What is your institutional practice for neoadjuvant therapy prior to transplanting cholangiocarcinoma?

We have largely been following the Mayo Protocol for perihilar cholangiocarcinoma, which is outlined here: A collaborative approach using liver transplant for perihilar cholangiocarcinoma treatment - we use chemoRT and capecitabine or 5FU. I do not think it would be wrong to cycle in some gemcitabine-based treatment, but I would steer clear of the immunotherapy to not compromise the transplanted organ (i.e., induce organ rejection) in any way. The estimated half-life is 18 days or so, but IO effects can linger for years after receipt of treatment (see, for example, Durbin et al., PMID 40146104).

Another helpful reference for Mayo Protocol - Tan et al., PMID 32671802.