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:
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.
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
Research background

Evidence on the safety of immunotherapy in liver transplant recipient is limited. Its efficacy on treating post-liver transplant hepatocellular carcinoma (HCC) recurrence is unknown.

Research motivation

To study the potential role of immunotherapy in the setting of post-liver transplant HCC recurrence.

Research objectives

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

Research methods

A review of current literature describing immune checkpoint inhibitor therapy in a patient with prior liver transplantation. Patients from our institution were included for review.

Research results

There were 28 patients identified. The rejection rate was 32% (n = 9). Early mortality occurred in 21% (n = 6) and were mostly related to acute rejection (18%, n = 5). Patients with acute rejection were given immunotherapy earlier after transplantation (median 2.9 years vs 5.3 years, P = 0.02). Their progression-free survival (1.0 ± 0.1 vs 3.5 ± 1.1 mo, P = 0.02) and overall survival (1.0 ± 0.1 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%.

Research conclusions

Rejection risk is the major obstacle to immunotherapy use in liver transplant recipients.

Research perspectives

Further studies on the potential risk factors of rejection are warranted.