Harnessing the Power of Immunotherapy in Liver Transplantation for HCC

HCC is a leading cause of cancer-related mortality in chronic liver disease patients. Liver transplant is a potential curative treatment for eligible candidates. With the increasing number of approved immunotherapies for treatment of HCC in the past few years, there is an evolving role for its use in both the pre- and post-transplant period.

Although there is an increased risk of allograft rejection with immunotherapy exposure, emerging data suggest more promising safety outcomes and several trials are under way. Due to the lack of guidelines on this matter, most centers have individual protocols based on center expertise and experience.

Future studies should target the safety profile of immunotherapy in transplant patients, the optimal washout period between the last dose and transplant, and a scoring system to predict patients at higher risk of allograft rejection post-transplant in this patient population. Based on these results, immunotherapy may be utilized earlier in the treatment paradigm for HCC, perhaps to downstage patients who previously would not have qualified for liver transplant.