Abstract:

Objective To evaluate the safety of liver transplantation（LT）in patients with hepatocellular carcinoma（HCC）treated with monoclonal antibodies against programmed death-1（PD-1）. Methods The clinical data and survival of 5 HCC patients who underwent liver transplantation and regular follow-up in the Department of Organ Transplantation of Guizhou Provincial People's Hospital from January 2019 to June 2022 were retrospectively analyzed，and the relevant data of patients reported in the literature focusing on acute rejection and tumor recurrence since 2018were collected. Results All the 5 cases underwent classical orthotopic liver transplantation. The median follow-up time was 12 months. Eight literatures reported 38 patients，of whom 7 patients had biopsy-confirmed acute rejection，with an incidence of 18.42%（7/38）. Two patients died due to graft loss，with a mortality rate of 5.26%（2/38）. Two patients had tumor recurrence，with a recurrence rate of 5.55%（2/38）. Conclusion The use of PD-1 inhibitors as a bridging therapy in HCC patients waiting for liver transplantation can benefit some patients，but there are also a few patients with the risk of acute rejection and even death due to graft loss. 

Key words:

Programmed death-1 , Liver transplantation , Hepatocellular carcinoma , Immune checkpoint inhibitors

摘要：

目的 探讨肝细胞肝癌（hepatocellular carcinoma，HCC）患者使用程序性死亡受体 -1 （programmed death-1，PD-1）单克隆抗体治疗后再行肝移植（liver transplantation，LT）治疗的安全性。方法 回顾性分析 2019 年 1 月至 2022 年 6 月 5 例在贵州省人民医院器官移植科行肝移植治疗并规律随访的患者临床资料与生存情况，并收集 2018 年以来的文献相关资料，重点观察急性排斥反应及肿瘤复发情况。 结果 5 例肝移植术式均为原位经典全肝移植，中位随访时间为 12 个月，无急性排斥反应发生，无肿瘤复发病例。8 篇文献报道了 38 例患者，其中 7 例出现急性排斥反应，发生率为 18.42%（7/38），其中 2 例移植物丧失导致死亡，病死率为 5.26%（2/38）。2 例出现肿瘤复发，复发率为 5.55%（2/38）。 结论 HCC 患者等待肝移植手术期间使用 PD-1 抑制剂作为桥接治疗可使部分患者获益，但也存在少数患者术后发生急性排斥反应甚至移植物丧失导致死亡的风险。 

关键词:

程序性死亡受体 -1 , 肝移植 , 肝细胞肝癌 , 免疫检查点抑制剂