Liver transplantation can provide significant outcomes for unresectable biliary tract cancers, but patient selection is critical.

• 1-, 3-, and 5-year survival rates are 88%, 68%, and 58%, respectively.
• Recurrence occurs in 40.8% of patients, with a median time to recurrence of 16 months.

Consider lymph node positivity, ICCA subtype, and tumor size as key predictors of recurrence to guide surgical decision-making.

• Pretransplant diagnoses often differed from final pathology in 26.5% of cases, indicating diagnostic challenges.