Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in HCC: A systematic review and individual patient data meta-analysis.
Rezaee-Zavareh, M. S., et al.Journal of Hepatology 2025; 82(1): 107-119.
Aims
The study aimed to synthesise available evidence on the role of immune checkpoint inhibitor in hepatocellular carcinoma (HCC) patients following liver transplantation.
Interventions
The PubMed, Web of Science and Scopus databases were searched for literature. Titles and abstract were screened by two independent reviewers. The Newcastle–Ottawa Scale was used to assess the quality of the included studies.
Participants
30 studies were included in the review.
Outcomes
The main outcomes of interest were allograft rejection, the result of rejection treatment (full recovery, graft loss, death), overall survival, HCC recurrence rate, and pathology findings on explant.
Follow-up
N/A
CET Conclusions
This is an interesting systematic review that relies on individual patient data from multiple reports. A broad search strategy was used and two authors selected studies independently, although it is unclear if data was extracted in duplicate. 33 Studies, with a total 127 patients were found, after requesting individual patient data, 91 cases from 30 studies were included. In conclusion, the review found that liver transplant outcomes were acceptable when preceded by Immune Checkpoint Inhibitors. The Immune Checkpoint Inhibitor washout period was associated with the risk of allograft rejection and can therefore be moderated to potentially improve outcomes. There are multiple limitations to this study design: Case were from case reports/series or cohort studies with small sample size and without a control group. There is a significant risk of publication bias, such that more positive outcomes are reported.
Trial registration
PROSPERO - CRD42023494951