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 in | American journal of transplantation |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
18.04.2024
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Abstract | 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. |
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AbstractList | 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. |
Author | Guo, Zhiyong Liu, Chao Björn, Nashan Zhang, Jian Chen, Huanwei Wang, Shaoping Xiong, Jun Zhu, Jiaxing Liang, Wenjin Wang, Yanfeng Zheng, Shusen Jia, Zehua Zhang, Shuhua Zhu, Zhijun Li, Jian Hu, Zemin Li, Ling Zheng, Yujian Wang, Wenjing Sun, Qiang Zhang, Fan Liu, Yao Jia, Yingbin Wang, Mengchao Liu, Ying He, Xiaoshun Schlegel, Andrea Li, Chuanjiang Deng, Feiwen Lu, Xinjun Han, Zemin Xu, Leibo Qu, Wei Zeng, Ping Yu, Sheng Lin, Yimou Zheng, Zhouying Ling, Qi Wang, Tielong Luo, Qijie |
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Qi organization: Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 311121, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 311121, China – sequence: 4 givenname: Leibo surname: Xu fullname: Xu, Leibo organization: Department of Pancreato-Biliary Surgery and Liver Transplantation Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China – sequence: 5 givenname: Tielong surname: Wang fullname: Wang, Tielong organization: Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China – sequence: 6 givenname: Jiaxing surname: Zhu fullname: Zhu, Jiaxing organization: Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510120, China – sequence: 7 givenname: Yimou surname: Lin fullname: Lin, Yimou organization: Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 311121, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 311121, China – sequence: 8 givenname: Xinjun surname: Lu fullname: Lu, Xinjun organization: Department of Pancreato-Biliary Surgery and Liver Transplantation Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China – sequence: 9 givenname: Wei surname: Qu fullname: Qu, Wei organization: Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing100000, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing100000, China – sequence: 10 givenname: Fan surname: Zhang fullname: Zhang, Fan organization: Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing100000, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing100000, China – sequence: 11 givenname: Zhijun surname: Zhu fullname: Zhu, Zhijun organization: Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing100000, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing100000, China – sequence: 12 givenname: Jian surname: Zhang fullname: Zhang, Jian organization: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510080, China – sequence: 13 givenname: Zehua surname: Jia fullname: Jia, Zehua organization: Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, 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Department of Hepatobiliary Surgery & Liver Transplantation Center, General Hospital of Southern Theater Command, Guangzhou 510010, China – sequence: 23 givenname: Mengchao surname: Wang fullname: Wang, Mengchao organization: Department of Hepatobiliary Surgery & Liver Transplantation Center, General Hospital of Southern Theater Command, Guangzhou 510010, China – sequence: 24 givenname: Shaoping surname: Wang fullname: Wang, Shaoping organization: Department of Hepatobiliary Surgery & Liver Transplantation Center, General Hospital of Southern Theater Command, Guangzhou 510010, China – sequence: 25 givenname: Zemin surname: Han fullname: Han, Zemin organization: Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China – sequence: 26 givenname: Sheng surname: Yu fullname: Yu, Sheng organization: Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern 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Keywords | immune checkpoint inhibitors allograft rejection hepatocellular carcinoma liver transplantation |
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Snippet | Immune checkpoint inhibitors (ICIs) as a downstaging or bridging therapy for liver transplantation (LT) in hepatocellular carcinoma (HCC) patients is rapidly... |
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Title | Pre-transplant Use of Immune Checkpoint Inhibitors for Hepatocellular Carcinoma: A Multicenter, Retrospective Cohort Study |
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