Immunotherapy before liver transplant in unresectable hepatocellular carcinoma: a case report

Background: Hepatocellular carcinoma (HCC) is a leading cause of global cancer mortality, with liver transplantation as the sole curative treatment. For advanced disease, first-line systemic therapies including immune checkpoint inhibitors ( ICIs) have shown a survival benefit, but there is scarce data on clinical outcomes when used prior to transplantation. Case Description: We present three case studies of patients who received immunotherapy with atezolizumab/bevacizumab or ipilimumab/nivolumab before liver transplant. We reviewed clinical outcomes including disease response, adverse events related to systemic therapy, as well as graft function postoperatively. One case demonstrated a 45% reduction in total HCC tumour burden whereas another showed stable disease with ICIs. No adverse clinical outcomes such as graft rejection or poor wound healing were noted post-transplant. Indeed, all three patients were successfully transplanted with excellent graft function at the last follow-up. Conclusions: Our observations and data suggest ICIs are a viable option for treatment in the pretransplant setting. It does not routinely lead to fatal graft rejection and may lengthen eligibility times until a donor organ is available.