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

Abstract

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.

Sequential regorafenib or nivolumab therapy in recurrent hepatocellular carcinoma with sorafenib failure in liver transplant patients does not improve prognosis

“…Our team does not use nivolumab. A previous study showed that among the 47 patients treated with ICIs, 31.9% of patients had graft rejection and the median survival time was 6.5 months (0.3-48 months) [15]. Rejection was often accompanied by high mortality, and 44% of all patients died because of graft failure [15].…”

Therapeutic Effects of Anti-PD1 Immunotherapy on Hepatocellular Carcinoma Under Administration of Tacrolimus

“…Patients treated with a steroid (2/2) and cyclosporine (1/1) had a 100% graft rejection rate. 42 Abdel-Wahab et al reviewed cases from their hospital and reported that 16 (41%) of 39 patients experienced transplant rejection. They found that CNIs were the most effective single immunosuppressive agents for preventing graft rejection when used at the initiation of ICI treatment, with a graft rejection rate of 11% (1/9) and tumor response rate of 25% (2/8).…”

Sequential Regorafenib or Nivolumab Therapy in Recurrent Hepatocellular Carcinoma with Sorafenib Failure in Liver Transplant Patients Does Not Improve Prognosis

“…Our team does not use nivolumab. A previous study showed that among the 47 patients treated with ICIs, 31.9% of patients had graft rejection and the median survival time was 6.5 (0.3-48) months [15]. Rejection was often accompanied by high mortality, and 44% of all patients died because of graft failure [15].…”

“…A previous study showed that among the 47 patients treated with ICIs, 31.9% of patients had graft rejection and the median survival time was 6.5 (0.3-48) months [15]. Rejection was often accompanied by high mortality, and 44% of all patients died because of graft failure [15]. The rejection rate of patients treated with nivolumab was the highest (33%, 3/9 cases), which indicated the worst prognosis in those patients [16].…”