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Liver Transplantation After Immune Checkpoint Inhibition in Hepatocellular Carcinoma-Data From the Multinational
Ulrike Bauer1, Maria R Troppmair2, Najib Ben Khaled3,4
1TUM School of Medicine and Health-Clinical Department of Internal Medicine II, TUM University Hospital, Munich, Germany.
None:
Evidence supporting the safety and efficacy of immune checkpoint inhibitors (ICI) before liver transplantation (LTx) in hepatocellular carcinoma (HCC) is increasing, but risks of graft rejection and tumour recurrence remain major concerns. We evaluated post-transplant outcomes across 10 European centres using data from the multinational LITCHI (Liver transplantation after immune checkpoint inhibition) registry. Clinical and tumour characteristics, ICI regimens and post-transplant immunosuppression were assessed, and overall and rejection-free survival were estimated using the log-rank test. Among 18 patients who underwent LTx following ICI, 15 were treated with atezolizumab plus bevacizumab. One-year survival was 77% (95% CI 67.3-87.8) and four rejection episodes occurred, with one fatal case after a 13-day wash-out and three non-fatal episodes, each responsive to escalation of immunosuppression. Overall, however, no intensified immunosuppression was required in our cohort. Despite tumour burden beyond Milan criteria in most patients before ICI initiation, HCC recurrence occurred in only one patient.
