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Purpose <p>Systemic therapies are increasingly being explored as strategies to downstage or bridge patients with unresectable hepatocellular cancer (HCC) to liver transplantation (LT). This systematic review aimed to assess pooled survival and posttransplant outcomes in patients receiving such therapies.</p> Methods <p>We searched PubMed, Embase and Medline through September 2025 to identify interventional and observational studies on adult patients with HCC treated with any systemic regimen before LT. Outcomes included 1- and 3-year overall survival (OS) and proportions of recurrence, mortality and rejection. We assessed risk of bias and quality using established tools and presented pooled cumulative incidence proportions and prevalences in forest plots.</p> Results <p>Fourteen studies were included, encompassing 412 patients, with up to 26 possible overlaps. After LT, the pooled OS was 88% at 1 year (95%CI: 81% to 93%) and 76% at 3 years (95%CI: 65% to 85%). Acute rejection occurred in 21% patients overall (95%CI: 12% to 34%) and mortality in 17% (95%CI: 10% to 26%). HCC recurrence concerned 23% of patients (95%CI: 16% to 32%) at a median time-to-recurrence of 13.5 months (95%CI: 4.7 to 22.4).</p> Conclusion <p>We pooled posttransplant cumulative incidence proportions in HCC patients who received systemic therapy before LT, providing reference estimates to help interpret outcomes across HCC stages.</p>

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Pretransplant Systemic Therapies for Hepatocellular Carcinoma: A Systematic Review of Posttransplant Outcomes

  • 期刊论文

  • 发表日期：

    2026年2月14日

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  • Joana Rodrigues Ribeiro,
  • Célia Procter,
  • Christian Toso

摘要

Purpose

Systemic therapies are increasingly being explored as strategies to downstage or bridge patients with unresectable hepatocellular cancer (HCC) to liver transplantation (LT). This systematic review aimed to assess pooled survival and posttransplant outcomes in patients receiving such therapies.

Methods

We searched PubMed, Embase and Medline through September 2025 to identify interventional and observational studies on adult patients with HCC treated with any systemic regimen before LT. Outcomes included 1- and 3-year overall survival (OS) and proportions of recurrence, mortality and rejection. We assessed risk of bias and quality using established tools and presented pooled cumulative incidence proportions and prevalences in forest plots.

Results

Fourteen studies were included, encompassing 412 patients, with up to 26 possible overlaps. After LT, the pooled OS was 88% at 1 year (95%CI: 81% to 93%) and 76% at 3 years (95%CI: 65% to 85%). Acute rejection occurred in 21% patients overall (95%CI: 12% to 34%) and mortality in 17% (95%CI: 10% to 26%). HCC recurrence concerned 23% of patients (95%CI: 16% to 32%) at a median time-to-recurrence of 13.5 months (95%CI: 4.7 to 22.4).

Conclusion

We pooled posttransplant cumulative incidence proportions in HCC patients who received systemic therapy before LT, providing reference estimates to help interpret outcomes across HCC stages.