Liver Transplantation After Immune Checkpoint Inhibition in Hepatocellular Carcinoma-Data From the Multinational LITCHI Registry.

For patients with advanced liver cancer, getting a new liver can be a lifesaver. To shrink tumors before surgery, doctors increasingly use a type of treatment called immune checkpoint inhibitors. These are immunotherapy drugs that help the body's own immune system recognize and attack the cancer. However, doctors have long worried that firing up the immune system before a transplant might cause the patient's body to reject the new, donated organ, or that the cancer might quickly return. To understand these risks, researchers evaluated data from a European registry called LITCHI.

The team tracked eighteen liver cancer patients across ten medical centers who received a liver transplant after immunotherapy. Most of these patients had been treated with a specific drug combination of atezolizumab and bevacizumab. The initial results were highly encouraging. One year after their transplants, 77 percent of the patients were still alive. Furthermore, the cancer returned in only one patient, even though most of the group initially had tumors that were larger or more numerous than what is typically allowed for a standard transplant.

While the overall success rate was positive, the study did highlight real risks regarding organ rejection. Four patients experienced rejection episodes. Three of these cases were successfully managed by increasing the patients' standard anti-rejection medications. Unfortunately, one case was fatal, occurring after a thirteen-day break from the immunotherapy drugs. Because this study only looked at eighteen people, the researchers caution that these are early findings. Larger studies are needed to confirm the safety of this approach and to validate exactly how to manage medications to keep patients safe.