Hepatocellular carcinoma (HCC) remains the leading oncological indication for liver transplantation (LT), with evolving and broadened inclusion criteria. Immune checkpoint inhibitors (ICIs) gained a central role in systemic HCC treatment and showed potential in the peri-transplant setting as downstaging/bridging therapy before LT or as a treatment for HCC recurrence following LT. However, the antagonistic mechanisms of action between ICIs and immunosuppressive drugs pose significant challenges, particularly regarding the risk of acute rejection (AR). This review analyzes the main signaling pathways targeted by ICI therapies and summarizes current studies on ICI therapy before and after LT. The literature on this topic is limited and highly heterogeneous, precluding definitive evidence-based conclusions. The use of ICIs before LT appears promising, provided that a sufficient wash-out period is implemented. In contrast, the results of post-LT ICI therapy do not support its wide clinical application due to high AR rates and overall poor response to treatment. In the future, modern graft preservation techniques might support the selection of good ICI responders, but data from high-level studies are urgently needed.
肝细胞癌（HCC）仍是肝移植（LT）最主要的肿瘤适应症，其纳入标准不断演变并趋于宽泛。免疫检查点抑制剂（ICIs）在HCC全身治疗中占据核心地位，并在移植围手术期作为降期/桥接治疗（LT前）或移植后HCC复发的治疗手段显示出潜力。然而，ICIs与免疫抑制药物之间的拮抗作用机制带来了重大挑战，尤其是在急性排斥反应（AR）风险方面。本综述分析了ICI疗法靶向的主要信号通路，并总结了当前关于LT前后ICI治疗的研究。该主题的文献有限且高度异质，尚无法得出明确的循证结论。若实施充分的洗脱期，LT前使用ICIs似乎前景可观。相比之下，由于高AR发生率及总体治疗反应不佳，LT后ICI治疗的结果不支持其广泛的临床应用。未来，现代移植物保存技术可能有助于筛选对ICI治疗反应良好的患者，但亟需高水平研究的数据支持。
Liver Transplantation for Hepatocellular Carcinoma in the Era of Immune Checkpoint Inhibitors
肿瘤(癌症)患者之家