Prognosis after liver transplantation in patients treated with anti- PD-1 immunotherapy for advanced hepatocellular carcinoma: case series

BACKGROUND Programmed death protein-1 (PD-1) inhibitors and liver transplantation (LT) are alternative treatments for hepatocellular carcinoma (HCC) patients. The application of PD-1 inhibitors for HCC therapy increases T cell immune activity, while immunosuppression is required for patients receiving transplantation. More clinical investigation is required to determine methods to balance these treatment effects. In this article, we are the first to describe the clinical characteristics, imaging findings, and outcomes of 5 LT patients who had a history of HCC and received anti-PD-1 therapy. METHODS Data from 5 patients who were diagnosed with HCC and received LT after PD-1 inhibition were analyzed. The doses and courses of PD-1 and preoperative and postoperative characteristics were compared and analyzed. RESULTS The mean interval between PD-1 inhibition and LT was 63.80±18.26 days. One patient experienced recurrence in the liver, vertebrae and lungs after 7 months, and 1 patient experienced recurrence in the lungs after 3 months. All patients displayed normal liver function at the latest follow-up visit. No acute allograft rejections occurred in any patient. CONCLUSIONS PD-1 inhibitors may be safe for the treatment of HCC before LT when the interval between the two treatments is sufficient. Further investigations are needed for to validate these findings.