Pre-transplant Use of Immune Checkpoint Inhibitors for Hepatocellular Carcinoma: A Multicenter, Retrospective Cohort Study

Immune checkpoint inhibitors (ICIs) as a downstaging or bridging therapy for liver transplantation (LT) in hepatocellular carcinoma (HCC) patients is rapidly increasing. However, the evidence about the feasibility and safety of pre-LT ICIs therapy is limited and controversial. To this end, a multice...

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Published inAmerican journal of transplantation
Main Authors Guo, Zhiyong, Liu, Yao, Ling, Qi, Xu, Leibo, Wang, Tielong, Zhu, Jiaxing, Lin, Yimou, Lu, Xinjun, Qu, Wei, Zhang, Fan, Zhu, Zhijun, Zhang, Jian, Jia, Zehua, Zeng, Ping, Wang, Wenjing, Sun, Qiang, Luo, Qijie, Hu, Zemin, Zheng, Zhouying, Jia, Yingbin, Li, Jian, Zheng, Yujian, Wang, Mengchao, Wang, Shaoping, Han, Zemin, Yu, Sheng, Li, Chuanjiang, Zhang, Shuhua, Xiong, Jun, Deng, Feiwen, Liu, Ying, Chen, Huanwei, Wang, Yanfeng, Li, Ling, Liang, Wenjin, Schlegel, Andrea, Björn, Nashan, Liu, Chao, Zheng, Shusen, He, Xiaoshun
Format Journal Article
LanguageEnglish
Published United States 18.04.2024
Subjects
immune checkpoint inhibitors
allograft rejection
hepatocellular carcinoma
liver transplantation
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Summary:Immune checkpoint inhibitors (ICIs) as a downstaging or bridging therapy for liver transplantation (LT) in hepatocellular carcinoma (HCC) patients is rapidly increasing. However, the evidence about the feasibility and safety of pre-LT ICIs therapy is limited and controversial. To this end, a multicenter, retrospective cohort study was conducted in 11 Chinese centers. The results showed that 83 recipients received pre-LT ICIs therapy during the study period. The median post-LT follow up was 8.1 (interquartile range [IQR] 3.3-14.6) months. During the short follow-up, 23 (27.7%) recipients developed allograft rejection, and 7 of them (30.4%) was diagnosed by liver biopsy. Multivariate logistics regression analysis showed that time interval between the last administration of ICIs therapy and LT (TLAT) ≥ 30 days was an independent protective factor for allograft rejection (OR = 0.096, 95%CI 0.026-0.357; P < 0.001). Multivariate Cox analysis showed that allograft rejection was an independent risk factor for overall survival (OS) (HR = 9.960, 95%CI 1.006-98.610; P = 0.043). We conclude that patients who receive a pre-LT ICIs therapy with a TLAT shorter than 30 days have a much higher risk of allograft rejection than those with a TLAT longer than 30 days. The presence of rejection episodes might be associated with a higher post-LT mortality.
ISSN:1600-6143