Pretransplant immunotherapy increases acute rejection yet improves survival outcome of HCC patients with MVI post-liver transplantation
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View abstract on PubMed
Summary
This summary is machine-generated.Pretransplant immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) before liver transplantation (LT) increase rejection risk but may benefit patients with microvascular invasion (MVI). Further research is needed to optimize ICI use in HCC downstaging.
Area Of Science
- Hepatobiliary Surgery
- Transplant Immunology
- Oncology
Background
- Immune checkpoint inhibitors (ICIs) are promising for hepatocellular carcinoma (HCC) downstaging before liver transplantation (LT).
- The safety and efficacy of pretransplant ICI exposure require further investigation.
- Microvascular invasion (MVI) is a significant risk factor in LT recipients.
Purpose Of The Study
- To evaluate the feasibility and safety of pretransplant ICI therapy in HCC patients undergoing LT.
- To assess the impact of pretransplant ICI exposure on perioperative outcomes, survival, and recurrence.
- To investigate the role of ICI in HCC patients with MVI.
Main Methods
- Retrospective analysis of 159 HCC patients who underwent LT.
- Comparison of outcomes between 39 patients receiving pretransplant ICI therapy and 120 patients who did not.
- Analysis of perioperative rejection rates, mortality, overall survival (OS), and recurrence-free survival (RFS).
Main Results
- Pretransplant ICI use was associated with significantly higher acute rejection (23.1% vs 5%) and rejection-related mortality (12.8% vs 0%) rates.
- No significant differences were observed in 90-day OS or RFS between ICI and non-ICI groups.
- Pretransplant ICI exposure showed a protective effect on OS in HCC patients with MVI, with comparable RFS and OS to non-ICI recipients without MVI.
Conclusions
- Pretransplant ICI therapy increases perioperative risks, including acute rejection and mortality, in HCC patients undergoing LT.
- ICI may offer survival benefits for HCC patients with MVI, warranting further investigation.
- Optimizing downstaging protocols and patient selection is crucial to balance immunotherapy's benefits and risks, reducing rejection and improving long-term survival.
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