Standardized immunosuppressive protocol to prevent rejection under immunotherapy for post liver transplantation HCC recurrence: A French center's experience

Abstract

In current guidelines, liver transplantation (LT) should be considered in patients with early-stage hepatocellular carcinoma (HCC) because of their lower risk of recurrence and excellent long-term overall survival (OS). To broaden curative opportunities in intermediate and advanced HCC, downstaging strategies are emerging and associated with similar OS compared to patients initially meeting LT criteria. These strategies may however expose these patients to higher HCC recurrence risk. HCC recurrence post LT is essentially metastatic and extrahepatic, and these patients’ prognosis is very poor. The treatments used in this case are tyrosine kinase inhibitors (TKIs) with a low response rate and bad tolerance. If immunotherapy is the new standard of care for advanced and metastatic HCC, scarce data about their administration in liver transplanted recipients in case of HCC recurrence are available. As immunosuppressive (IS) treatment and immunotherapy agents share common targets, utilization of immunotherapy in liver recipients remains complex and exposes patients to acute cellular rejection (ACR). We would like to share in this letter our center experience with eight patients that received immunotherapy post LT as long as a standardized specific IS regimen that aims to lower ACR risk and allow immunotherapy to be effective.