Immunotherapy and Liver Transplantation for Hepatocellular Carcinoma
Summary
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, and liver transplantation remains the most definitive curative treatment for selected patients. Over the past decade, the emergence of immunotherapy—particularly immune checkpoint inhibitors—has transformed the therapeutic landscape for advanced HCC. These agents can induce deep tumour responses that enable downstaging of disease beyond conventional criteria and may serve as bridging strategies while patients await transplantation. At the same time, peri-transplant immunotherapy raises critical considerations regarding graft tolerance and the risk of acute rejection. Optimal sequencing, timing of last immunotherapy dose and immunosuppressive regimens are under active investigation to balance antitumour efficacy with allograft safety. Research efforts are also exploring biomarkers of response and mechanisms of immune-mediated rejection to refine patient selection and management. Together, these advances underscore a new era in transplant oncology, in which multidisciplinary approaches integrate systemic immunomodulation with surgical intervention to improve long-term outcomes for patients with HCC.
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Immunotherapy and Liver Transplantation for Hepatocellular Carcinoma publication trend
The graph below shows the total number of articles in immunotherapy and liver transplantation for hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).
Technical terms
Hepatocellular carcinoma (HCC): Primary malignant tumour arising from hepatocytes, often in the setting of chronic liver disease.
Immune checkpoint inhibitor (ICI): A monoclonal antibody that blocks regulatory pathways in T cells (eg, PD-1/PD-L1), enhancing anti-tumour immunity.
Neoadjuvant therapy: Treatment administered before the main surgical intervention to reduce tumour burden.
Downstaging: Use of locoregional or systemic therapies to decrease tumour size or number so that patients meet criteria for curative intervention.
Bridging therapy: Interim treatment to control tumour growth during the wait for transplantation.
Acute rejection: Host immune response against the transplanted organ, occurring days to months post-transplant.
References
- Transplant oncology – Current indications and strategies to advance the field. JHEP Reports (2023).
- Case Report: Successful liver transplantation after achieving complete clinical remission of advanced HCC with Atezolizumab plus Bevacizumab combination therapy. Frontiers in Immunology (2023).
- Immunotherapy for Hepatocellular Carcinoma in the Setting of Liver Transplantation: A Review. International Journal of Molecular Sciences (2023).
- Immune Checkpoint Inhibitors as Therapy to Down-Stage Hepatocellular Carcinoma Prior to Liver Transplantation. Cancers (2022).
- Liver Transplantation for Hepatocellular Carcinoma after Downstaging or Bridging Therapy with Immune Checkpoint Inhibitors. Cancers (2021).
- European Society of Organ Transplantation (ESOT) Consensus Report on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma. Transplant International (2023).
- Immunotherapy and Liver Transplantation: A Narrative Review of Basic and Clinical Data. Cancers (2023).
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