Bredin Philip, Galvin Zita, O'Kane Grainne M
St Vincent's University Hospital, Elm Park.
University College Dublin, Ireland.
Curr Opin Organ Transplant. 2025 Feb 1;30(1):3-11. doi: 10.1097/MOT.0000000000001187. Epub 2024 Dec 2.
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape in advanced hepatocellular carcinoma and increasingly are being evaluated in earlier stage disease. Herein we explore the role of ICIs pre-liver transplant for liver cancers.
Given the high response rates with combination approaches including locoregional treatments, more patients with liver confined disease, without vascular invasion, who have received ICIs are now being rendered eligible for potential liver transplant. This opportunity to expand the population who may benefit from liver transplant has also come with challenges recognizing the global shortage of organs. Post-liver transplant immunosuppression potentially competes with the immune-stimulating effects of ICIs and graft rejection has been a concern. ICIs may provide an opportunity to maintain patients on the waiting list but an understanding of who is likely to benefit is needed, to circumvent possible toxicities. In addition, ICIs are now considered standard of care, in combination with chemotherapy, for advanced cholangiocarcinoma, where the role of liver transplant is evolving.
As the eligibility criteria globally for liver transplant in the setting of malignancy continues to expand, the integration of ICIs becomes increasingly important.
免疫检查点抑制剂（ICIs）已经改变了晚期肝细胞癌的治疗格局，并且越来越多地在早期疾病中进行评估。在此，我们探讨ICIs在肝癌肝移植前的作用。
鉴于包括局部区域治疗在内的联合治疗方法具有较高的缓解率，现在越来越多局限于肝脏、无血管侵犯且接受过ICIs治疗的患者有资格接受潜在的肝移植。扩大可能从肝移植中获益人群的这一机会也带来了挑战，因为全球器官短缺。肝移植后的免疫抑制可能与ICIs的免疫刺激作用相互竞争，移植物排斥一直是一个问题。ICIs可能为维持患者在等待名单上提供机会，但需要了解谁可能从中获益，以规避可能的毒性。此外，ICIs现在被认为是晚期胆管癌联合化疗的标准治疗方法，在这种情况下，肝移植的作用正在不断演变。
随着全球恶性肿瘤患者肝移植资格标准的不断扩大，ICIs的整合变得越来越重要。
