2021
DOI: 10.3390/cancers13246307
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Liver Transplantation for Hepatocellular Carcinoma after Downstaging or Bridging Therapy with Immune Checkpoint Inhibitors

Abstract: Liver transplantation offers excellent outcomes for patients with HCC. For those who initially present within the Milan criteria, bridging therapy is essential to control disease while awaiting liver transplant. For those who present beyond the Milan criteria, a liver transplant may still be considered following successful downstaging. Since the introduction of atezolizumab as part of the first-line treatment for HCC in 2020, there has been increasing interest in the use of ICIs as bridging or downstaging ther… Show more

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Cited by 21 publications
(18 citation statements)
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“…According to the theory of immune microenvironment, tumor cells do not grow in isolation but interact with other cells such as surrounding endothelial cells and fibroblast immune cells, leading to macrophage infiltration and fibroblast proliferation and angiogenesis, which together determine the progression of the tumor [ 9 ]. Immunotherapy for liver cancer, represented by immune checkpoint inhibitors, is being used in conjunction with traditional HCC treatments to further improve patient prognosis [ 10 ].…”
Section: Introductionmentioning
confidence: 99%
“…According to the theory of immune microenvironment, tumor cells do not grow in isolation but interact with other cells such as surrounding endothelial cells and fibroblast immune cells, leading to macrophage infiltration and fibroblast proliferation and angiogenesis, which together determine the progression of the tumor [ 9 ]. Immunotherapy for liver cancer, represented by immune checkpoint inhibitors, is being used in conjunction with traditional HCC treatments to further improve patient prognosis [ 10 ].…”
Section: Introductionmentioning
confidence: 99%
“…Conversion therapies also present the unique possibility of expanding the population eligible for liver transplantation. Studies on conversion therapies prior to liver transplantation for patients with HCC outside the Milan criteria are still limited and have mixed outcomes (68)(69)(70)(71)(72)(73)(74). Despite the concern that an ICI might increase the possibility of acute rejection and graft loss in the early post-transplantation period, transplantation can be performed safely with a sufficient washout period between ICI administration and transplantation (71).…”
Section: A Combination Of An Ici and An Aad Offers Hope As A Conversi...mentioning
confidence: 99%
“…According to AASLD guidelines, patients beyond Milan criteria should be considered for liver transplant after downstaging therapy to meet the criteria [ 13 ]. Bridging therapies are recommended for patients who spend prolonged periods on the waitlist and to decrease progression of disease [ 14 ]. The AASLD does not favor one bridging strategy over another in patients awaiting transplant who are within Milan criteria [ 13 ].…”
Section: Hepatocellular Carcinoma Therapymentioning
confidence: 99%
“…Among the fourcases that resulted in graft loss, concomitant use of steroids and anti-thymocyte globulin were used in three of the cases. Gao et al proposed plasmapheresis as a potential treatment modality to wash out remaining effects of immunotherapy agents given the reversibility of target-binding [ 14 ]. In three of the four cases, plasma exchange was employed in addition to these medical therapies along with the implementation of IV Immunoglobulin therapy in two cases.…”
Section: Pre-transplant Use Of Immunotherapymentioning
confidence: 99%