Gu Yufeng, Xu Shengjun, Wang Zhengxin, Yang Jiayin, Zheng Shusen, Wei Qiang, Liu Zhikun, Xu Xiao
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China.
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Chin J Cancer Res. 2023 Apr 30;35(2):92-107. doi: 10.21147/j.issn.1000-9604.2023.02.02.
Liver transplantation (LT) is a highly curative therapy for patients with hepatocellular carcinoma (HCC). However, due to the shortage of donor livers and rapid progression of HCC, a majority of patients are dropped out from the waitlist. Recently, immunotherapy has shown great promise in the treatment of advanced HCC. However, the use of immunotherapy is limited in LT mainly due to the potentially increasing risk of graft rejection. One of the main challenges for researchers is the protection of donor graft from an immunotherapy-boosted immune response mounted by the host. Besides, the safety, availability, and costs of immunotherapy are other challenges that need to be addressed. Here, we reviewed the literature involving patients who received immunotherapy prior to transplant to avoid waitlist dropouts and following transplantation to prevent the progression of tumor recurrence and metastasis. Statistically, the incidence of rejection was 25.0% pre-transplant and 18.5% post-transplant. Based on the review of these clinical studies, we can conclude that conducting clinical trials on the safety and efficacy of currently available immunotherapy drugs and identifying novel immunotherapy targets through extensive research may be promising for patients who do not meet the selection criteria for LT and who experience post-transplant recurrence. To date, the clinical experience on the use of immunotherapy before or after LT comes from individual case studies. Although some of the reported results are promising, they are not sufficient to support the standardized use of immunotherapy in clinical practice.
肝移植（LT）是肝细胞癌（HCC）患者的一种具有高度治愈性的治疗方法。然而，由于供肝短缺以及HCC的快速进展，大多数患者从等待名单中退出。近年来，免疫疗法在晚期HCC的治疗中显示出巨大的潜力。然而，免疫疗法在肝移植中的应用受到限制，主要是因为移植物排斥反应的风险可能增加。研究人员面临的主要挑战之一是保护供体移植物免受宿主引发的免疫疗法增强的免疫反应的影响。此外，免疫疗法的安全性、可用性和成本是其他需要解决的挑战。在此，我们回顾了涉及在移植前接受免疫疗法以避免从等待名单中退出以及在移植后接受免疫疗法以预防肿瘤复发和转移进展的患者的文献。从统计学上看，移植前排斥反应的发生率为25.0%，移植后为18.5%。基于对这些临床研究的回顾，我们可以得出结论，对目前可用的免疫疗法药物的安全性和有效性进行临床试验，并通过广泛研究确定新的免疫疗法靶点，对于不符合肝移植选择标准且经历移植后复发的患者可能是有前景的。迄今为止，肝移植前后使用免疫疗法的临床经验来自个别病例研究。尽管一些报道的结果很有前景，但它们不足以支持免疫疗法在临床实践中的标准化应用。
