Pretransplant use of immune checkpoint inhibitors for hepatocellular carcinoma: A multicenter, retrospective cohort study

Zhiyong Guo, Yao Liu, Qi Ling, Leibo Xu, Tielong Wang, Jiaxing Zhu, Yimou Lin, Xinjun Lu, Wei Qu, Fan Zhang, Zhijun Zhu, Jian Zhang, Zehua Jia, Ping Zeng, Wenjing Wang, Qiang Sun, Qijie Luo, Zemin Hu, Zhouying Zheng, Yingbin JiaJian Li, Yujian Zheng, Mengchao Wang, Shaoping Wang, Zemin Han, Sheng Yu, Chuanjiang Li, Shuhua Zhang, Jun Xiong, Feiwen Deng, Ying Liu, Huanwei Chen, Yanfeng Wang, Ling Li, Wenjin Liang, Andrea Schlegel, Björn Nashan, Chao Liu, Shusen Zheng, Xiaoshun He

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Immune checkpoint inhibitors (ICIs) as a downstaging or bridging therapy for liver transplantation (LT) in hepatocellular carcinoma patients are rapidly increasing. However, the evidence about the feasibility and safety of pre-LT ICI 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 ICI therapy during the study period. The median post-LT follow-up was 8.1 (interquartile range 3.3-14.6) months. During the short follow-up, 23 (27.7%) recipients developed allograft rejection, and 7 of them (30.4%) were diagnosed by liver biopsy. Multivariate logistics regression analysis showed that the time interval between the last administration of ICI therapy and LT (TLAT) ≥ 30 days was an independent protective factor for allograft rejection (odds ratio = 0.096, 95% confidence interval 0.026-0.357; P <.001). Multivariate Cox analysis showed that allograft rejection was an independent risk factor for overall survival (hazard ratio = 9.960, 95% confidence interval 1.006-98.610; P =.043). We conclude that patients who receive a pre-LT ICI 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 higher post-LT mortality.

Original languageEnglish (US)
Pages (from-to)1837-1856
Number of pages20
JournalAmerican Journal of Transplantation
Volume24
Issue number10
DOIs
StatePublished - Oct 2024

Keywords

  • allograft rejection
  • hepatocellular carcinoma
  • immune checkpoint inhibitors
  • liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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