Managing hepatocellular carcinoma recurrence after liver transplantation: emerging role of immune checkpoint inhibitors

作者：Mohammad Saeid Rezaee Zavareh, Soo Young Hwang, Naomy Kim, Hasmik Adetyan, Nguyen Hoang Khoi Tran, Ju Dong Yang · 发表于：Discover Oncology · 年份：2025 · DOI：10.1007/s12672-025-03226-3 · 被引用次数：11 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Cancer Immunotherapy and Biomarkers、Hepatitis C virus research

Despite adherence to transplantation selection criteria, such as the Milan criteria, hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) occurs in 8-20% of cases. This highlights the need for improved patient selection strategies and better post-LT management to mitigate recurrence risks. This narrative review explores current approaches for managing HCC recurrence post-LT, with a focus on immune checkpoint inhibitors (ICIs). Surgery or locoregional therapies are preferred but are often unsuitable for disseminated disease, leaving systemic therapies-including tyrosine kinase inhibitors (TKIs) such as sorafenib, lenvatinib, and regorafenib-as primary options. Although ICIs have shown promise in advanced HCC and are increasingly used in LT settings, evidence for their post-LT application remains limited to case reports and series. Post-LT care is especially challenging due to the concurrent use of immunosuppressants, requiring a balance between managing acute rejection and administering ICI agents. This dual approach necessitates identifying biomarkers to predict ICI efficacy and allograft rejection. Key strategies may include using anti-CTLA-4 agents with potentially lower rejection rates, delaying ICI initiation post-LT, and optimizing combination immunosuppression regimens centered on tacrolimus. However, ICIs should be reserved for select cases or clinical trials, with multidisciplinary team collaboration being critical. Prospective studies are needed...