A Case of Hepatocellular Carcinoma (HCC) Immunotherapy Inducing Liver Transplant Rejection

Gómez, Paula; Naim, A.; Zucker, Kelly; Wong, Mark

doi:10.14309/00000434-201810001-02415

Cited by 10 publications

(4 citation statements)

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“…Based on the inclusion and exclusion criteria described above, a total of 28 articles 10 – 37 including 27 articles in English and 1 article in Chinese that met the criteria were identified. A total of 47 patients who received ICI treatments after LT were reported in this study ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

Xie

Dang

Sun

et al. 2022

Therapeutic Advances in Chronic Disease

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Up to now, a variety of immune checkpoint inhibitors (ICIs) have been proved to have good therapeutic effects in the treatment of hepatocellular carcinoma (HCC). However, the effects of their applications in liver transplant (LT) recipients are still unclear. In this analysis report, the clinical applications and therapeutic effects of ICIs on LT recipients with hepatic tumor recurrence or de novo carcinoma based on eight databases, including PubMed, EMBASE, Web of Science, Google Scholar, China National Knowledge Infrastructure, Wanfang Data, and CQVIP, were investigated. And the prior treatment, disease response, adverse reactions, and prognosis of patients with malignant tumors after LT and receiving ICI treatments were analyzed. After screening, a total of 28 articles with 47 recipients on the application of ICIs after LT were included. In these patients, their median age was 57 (14–71) years and the main type of tumor after LT was HCC (59.6%). The overall remission rate following ICI treatment was 29.8% (14/47) and the disease progression rate was 68.1% (32/47). Among all these patients, 31.9% (15/47) of patients had immune rejection; the median survival time was 6.5 (0.3–48) months, and the fatality rate was 61.7% (29/47). Considering that the therapeutic effect of ICIs in LT recipients with HCC recurrence or de novo carcinoma is not ideal, ICI treatment should be carefully considered for LT patients, and further research is needed.

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Section: Resultsmentioning

confidence: 99%

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

Xie

Dang

Sun

et al. 2022

Therapeutic Advances in Chronic Disease

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“…Immunotherapies have revolutionized advanced HCC management, with their specific role in transplantation still evolving but promising [5 ▪▪ ,6,7 ▪▪ ,11–14,26–34,35 ▪▪ ,36 ▪ ,37,38 ▪ ,39 ▪ ,40–42,54–67,68 ▪ ,69 ▪ ].…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors included ICI-liver transplantation time less than 1 year, autoimmune disease, young patients with DSA, and previous rejection. While results from clinical trials are evolving, some recent data suggest that adjuvant immunotherapy may improve the prognosis of patients with recurrence post liver transplantation [54–67,68 ▪ ,69 ▪ ]. A summary of current published literature is reported on Table 3.…”

Section: Current Role Of Immunotherapy After Liver Transplantation Fo...mentioning

confidence: 99%

Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy

Tabrizian,

Zeitlhoefler,

Hassan

et al. 2023

Current Opinion in Organ Transplantation

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Purpose of review The increasing success of liver transplantation in hepatocellular carcinoma (HCC) drives an ever-evolving search for innovative strategies to broaden eligible patients’ pools. Recent advances in immuno-oncology have turned the spotlight on immune checkpoint inhibitors (ICIs). This review offers an updated overview of ICIs in liver transplantation for HCC, exploring neoadjuvant and adjuvant approaches and addressing unanswered questions on safety, patients’ selection, and response predictors. Recent findings ICIs have transitioned from being a last-chance therapeutic hope to becoming an integral cornerstone in the treatment of advanced HCC, holding great promise as a compelling option not only to downstage patients for transplantation but also as an alternative strategy in addressing posttransplantation disease recurrence. Despite ongoing refinements in immunotherapeutic agents, the complex molecular pathways involved emphasize the need for a comprehensive approach to integrate immunotherapy in liver transplantation. Summary Initial concerns about graft rejection, with ICIs as a bridging therapy to liver transplantation, were successfully addressed using adequate immunosuppressants strategies and minimized with a sufficient washout period. Post-liver transplantation disease recurrence remains challenging, requiring a balance between effective therapy and preserving graft function. Emphasis should be placed on clinical trials validating the risk-benefit ratio of ICIs for liver transplantation, guiding appropriate patients’ selection, and establishing clear management pathways.

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“…A summary of 28 cases of liver transplant recipients who went on to receive IO is shown in Table 1; this is the most comprehensive list to date [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . HCC was the reason for LT in 22 of these cases.…”

Section: Immune Checkpoint Inhibitor Therapy Post Liver Transplantmentioning

confidence: 99%

Immune checkpoint inhibitors in liver transplant recipients - a review of current literature

Yin¹,

Baba²,

He³

et al. 2021

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Immuno-oncology, particularly with the development of immune checkpoint inhibitors (ICIs), has become a frontline category of cancer-directed therapy, including in the treatment of hepatocellular carcinoma (HCC). While liver transplant (LT) offers a potential cure for HCC, the use of ICIs is a topic of safety concern both pre-and posttransplant due to the risk of donor graft rejection. Nonetheless, some scenarios for which the therapeutic effects of ICI may be highly beneficial include the downstaging of unresectable HCC pre-transplant, or the treatment of recurrent HCC and secondary malignancies post-transplant. In this review, we explored the evidence surrounding the use of ICI in the peri-transplant setting, including safety and efficacy. In a comprehensive review of 28 cases of ICI use post-transplant, we found graft rejection in 9 of 28 cases (32%). Some factors that may increase the risk of rejection include younger age, less time between LT and ICI therapy, and PD-1/PD-L1 expression in the donor graft (particularly when using anti-PD-1/anti-PD-L1 ICIs). Despite these concerns, we relay a case of successful HCC downstaging with nivolumab and subsequent LT. We also describe several cases of response to ICIs post-LT (7 of 28 cases) among a group that is often heavily pre-treated. We conclude that ICIs are valuable options in the peritransplant setting that have demonstrated promising efficacy based on case reports. Controlled clinical trials are needed to further investigate the conditions that may allow safe delivery of these therapies.

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A Case of Hepatocellular Carcinoma (HCC) Immunotherapy Inducing Liver Transplant Rejection

Cited by 10 publications

References 0 publications

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy

Immune checkpoint inhibitors in liver transplant recipients - a review of current literature

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