Scientometrics
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1267-1278
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1267
Immunotherapy after liver transplantation: Where are we now?
Kin Pan Au, Kenneth Siu Ho Chok
Kin Pan Au, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Chok KSH proposed the study; Au KP and Chok KSH conducted the study and wrote up the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FACS, FRCS (Ed), MBBS, MD, MS, Associate Professor, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: March 16, 2021
Revised: March 25, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: October 27, 2021
Processing time: 253 Days and 19.6 Hours
Abstract
BACKGROUND

There is limited evidence on the safety of immunotherapy use after liver transplantation and its efficacy in treating post-liver transplant hepatocellular carcinoma (HCC) recurrence.

AIM

To assess the safety of immunotherapy after liver transplant and its efficacy in treating post-liver transplant HCC recurrence.

METHODS

A literature review was performed to identify patients with prior liver transplantation and subsequent immunotherapy. We reviewed the rejection rate and risk factors of rejection. In patients treated for HCC, the oncological outcomes were evaluated including objective response rate, progression-free survival (PFS), and overall survival (OS).

RESULTS

We identified 25 patients from 16 publications and 3 patients from our institutional database (total n = 28). The rejection rate was 32% (n = 9). Early mortality occurred in 21% (n = 6) and was mostly related to acute rejection (18%, n = 5). Patients who developed acute rejection were given immunotherapy earlier after transplantation (median 2.9 years vs 5.3 years, P = 0.02) and their graft biopsies might be more frequently programmed death ligand-1-positive (100% vs 33%, P = 0.053). Their PFS (1.0 ± 0.1 mo vs 3.5 ± 1.1 mo, P = 0.02) and OS (1.0 ± 0.1 mo vs 19.2 ± 5.5 mo, P = 0.001) compared inferiorly to patients without rejection. Among the 19 patients treated for HCC, the rejection rate was 32% (n = 6) and the overall objective response rate was 11%. The median PFS and OS were 2.5 ± 1.0 mo and 7.3 ± 2.7 mo after immunotherapy.

CONCLUSION

Rejection risk is the major obstacle to immunotherapy use in liver transplant recipients. Further studies on the potential risk factors of rejection are warranted.

Keywords: Liver transplant; Hepatocellular carcinoma; Recurrence; Immunotherapy; Rejection; Survival

Core Tip: A literature review was performed to identify patients with prior liver transplantation and subsequent immunotherapy. Among the 28 included patients, the rejection rate was 32% (n = 9). Patients who developed acute rejection were given immunotherapy earlier after transplantation (median 2.9 years vs 5.3 years, P = 0.02) and their graft biopsies might be more frequently programmed death ligand-1 positive (100% vs 33%, P = 0.053). Among the 19 patients treated for hepatocellular carcinoma (HCC), the overall objective response rate was 11%. Rejection risk is the major obstacle to immunotherapy for post-liver transplant HCC recurrence.