Chapter 8 - Transplant oncology and immunotherapy: Immunotherapy and liver transplants: Immunotherapy and liver transplants

Hepatocellular carcinoma (HCC) constitutes more than 80% of primary liver cancer worldwide with over half a million diagnosed patients per year. In recent years, treatment has also undergone a major development, with liver transplantation (LT) proving to improve HCC patient outcomes. The Milan criteria have played a significant role in identifying HCC patients who are likely to most benefit from LT, however, these criteria only provide eligibility for LT to 30% of those with HCC. Although the rapid evolution of immunotherapy over the recent years has shown to have a crucial role in the development of HCC outcomes, the setting of interventions that are implemented is controversial. The chance of graft rejection while using immune checkpoint inhibitors (ICPI) peri-transplant is the main concern. Additionally, immunotherapy in the palliative setting was previously deemed inappropriate for LT transplant due to the risk of allograft rejection. Recent studies have shown that LT recipients can benefit from ICPI when used appropriately. Given the limited amount of research available in the transplant setting, we aim in this chapter to summarize the current standing of ICPIs, immunosuppressants, and their controversial utilization in the pre-and post-setting of LT based on established literature.