Abstract:Biliary tract carcinoma (BTC), including intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), and distal cholangiocarcinoma (dCCA), is associated with poor prognosis. In recent years, advances in neoadjuvant therapy (NAT), molecular stratification, and transplant selection criteria have substantially expanded the role of liver transplantation in BTC. For pCCA, the combination of NAT and liver transplantation, particularly under the Mayo protocol, has significantly improved long-term survival in selected unresectable patients, although recurrence and vascular complications remain major challenges. For iCCA, liver transplantation has evolved from a contraindication to a potential therapeutic option in highly selected patients, especially those with very early-stage disease or those successfully downstaged by NAT, achieving survival outcomes comparable to hepatocellular carcinoma. Meanwhile, the emergence of targeted therapy and immunotherapy provides new opportunities for optimizing NAT strategies. This review summarizes the evolution of indications, prognostic factors, candidate selection, and recent advances in liver transplantation for BTC, and discusses future perspectives to inform clinical decision-making.