In a significant step forward for liver cancer treatment, researchers have found that a gap of at least 50 days between stopping immunotherapy and undergoing a liver transplant dramatically lowers the risk of graft rejection. This discovery offers new hope to patients battling hepatocellular carcinoma (HCC), the most common form of liver cancer globally.
Led by the University Hospitals of Geneva (HUG) and the University of Geneva (UNIGE), this international study could lead to safer, more effective treatment options for patients suffering from advanced HCC. The findings are being heralded as a major advance in reconciling two life-saving approaches: immunotherapy and liver transplantation.
Hepatocellular carcinoma accounts for 80-90% of primary liver cancer cases worldwide, with nearly 906,000 new cases and over 830,000 deaths reported in 2020 alone. Liver transplantation is considered the gold standard for treating HCC, potentially offering a cure by replacing the diseased organ.
Meanwhile, immunotherapy, especially immune checkpoint inhibitors (ICI), has shown remarkable results in attacking cancer cells, even achieving complete tumor remission in some cases.
However, combining these treatments has posed a dilemma. While ICI activates the immune system to target cancerous cells, it also increases the risk of immune cells attacking transplanted organs. This heightened risk of rapid graft rejection has made the integration of these therapies challenging—until now.
The Geneva-led study, which analyzed data from 119 patients across 29 hospitals globally, provides critical insights into minimizing these risks. The researchers discovered that timing is everything.
An interval of fewer than 30 days between the last immunotherapy dose and the liver transplant increases the rejection risk more than 21-fold. Extending the interval to 30-50 days reduces the risk, but only after 50 days does the rejection rate fall significantly.
Device for early detection of organ rejection
“Our work shows that 50 days is the sweet spot,” said Christian Toso, Head of Abdominal Surgery at the HUG and a professor at UNIGE. “Any shorter, and the risk is too high; any longer, and the cancer may progress.”
The implications of these findings extend beyond academic insight. By identifying the optimal interval, the study provides a foundation for integrating immunotherapy into liver transplantation protocols, offering patients a chance at remission and even a cure.
“This breakthrough aligns two cutting-edge treatments in a way that could save countless lives,” said Beat Moeckli, first author of the study and Senior Resident in Abdominal Surgery at HUG. “We hope this research will soon lead to official guidelines, helping expand access to liver transplants and improving patient outcomes.”
Building on decades of expertise in liver transplant research, HUG is poised to become a global leader in this evolving field. These advancements hope to reduce rejection risks, optimize patient selection criteria, and refine how transplants are performed in complex cancer cases.
This development marks a turning point in the fight against liver cancer, signaling a future where patients can benefit from the combined power of immunotherapy and transplantation.
Journal Reference
Moecli Beat, Wassmer, Charles-Henri, et al. Determining safe washout period for immune checkpoint inhibitors prior to liver transplantation: An international retrospective cohort study. Hepatology. DOI: 10.1097/HEP.0000000000001289