Liver transplantation for hepatocellular carcinoma following immunotherapy.

IF 1.8 4区 医学 Q3 TRANSPLANTATION
Rebecca Marino, Ahmed Talaat Hassan, Alexander Fagenson, Parissa Tabrizian
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引用次数: 0

Abstract

Purpose of review: To explore the emerging use of immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC) patients eligible for liver transplantation (LT), particularly as bridging and downstaging therapies. This review also addresses the clinical challenges of integrating ICIs into transplant protocols, including graft rejection, immune-related toxicities, and gaps in evidence.

Recent findings: ICIs have shown potential as bridging and downstaging therapies before LT, with multicentric studies reporting 75.6% successful downstaging, 85% 3-year post-LT survival, and 7.2% rejection-related mortality. A washout interval >94 days and older age have been identified as protective factors against allograft rejection. Combining locoregional therapies with ICIs has proven effective in the EMERALD-1 and LEAP-012 trials, which demonstrated improved progression-free survival (15.0 and 14.6 months, respectively) with ICI-TACE combinations. Similarly, the STAR-FIT phase II trial, combining TACE, SBRT, and avelumab, showed a 42% complete response rate and 12% conversion to curative therapy. Toxicity and rejection risk remain major challenges.

Summary: ICIs represent a promising tool for expanding transplant eligibility in HCC, but their integration into LT pathways remains complex. Safety concerns, particularly regarding timing and immune modulation, require careful evaluation. Prospective studies and biomarker development are needed to guide clinical decision-making. Novel therapies such as CAR-T cells may offer more targeted approaches in the future.

肝细胞癌免疫治疗后的肝移植。
综述的目的:探讨免疫检查点抑制剂(ICIs)在肝细胞癌(HCC)患者中用于肝移植(LT)的新应用,特别是作为桥接和降期治疗。本综述还讨论了将ICIs纳入移植方案的临床挑战,包括移植物排斥反应、免疫相关毒性和证据空白。最近的发现:在肝移植前,ICIs已显示出作为桥接和降低分期治疗的潜力,多中心研究报告75.6%的成功降低分期,85%的肝移植后3年生存率和7.2%的排斥相关死亡率。洗脱间隔为40 ~ 94天及年龄较大被认为是对抗同种异体移植排斥反应的保护因素。在EMERALD-1和LEAP-012试验中,局部局部治疗与ICIs联合已被证明是有效的,这表明ICI-TACE联合可改善无进展生存期(分别为15.0和14.6个月)。同样,STAR-FIT II期试验,联合TACE、SBRT和avelumab,显示出42%的完全缓解率和12%的转化为治愈性治疗。毒性和排斥风险仍然是主要的挑战。摘要:ICIs是扩大肝细胞癌移植资格的一种很有前途的工具,但它们与肝移植途径的整合仍然很复杂。安全问题,特别是时机和免疫调节,需要仔细评估。需要前瞻性研究和生物标志物开发来指导临床决策。CAR-T细胞等新疗法可能在未来提供更有针对性的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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