Immune Checkpoint Inhibitors for Recurrent Hepatocellular Carcinoma After Liver Transplantation - Safety Under an Immunosuppression-Preserving Strategy

Sep 23, 2026

Uploaded by Jake

Immune checkpoint inhibitors (ICIs) are standard first-line combinations for many cancers but carry concern for graft rejection in liver transplant recipients, where tumor response and safety remain unclear. This retrospective study evaluated liver transplant recipients with recurrent hepatocellular carcinoma treated with ICIs while maintaining baseline immunosuppressant doses and adding low-dose steroids only when clinically indicated. Among 25 patients, median PFS was 4.93 and 7.20 months by treatment line, with limited immune adverse events and PFS related to early recurrence after transplantation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

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ORIGINAL PAPER e-ISSN 2329-0358 © Ann Transplant, 2026; 31: e952135 DOI: 10. 12659/AOT.952135 Received: 2025.11.18 Accepted: 2026.01.20 Available online: 2026.02.04 Published: 2026.03.24 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABCDEF 1,2 AE 1,2 AE 1,2 AE 3 AE 3,4 AE 1-3,5 AE 1,2 AE 3 AE 1,2 Corresponding Author: Financial support: Conflict of interest: Immune Checkpoint Inhibitors for Recurrent Hepatocellular Carcinoma After Liver Transplantation: Safety Under an Immunosuppression-Preserving Strategy Shih-Chao Hsu Sheng-Hsien Chen Te-Hong Chen Wei-Fan Hsu Hung-Wei Wang Chun-Chieh Yeh Horng-Ren Yang Hsueh-Chou Lai Long-Bin Jeng Long-Bin Jeng, e-mail: [longbin.cmuh@gmail.com](longbin.cmuh@gmail.com) None declared None declared 1 Department of Surgery, China Medical University Hospital, Taichung City, Taiwan 2 Organ Transplant Center, China Medical University Hospital, Taichung City, Taiwan 3 Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan 4 Department of Surgery, Asian University Hospital, Asian University, Taichung City, Taiwan 5 School of Medicine, China Medical University, Taichung City, Taiwan Background: Immune checkpoint inhibitors (ICIs) are widely used as first-line combination therapies for many cancers. However, ICIs are associated with an increased risk of graft rejection in patients requiring liver transplants, and the tumor response rate has yet to be determined. Material/Methods: This retrospective study included liver transplant recipients who received ICIs for recurrent hepatocellular carcinoma. During ICI therapy, baseline immunosuppressant doses were maintained, with low-dose steroid treatments added when clinically indicated. Results: A total of 25 patients were included, with 12 receiving ICIs as first-line therapy, and 13 as second-line therapy. The median progression-free survival (PFS) was 4.93 months (95% CI, 2.33-28.63) and 7.20 months (3.80-32.47), respectively. One patient (4.0%) developed grade 2 hepatitis, and 2 (8%) experienced grade 3 gastrointestinal bleeding. Concurrent steroid use was associated with fewer immune-related adverse events (0% vs 30%, P=0.052) but showed a trend toward shorter PFS (HR=2.30, P=0.071). Two patients (8%) achieved complete remission, and 4 (16%) maintained disease control for more than 1 year. In multivariable analysis, recurrence within 1 year after transplantation was the only significant prognostic factor for PFS (HR=2.98, P=0.043). Conclusions: Our findings suggest that ICIs can be administered after liver transplantation without reducing baseline immunosuppressant doses, potentially minimizing the risk of fatal allograft rejection while still allowing antitumor activity. These results should be interpreted cautiously, and larger studies are needed to define the safe and appropriate use of ICIs in this population. Keywords: Hepatocellular Carcinoma • Immune Checkpoint Inhibitors • Immunosuppressive Agents • Liver Transplantation • Oncology • Retrospective Studies Full-text PDF: [https://www.annalsoftransplantation.com/abstract/index/idArt/952135](https://www.annalsoftransplantation.com/abstract/index/idArt/952135) 2654 4 2 34 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) e952135-1 Indexed in: [Science Citation Index Expanded] [Index Medicus/MEDLINE][Chemical Abstracts]

FAQs

What clinical strategy was used during ICI treatment in this study?

Baseline immunosuppressant doses were maintained, with low-dose steroid treatment added only when clinically indicated.

How effective were ICIs for patients with recurrent hepatocellular carcinoma after liver transplantation?

Median progression-free survival was 4.93 months for first-line and 7.20 months for second-line therapy, with complete remission in 4.0% and disease control in 16% for more than 1 year.

Which factor was the only significant prognostic indicator for progression-free survival?

Recurrence within 1 year after transplantation was the only significant prognostic factor for PFS in multivariable analysis.

Sep 23, 2026

Uploaded by Jake