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Anugwom et al. Hepatoma Res 2022;8:7 Hepatoma Research
DOI: 10.20517/2394-5079.2021.123

Perspective Open Access

Understanding immune perspectives and options for

the use of checkpoint immunotherapy in HCC post
liver transplant

2
1,2
Chimaobi M. Anugwom , Thomas M. Leventhal , Jose D. Debes 2,3
1
HealthPartners Digestive Care, Saint Paul, Minnesota, MN 55130, USA.
2
Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition and Division of Infectious Disease and
International Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
3
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Postbus 2040, The Netherlands.
Correspondence to: Dr. Chimaobi M. Anugwom, Department of Medicine, Division of Gastroenterology, Hepatology and
Nutrition and Division of Infectious Disease and International Medicine, University of Minnesota, 420 SE Delaware St., MMC
810, Minneapolis, MN 55455, USA. E-mail: anugw001@umn.edu
How to cite this article: Anugwom CM, Leventhal TM, Debes JD. Understanding immune perspectives and options for the use of
checkpoint immunotherapy in HCC post liver transplant. Hepatoma Res 2022;8:7. https://dx.doi.org/10.20517/2394-
5079.2021.123

Received: 11 Sep 2021 First Decision: 1 Dec 2021 Revised: 18 Dec 2021 Accepted: 20 Jan 2022 Published: 11 Feb 2022

Academic Editor: Antonio Bertoletti Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Treatment modalities for hepatocellular carcinoma (HCC) vary from surgical techniques and interventional
radiologic strategies to systemic therapy. For the latter, the use of immune checkpoint inhibitors (ICIs) has gained
popularity due to successful trials showing increased survival. In patients who have undergone liver
transplantation, recurrence of HCC poses a significant challenge. There is indeed considerable debate on the
efficacy and safety of ICI use in liver transplant recipients due to competing immune interests in maintaining a
healthy graft and combating the tumor. Recent reports and case series have highlighted a role for the type of
immune therapy, timing of therapy, tissue expression of PD-1 and modulation of immunosuppression, in the
understanding of the efficacy and risks of ICIs for HCC in liver transplant. In this article, we appraise the available
literature on the usage of ICIs for HCC in liver transplant recipients and provide perspectives on immune concerns
as well as potential recommendations to consider during the management of such complex cases.
Keywords: Hepatocellular carcinoma, liver transplant, checkpoint inhibitors

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
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