent LT. A total of 17 patients have now undergone LT for ICCA at our institution. This study reports long term outcomes for these patients.

*Methods: Retrospective review of a prospectively-maintained database was performed of patients undergoing LT for ICCA under an investigational protocol. Survival analysis was performed using the Kaplan-Meier method to report overall and recurrence-free survival.

*Results: Seventeen patients underwent LT for ICCA. All patients had unresectable tumors and no extrahepatic disease. The study group underwent neoadjuvant therapy and maintained disease stability for more than six months. This patient population exhausted all therapeutic options and harbored tumor volume as great as 20 cm. Median follow up was 20.6 months. Five patients had cancer recurrence, and four patients died. Patient survival at 1-, 3- and 5-years was 100%, 80%, 60%. Recurrence-free survival at 1-, 3- and 5-years was 65%, 65%, and 32%. Sites of recurrence include the lung (n=2), bone (n=2), bowel (n=1), omentum (n=1), and brain (n=1). One patient had hepatic artery thrombosis and underwent a second LT.

*Conclusions: Median survival for unresectable ICCA treated with systemic chemotherapy is less than 1 year. For patients with unresectable ICCA who undergo neoadjuvant therapy and demonstrate disease stability, LT offers an opportunity for long term survival. Additional research should identify factors prognostic for disease stability to inform patient selection.

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