Liver transplantation (LT) is a curative treatment for hepatocellular carcinoma (HCC). However, lifelong immunosuppressive therapy required to prevent graft rejection inevitably compromises antitumor immunity, thereby increasing the risk of HCC recurrence and metastasis, particularly common in the lungs. This review delves into the complex dynamic equilibrium between immune cell subsets mediating rejection and antitumor immunity, systematically analyzes the impact of current immunosuppressive regimens on this balance, and highlights emerging strategies aimed at minimizing rejection while preserving or enhancing antitumor efficacy. These strategies include immunosuppressive regimen optimization, such as mTOR inhibitor application and calcineurin inhibitor (CNI) minimization, novel immunotherapies, including immune checkpoint inhibitors (ICIs) and adoptive cell therapy (ACT), and immune tolerance induction. This review also summarizes advances in biomarker research guiding immunosuppressant withdrawal, aiming to provide a theoretical basis and clinical insights for personalized immunotherapy strategies and comprehensive tumor management in LT recipients with HCC.
肝移植是肝细胞癌的根治性治疗手段。然而，为预防移植物排斥而需终身使用的免疫抑制治疗，不可避免地会削弱抗肿瘤免疫，从而增加肝癌复发和转移的风险，其中肺转移尤为常见。本文深入探讨了介导排斥反应与抗肿瘤免疫的免疫细胞亚群间复杂的动态平衡，系统分析了当前免疫抑制方案对这一平衡的影响，并重点阐述了旨在最小化排斥反应同时保留或增强抗肿瘤效力的新兴策略。这些策略包括免疫抑制方案优化（如mTOR抑制剂的应用和钙调神经磷酸酶抑制剂的最小化）、新型免疫疗法（包括免疫检查点抑制剂和过继性细胞疗法）以及免疫耐受诱导。本文还总结了指导停用免疫抑制剂的生物标志物研究进展，旨在为肝细胞癌肝移植受者的个体化免疫治疗策略及综合肿瘤管理提供理论依据和临床启示。
肿瘤(癌症)患者之家