Liver transplantation for hepatocellular carcinoma following checkpoint inhibitor therapy with nivolumab.
Liver transplantation for hepatocellular carcinoma following checkpoint inhibitor therapy with nivolumab.
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DOI：
10.1111/ajt.16965
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发表时间：
2022-06
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有限的病例系列描述了关于肝移植（LT）前检查点抑制剂（CPI）安全性的相互矛盾的结果。我们回顾了2018年1月1日至2021年1月30日期间接受CPI治疗肝细胞癌LT的所有连续患者的单中心数据。评估从CPI到LT的时间、免疫抑制、活检证实的急性细胞排斥反应（BPACR）、移植物丢失和死亡。5例平均年龄65岁（范围61-71）的患者在CPI后接受了纳武利尤单抗LT。从上次CPI到LT的时间范围为0.3至11个月。2例患者从CPI末次给药到LT <3个月发生BPACR和严重肝坏死，其中1例患者需要再次移植，BPACR复发，但随访38个月未发生移植物丢失。接受LT的患者中没有一个在CPI末次给药后>3个月发生BPACR。总之，移植前使用CPI，特别是在LT后90天内，与BPACR和免疫介导的肝坏死相关。未来的多中心研究应考虑从最后一剂CPI到LT的足够间隔，以减轻不良免疫介导结局和移植物丢失的风险。
Limited case series describe conflicting results regarding the safety of checkpoint inhibitors (CPI) prior to liver transplantation (LT). We reviewed single-center data on all consecutive patients who underwent LT for hepatocellular carcinoma treated with CPI between January 1, 2018, and January 30, 2021. Time from CPI to LT, immunosuppression, biopsy-proven acute cellular rejection (BPACR), graft loss and death were evaluated. Five patients with a mean age 65 (range 61–71) years underwent LT after CPI with nivolumab. Time from last CPI to LT ranged from 0.3 to 11 months. Two patients with <3 months from the last dose of CPI to LT developed BPACR and severe hepatic necrosis, one of whom required retransplantation with recurrent BPACR but without recurrent graft loss over 38 months of follow up. None of the patients who underwent LT >3 months from the last dose of CPI had BPACR. In conclusion, pretransplant use of CPIs, particularly within 90 days of LT, was associated with BPACR and immune-mediated hepatic necrosis. Future multicenter studies should consider a sufficient interval from the last dose of CPI to LT to mitigate the risk for adverse immune-mediated outcomes and graft loss.
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影响因子：
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作者：
Dong Y;Sun Q;Zhang X
通讯作者：
Zhang X
影响因子：
158.5
作者：
Finn, Richard S.;Qin, Shukui;Cheng, Ann-Lii
通讯作者：
Cheng, Ann-Lii
DOI：
10.1111/ajt.15617
发表时间：
2020-03
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
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DOI：
10.1002/hep.27752
发表时间：
2015-06
期刊：
Hepatology (Baltimore, Md.)
影响因子：
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作者：
Yao FY;Mehta N;Flemming J;Dodge J;Hameed B;Fix O;Hirose R;Fidelman N;Kerlan RK Jr;Roberts JP
通讯作者：
Roberts JP