Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1267
Peer-review started: February 14, 2021
First decision: March 16, 2021
Revised: March 25, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: October 27, 2021
Processing time: 253 Days and 19.6 Hours
Evidence on the safety of immunotherapy in liver transplant recipient is limited. Its efficacy on treating post-liver transplant hepatocellular carcinoma (HCC) recurrence is unknown.
To study the potential role of immunotherapy in the setting of post-liver transplant HCC recurrence.
To assess the safety of immunotherapy after liver transplantation and to assess its efficacy on treating post-liver transplant HCC recurrence.
A review of current literature describing immune checkpoint inhibitor therapy in a patient with prior liver transplantation. Patients from our institution were included for review.
There were 28 patients identified. The rejection rate was 32% (n = 9). Early mortality occurred in 21% (n = 6) and were mostly related to acute rejection (18%, n = 5). Patients with acute rejection were given immunotherapy earlier after transplantation (median 2.9 years vs 5.3 years, P = 0.02). Their progression-free survival (1.0 ± 0.1 vs 3.5 ± 1.1 mo, P = 0.02) and overall survival (1.0 ± 0.1 vs 19.2 ± 5.5 mo, P = 0.001) compared inferiorly to patients without rejection. Among the 19 patients treated for HCC, the rejection rate was 32% (n = 6) and the overall objective response rate was 11%.
Rejection risk is the major obstacle to immunotherapy use in liver transplant recipients.
Further studies on the potential risk factors of rejection are warranted.