Standardized Management Pathway to Prevent Acute Rejection After Liver Transplantation Following ICI Therapy for Downstaging HCCOA
Background:Immune checkpoint inhibitors(ICIs)have shown promise in downstaging hepatocellular carcinoma(HCC)for liver transplantation(LT),enabling previously ineligible patients to meet transplant criteria.However,their use raises concerns about post-transplant acute rejection(AR)based on data lacking information regarding standardized management pathways and notably perioperative protocols,including immunosuppression protocols and monitoring.Methods:This study evaluated 59 LT recipients divided into three groups(two control groups),including 13 ICI-exposed patients(third group).All groups followed a standardized immunosuppression protocol and monitoring embedded into an enhanced recovery after surgery(ERAS)protocol,featuring basiliximab and steroid induction,early mammalian target of rapamycin inhibitor(mTOR)use,and reduced tacrolimus dosing.Results:Despite varied ICI washout intervals(median 36 days),no AR episodes were observed in any group.One-year overall survival and recurrence-free survival were 93%/85%and 100%/85%in standard patients,and 77%/69%in ICI-exposed patients,respectively.The most frequent complications were biliary and infectious,with no significant intergroup differences.Conclusions:These findings suggest that in a standardized clinical pathway with structured immunosuppressive protocols,therapeutic drug monitoring,and early complication surveillance,LT can be safely performed after ICI exposure without increasing rejection risk.The study underscores the need for standardized clinical pathways and consistent reporting of immunosuppressive regimens to optimize outcomes in this emerging patient population.
Ning Wang;Zebin Zhu;Hao Zheng;Can Qi;Xiaodong Yuan;Xuefeng Li;Zhijun Xu;Jiwei Qin;Wei Wu;Jizhou Wang;Ruipeng Song;Zhiyong Guo;Lianxin Liu;Shu-Geng Zhang;Björn Nashan
The Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaOrgan Transplant Centre,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology,Guangzhou,China Guangdong Provincial International Cooperation Base of Science and Technology(Organ Transplantation),Guangzhou,China NHC Key Laboratory of Assisted Circulation(Sun Yat-sen University),Guangzhou,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,ChinaThe Transplantation Center,First Affiliated Hospital,School of Life Sciences and Medical Center,University of Sciences&Technology of China,Hefei,China Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology,Guangzhou,China Research Centre of Big Data and Artificial Intelligence of Medicine,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China
医药卫生
acute rejection丨enhancedrecovery after livertransplantation丨hepatocellularcarcinoma丨immune checkpoint inhibitortherapy l immunosuppression protocol lperioperative protocol l quality management丨standardized management pathway
《Health Care Science》 2026 (3)
P.196-206,11
Anhui Provincial Department of Education,Grant/Award Number:2022AH020077。
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