Background: Liver transplantation (LT) has traditionally been restricted to well-defined indications. However, recent advancements and updated guidelines from societies such as the European Association for the Study of the Liver (2024) have prompted a reassessment of off-label indications. Mucinous adenocarcinoma of the extrahepatic bile duct is a rare and poorly characterized subtype of cholangiocarcinoma, with limited data on both its prognosis and optimal management.
Methods: We conducted a literature review in UpToDate, PubMed, and Scielo, identifying only four relevant studies meeting our criteria (free full-text, English/French/Spanish, 2010-2025, focused on pathological or prognostic features of mucinous bile duct adenocarcinoma). We aimed to compare our patient's case with existing literature to assess the appropriateness of LT.
Case report: A 68-year-old BRCA mutation carrier with progressive liver failure and suspected cholangiocarcinoma underwent LT after multidisciplinary consensus, despite negative cytology and fine-needle aspiration. Histology confirmed a mucinous adenocarcinoma of the common bile duct (pT2a pTN0). Two years posttransplant, the patient developed a recurrence in the peritoneum and the abdominal wall but remains clinically stable and is undergoing chemotherapy.
Discussion: Literature suggests that mucinous components in solid tumors are associated with a worse prognosis. In intrahepatic mucinous cholangiocarcinoma, surgery and chemotherapy appear to improve survival. Our case supports the potential role of LT in selected patients with early-stage tumors (e.g., pT1-pT2), even in rare or aggressive histologies. Although LT indications remain strict, selected cases of mucinous bile duct tumors with favorable profiles may benefit from transplantation. Multidisciplinary evaluation and individualized treatment strategies are essential in the era of transplant oncology.
Copyright © 2026 Elsevier Inc. All rights reserved.