Introduction: The tyrosine kinase inhibitors (TKIs) sorafenib and lenvatinib represent the first-line systemic therapy of choice for patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). Under sorafenib and lenvatinib, HCC patients have shown increasingly improved overall survival in clinical studies over the years. In contrast, data on overall survival for patients with HCC recurrence after LT under TKIs are scarce and limited to small retrospective series. In this retrospective, multicenter study, we investigated the efficacy of TKI therapy and the influence of immunosuppression in patients with HCC recurrence after LT. Methods: Retrospective data were collected from four transplant centers from Germany and Austria. We included patients with HCC recurrence after LT between 2007 and 2020 who were treated with a TKI. Results: In total, we analyzed data from 46 patients with HCC recurrence after LT. The most common underlying liver disease was hepatitis C, accounting for 52.2%. The median time to relapse was 11.8 months (range 0–117.7 months). The liver graft was affected in 21 patients (45.7%), and 36 patients (78.3%) had extrahepatic metastases at initial diagnosis of recurrence, with the lung being the most commonly affected (n= 25, 54.3%). Of the total, 54.3% (n= 25) of the patients were initially treated locally; 39 (85.8%) and 7 (15.2%) patients received sorafenib and lenvatinib, respectively, as first-line systemic therapy. Median overall survival of the whole cohort was 10.9 months (95% confidence interval (95% CI) 6.9–14.9 months) and median progression free survival was 5.7 months (95% CI 2.0–9.4 months) from treatment initiation. Conclusion: Since history of liver transplantation is considered a contraindication for immunotherapy, prognosis of patients with HCC recurrence after LT remains poor.
引言：酪氨酸激酶抑制剂（TKI）索拉非尼和仑伐替尼是肝移植（LT）后肝细胞癌（HCC）复发患者的一线全身治疗选择。在索拉非尼和仑伐替尼治疗下，多年来临床研究中HCC患者的总生存期持续改善。相比之下，关于肝移植后HCC复发患者在TKI治疗下总生存期的数据较为匮乏，仅限于小规模回顾性研究。本项回顾性多中心研究旨在探讨TKI治疗对肝移植后HCC复发患者的疗效及免疫抑制治疗的影响。方法：回顾性收集德国和奥地利四个移植中心的数据，纳入2007年至2020年间肝移植后HCC复发并接受TKI治疗的患者。结果：共分析46例肝移植后HCC复发患者数据。最常见的基础肝病为丙型肝炎（占52.2%）。中位复发时间为11.8个月（范围0-117.7个月）。移植肝受累者21例（45.7%），36例（78.3%）在复发初诊时存在肝外转移，其中肺部转移最常见（25例，占54.3%）。总体患者中54.3%（25例）曾接受局部治疗；39例（85.8%）和7例（15.2%）分别以索拉非尼和仑伐替尼作为一线全身治疗方案。全队列中位总生存期为10.9个月（95%置信区间6.9-14.9个月），自治疗开始的中位无进展生存期为5.7个月（95%置信区间2.0-9.4个月）。结论：由于肝移植病史被视为免疫治疗的禁忌证，肝移植后HCC复发患者的预后仍然较差。
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