24 March 2026 : Original article
Immune Checkpoint Inhibitors for Recurrent Hepatocellular Carcinoma After Liver Transplantation: Safety Under an Immunosuppression-Preserving Strategy
Shih-Chao Hsu ABCDEF 1,2*, Sheng-Hsien Chen AE 1,2, Te-Hong Chen AE 1,2, Wei-Fan Hsu AE 3, Hung-Wei Wang AE 3,4, Chun-Chieh Yeh AE 1,2,3,5, Horng-Ren Yang AE 1,2, Hsueh-Chou Lai AE 3, Long-Bin Jeng AE 1,2DOI: 10.12659/AOT.952135
Ann Transplant 2026; 31:e952135
Table 2 Clinical characteristics, immunosuppressant use, and treatment details at the initiation of systemic therapy in patients with recurrent hepatocellular carcinoma after liver transplantation. Data are shown as n (%) or median [IQR].
| All ICIs group (n=25) | First-line group (n=12) | Second-line group (n=13) | |
|---|---|---|---|
| mALBI grade, n (%) | |||
| 1 | 19 (76.0%) | 9 (75.0%) | 10 (76.9%) |
| 2a | 6 (24.0%) | 3 (25.0%) | 3 (23.1%) |
| 2b | 0 | 0 | 0 |
| Immunosuppressant, n (%) | |||
| Tacrolimus | 24 (96.0%) | 11 (91.7%) | 13 (100%) |
| MMF | 6 (24.0%) | 2 (18.2%) | 4 (30.8%) |
| Everolimus | 18 (72.2%) | 11 (91.7%) | 7 (53.8%) |
| Steroid | 15 (60.0%) | 7 (58.3%) | 8 (61.5%) |
| No. of immunosuppressant classifications, n (%) | |||
| ≤1 | 4 (16.0%) | 1 (8.3%) | 3 (23.1%) |
| 2 | 8 (32.0%) | 5 (41.7%) | 3 (23.1%) |
| ≥3 | 13 (52.0%) | 6 (50.0%) | 7 (53.8%) |
| AFP level, ng/ml (Median [IQR]) | 17.7 [3.81–432.0] | 17.4 [5.18–280.71] | 28.9 [2.94–432.0] |
| LT to recurrence time, months (median [95% CI]) | 7.9 [2.97–14.9] | 5.5 [3.68–16.48] | 9.5 [2.97–14.90] |
| PFS, months (median [95% CI]) | 5.6 [4.37–9.37] | 4.9 [3.10–8.35] | 7.2 [4.70–26.90] |
| OS, months (median [95% CI]) | 8.5 [4.77–18.80] | 6.4 [4.23–16.10] | 13.7 [4.70–26.90] |
| LT – liver transplantation; ICIs – immune checkpoint inhibitors; mALBI – modified albumin-bilirubin; OS – overall survival; PFS – progression-free survival; AFP – alpha-fetoprotein; MMF – mycophenolate mofetil. | |||