Immune checkpoint inhibitor-related T-cell-mediated rejection increases the risk of perioperative graft loss after liver transplantation.
10.1097/CM9.0000000000003669
- Author:
Li PANG
1
;
Yutian LIN
1
;
Tao DING
2
;
Yanfang YE
3
;
Kenglong HUANG
1
;
Fapeng ZHANG
1
;
Xinjun LU
1
;
Guangxiang GU
1
;
Haoming LIN
1
;
Leibo XU
1
;
Kun HE
4
;
Kwan MAN
2
;
Chao LIU
1
;
Wenrui WU
1
Author Information
1. Liver Transplantation Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
2. Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China.
3. Clinical Research Design Division, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
4. Department of Hepatobiliary Surgery, Zhongshan City People's Hospital, Zhongshan, Guangdong 528445, China.
- Publication Type:Journal Article
- Keywords:
Allograft rejection;
Graft loss;
Hepatocellular carcinoma;
Immunotherapy;
Liver transplantation
- MeSH:
Humans;
Liver Transplantation/adverse effects*;
Male;
Female;
Middle Aged;
Retrospective Studies;
Graft Rejection/immunology*;
Immune Checkpoint Inhibitors/therapeutic use*;
Adult;
T-Lymphocytes/drug effects*;
Graft Survival/immunology*;
Aged
- From:
Chinese Medical Journal
2025;138(15):1843-1852
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss.
METHODS:This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed.
RESULTS:Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042).
CONCLUSION:IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
