Downstaging of advanced hepatocellular carcinoma followed by liver transplantation using immune checkpoint inhibitors: Where do we stand?

Table 1 Studies analysed and their key findings

Ref.	Design	Sample size	ICIs used	Key findings
Tabrizian et al[11]	Case series	9	Nivolumab	Significant PD-L1 expression in donor allograft may indicate a subclinical all-immune response and identify patients at high risk of rejection
Chen et al[12]	Case report	1	Toripalimab	The effect of PD-1 antibody leads to the failure of the graft’s attempt to achieve “immune escape” by expressing PD-L1, which results in fatal acute rejection response
Nordness et al[13]	Case report	1	Nivolumab	Profound caution is needed when using nivolumab in patients with HCC who are either still awaiting or have previously undergone solid organ transplant. It is unclear given their mechanism of action, if a defined waiting period would be helpful before transplant
Kumar et al[14]	Case report	1	Atezolizumab, Bevacizumab	Atezolizumab plus bevacizumab effective as downstaging therapy for liver transplantation in HCC with PVTT
Aby et al[15]	Case report	1	Nivolumab	In carefully selected patients, ICI may serve as a bridge to LT
Chouik et al [16]	Case report	1	Atezolizumab + Bevacizumab	Complete clinical remission achieved; successful LT with no recurrence at 10-month follow-up
Kuo et al[17]	Case series	4	Atezolizumab, Nivolumab, Pembrolizumab	Safe washout period of 42 days recommended for LT following ICI therapy
Schnickel et al[18]	Case Series	5	Nivolumab	Pretransplant use of ICIs, particularly within 90 days of LT, was associated with biopsy-proven acute cellular rejection and immune-mediated hepaticnecrosis

ICI: Immune checkpoint inhibitors; PD-L1: Programmed death ligand 1; HCC: Hepatocellular carcinoma; PVTT: Portal vein tumor thrombosis; LT: Liver transplantation.