Transplant Timing in Perihilar Cholangiocarcinoma: Ann of Surgery, Feb. 2026

This large single-centre analysis evaluated whether earlier liver transplantation improves survival in patients with perihilar cholangiocarcinoma (pCCA) treated with standardised neoadjuvant therapy and transplant protocol.

The key question:

Does transplanting within 6 months of protocol registration improve outcomes?

Study Overview

392 patients in the intention-to-treat cohort

256 underwent liver transplantation

Median time to transplant/dropout: ~5.7 months

Key Findings

Shorter wait times (0–3 months) did NOT improve overall survival.

Waiting longer (≥6 months) did not worsen intention-to-treat survival.

Importantly, among transplanted patients:

Waiting ≥6 months was associated with lower post-transplant mortality.

Survival benefit became more pronounced beyond 9 months.

Waiting time was not associated with increased residual tumour in the explant.

Clinical Interpretation

This study challenges the assumption that “earlier is better” for transplant in pCCA.

A minimum 6-month waiting period may:

Allow biological selection of favourable tumour behaviour

Reduce post-transplant mortality

Maintain overall survival in the broader cohort

Take-Home Message for Hepatobiliary & Transplant Teams

Transplantation within 6 months of registration does not enhance survival, and waiting ≥6 months may optimise outcomes without compromising overall patient survival.

This reinforces the importance of disciplined protocol adherence and biological selection in pCCA transplant programs.