Background and Aims Liver transplantation has been proposed as an alternative treatment for patients with unresectable hilar cholangiocarcinoma (hCCA), but it is still controversial in some aspects. Therefore, this study was conducted to summarize the clinical efficacy of liver transplantation for 6 patients with unresectable hCCA, so as to provide information for clinical decision-making.Methods The clinicopathologic data and survival status of 6 hCCA patients who underwent liver transplantation and regular follow-up in Shanghai Jiaotong University School of Medicine affiliated Ruijin Hospital from January 2015 to March 2021 were retrospectively analyzed.Results All the 6 patients underwent the standard orthotopic whole liver transplantation. The postoperative pathology showed mass-forming type lesion in 2 cases, infiltrating type lesion in 2 cases and endophytic type lesion in 2 cases; the diameter >3 cm in 4 cases; peripheral nerve invasion in 2 cases, portal vein invasion in 3 cases and intrahepatic metastasis in 2 cases; adenosquamous carcinoma in 1 case and adenocarcinoma in 5 cases; G2-moderately differentiated histological grade in 3 cases and G3-poor differentiated histological grade in 3 cases; pTMN stage II in 1 case, stage IIIa in 1 cases, stage IIIc in 2 cases and stage IV in 1 case. During follow-up, 3 cases were alive, of whom, long-term tumor-free survival was achieved in 2 cases with endophytic and polypoid type adenocarcinoma and decompensated cirrhosis, and 1 case with mass-forming type adenocarcinoma undergoing preoperative neoadjuvant chemoradiotherapy survived with disease free for 20 months by far; 3 cases were dead, of whom 1 case with mass-forming type adenosquamous cholangiocarcinoma survived for 18 months after operation, and 2 cases with biliary tract infiltration survived for 2 months and 24 months, respectively. Preoperative biliary drainage and combination of immunosuppressor and chemotherapy after surgery exerted no obvious effect on the survival of the patients.Conclusion In hCCA patients, liver transplantation may offer better results to those with endophytic and polypoid type adenocarcinoma and decompensated liver cirrhosis as well as exclusion of lymph node metastasis, even no preoperative neoadjuvant chemoradiotherapy is given, but yield dismal results in those with lymph node metastasis and peripheral infiltration.