免疫检查点抑制剂在肝移植前在肝细胞癌中使用的安全性
L Aceituno1,2, C Magyar1,3,4, P Tabrizian5
1Multi-Organ Transplant, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Alimentary pharmacology & therapeutics
|February 5, 2026
概括
肝细胞癌 (HCC) 肝移植 (LT) 前的免疫检查点抑制剂 (ICI) 与没有ICI相比显示出类似的排斥率. 在LT前的ICI可以安全管理,成功治疗排斥发作,并且对整体存活率没有重大影响.
科学领域:
- 肝胆道手术 肝胆道手术
- 移植免疫学 移植免疫学
- 在瘤学瘤学.
背景情况:
- 免疫检查点抑制剂 (ICI) 越来越多地用于晚期肝细胞癌 (HCC),可能有助于移植候选人.
- 使用ICI作为通往肝移植 (LT) 的桥梁,需要仔细评估其安全性和有效性.
- 这项研究调查了在接受 HCC 的移植前ICI 后接受LT 的患者的安全概况.
研究的目的:
- 评估免疫检查点抑制剂 (ICI) 在肝移植 (LT) 之前给肝细胞癌 (HCC) 患者的安全性.
- 为了比较在LT前接受ICI和未接受ICI的患者之间的排斥率,移植失败,HCC复发和死亡率.
主要方法:
- 一项多中心的回顾性队列研究包括48名在LT前接受ICI治疗的患者 (ICI队列).
- 建立了144名患者的倾向性得分匹配的对照队列,这些患者在没有先前ICI的情况下接受了HCC的LT.
- 结果包括排斥,移植失败,HCC复发和死亡率在两个队列之间进行了比较.
主要成果:
- 排斥发生在ICI队列的18.8%,LT后31天的中位数发作;排斥率与非ICI队列 (19.4%) 类似.
- 较短的洗期与排斥有关 (p=0.029),但所有排斥发作都成功管理.
- 在ICI和非ICI队列之间,在移植失败,HCC复发,总体死亡率或总体存活率方面没有发现显著差异.
结论:
- 在肝细胞癌 (HCC) 肝移植 (LT) 之前接受免疫检查点抑制剂 (ICI) 的患者中,拒绝率相似.
- 在LT前ICI的使用可以安全地管理,拒绝发作是可以治疗的,并且不会显著影响长期的结果.
- 在特定的HCC患者中,ICI可以被认为是降低或桥梁到LT的安全选择.
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