Open AccessUnderstanding immune perspectives and options for the use of checkpoint immunotherapy in HCC post liver transplant
Author(s) -
Chimaobi M. Anugwom,
Thomas M. Leventhal,
José D. Debes
Publication year - 2022
Publication title -
hepatoma research
Language(s) - English
Resource type - Journals
eISSN - 2454-2520
pISSN - 2394-5079
DOI - 10.20517/2394-5079.2021.123
Subject(s) - medicine , immunosuppression , liver transplantation , immunotherapy , hepatocellular carcinoma , immune system , oncology , intensive care medicine , milan criteria , immunology , transplantation
Treatment modalities for hepatocellular carcinoma (HCC) vary from surgical techniques and interventional radiologic strategies to systemic therapy. For the latter, the use of immune checkpoint inhibitors (ICIs) has gained popularity due to successful trials showing increased survival. In patients who have undergone liver transplantation, recurrence of HCC poses a significant challenge. There is indeed considerable debate on the efficacy and safety of ICI use in liver transplant recipients due to competing immune interests in maintaining a healthy graft and combating the tumor. Recent reports and case series have highlighted a role for the type of immune therapy, timing of therapy, tissue expression of PD-1 and modulation of immunosuppression, in the understanding of the efficacy and risks of ICIs for HCC in liver transplant. In this article, we appraise the available literature on the usage of ICIs for HCC in liver transplant recipients and provide perspectives on immune concerns as well as potential recommendations to consider during the management of such complex cases.