Lecture : Hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC) are the two main primary liver cancers. The incidence of ICC is gradually increasing worldwide. Because its prognosis is poor due to poor outcomes from high recurrence rates, even after macroscopic curative resection, patients with ICC are typically excluded from liver transplantation (LT). However, a small number of LT recipients have been incidentally diagnosed with ICC after pathological examination of the explanted livers. Most patients have a past history of HCC treatment and half have a second primary liver cancer. Prognosis of incidentally detected ICC following LT is as poor as that following hepatic resection, except in patients with very early ICC. Very early ICC showed favorable posttransplant prognosis, thus this selection condition can be prudently considered for LT indication. Patients with single ≤2 cm ICC at pathologic examination after LT achieve good 5-year survival and a low recurrence rate. Patients with cirrhosis and very early ICC may become candidates for LT. A prospective multicenter clinical trial is needed to further confirm these results. Selected patients with locally advanced ICC who show pretransplant disease stability on neoadjuvant therapy might benefit from LT. There is a prospective case-series of LT for ICC in patients with stable disease after neoadjuvant therapy under the Methodist–MD Anderson selection criteria. In conclusion, currently, pathologically proven ICC is a contraindication for LT in many transplant centers. Majority of ICCs have been diagnosed incidentally at the explant livers, and misdiagnosed or combined with HCC. Very early ICC appears to be an eligible indication for LT. Successfully down-staged or stable ICC appears to be an indication of clinical trial for LT.