Abstract: Hepatocellular carcinoma with bile duct tumor thrombus is a highly aggressive subtype associated with poor prognosis, and its suitability for liver transplantation remains contro-versial. Current evidence suggests that strictly selected patients, such as those meeting the Milan criteria, with low alpha‑fetoprotein levels, or Satoh type Ⅰ-Ⅱ of bile duct tumor thrombus may benefit from liver transplantation. In contrast, patients with elevated tumor markers, Satoh type Ⅲ, or concurrent major vascular invasion tend to have poorer outcomes following transplantation. Downstaging conversion therapies may potentially expand the indications for liver transplantation in this population. Technically, successful cases have been reported for both liver transplantation combined with extrahepatic bile duct resection and hepaticojejunostomy, as well as for transplan-tation preserving the native bile duct with end‑to‑end donor‑recipient bile duct anastomosis. However, the applicability and relative merits of these surgical approaches require further investigation. By reviewing the relevant literature and incorporating the authors′ team clinical experience, the authors provide an in‑depth discussion on the applicability, feasibility, and long‑term outcomes of liver transplantation for hepatocellular carcinoma patients with bile duct tumor thrombus, aiming to offer insights for clinical decision‑making and to clarify future research directions in this field.