Determining safe washout period for immune checkpoint inhibitors prior to liver transplantation : An international retrospective cohort study

Article Article scientifique Article Determining safe washout period for immune checkpoint inhibitors prior to liver transplantation : An international retrospective cohort study eng 2025-03-05 author Moeckli Beat 0000-0002-9020-8416 Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 848954 Département de chirurgie (CHIRU) author Wassmer Charles-Henri Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 683357 Département de chirurgie (CHIRU) author El Hajji Sofia 0000-0002-3028-6148 Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 807059 author Sukumaran Rohan Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 778229 author Rodrigues Ribeiro Joana Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 877071 author Tabrizian Parissa Recanati/Miller Institute, Mount Sinai Medical Center, New York, USA. author Feng Hao Department of Liver Surgery, Renji Hospital, Shanghai. author Schnickel Gabriel Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA. author Kulkarni Anand V Department of Hepatology, AIG Hospitals, Hyderabad, India. author Allaire Manon AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France. author Asthana Sonal Department of Hepatobiliary Surgery and Transplantation, Aster Hospitals, Bangalore, India. author Karvellas Constantine J Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. author Meeberg Glenda Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. author Wei Lai Institute of Organ Transplantation, Tongji Hospital, Wuhan, China. author Chouik Yasmina Department of Hepatology, Croix-Rousse Hospital, Lyon, France. author Kumar Pramod Department of Hepatology, BGS Gleneagles Global Hospital, Bengaluru,India. author Gartrell Robyn Department of Pediatrics, Division of Pediatric Oncology, Columbia University Medical Center, New York, USA.,Department of Oncology, Division of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, USA. author Martinez Mercedes Department of Pediatrics, Division of Pediatric Oncology, Columbia University Medical Center, New York, USA. author Kang Elise Department of Pediatrics, Division of Pediatric Oncology, Columbia University Medical Center, New York, USA. author Sogbe Miguel Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain. author Sangro Bruno Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain. author Schwacha-Eipper Birgit University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland. author Schmiderer Andreas Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria. author Krendl Felix J Department of Visceral, Transplant and Thoracic Surgery, Center for Operative Medicine, Medical University of Innsbruck. author Goossens Nicolas Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 509893 Département de médecine (DEMED) author Lacotte Stéphanie 0000-0002-5921-6389 Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 714209 Département de chirurgie (CHIRU) author Compagnon Philippe Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 894594 Département de chirurgie (CHIRU) author Toso Christian 0000-0003-1652-4522 Department of surgery, Faculty of Medicine, University of Geneva, Switzerland. 92271 Département de chirurgie (CHIRU) 10.1097/HEP.0000000000001289 40042053 0270-9139 https://journals.lww.com/hep/abstract/9900/determining_safe_washout_period_for_immune.1187.aspx Background aims: Immune checkpoint inhibitors (ICI) are increasingly used in patients with advanced hepatocellular carcinoma (HCC) patients awaiting liver transplantation (LT). However, concerns about the risk of post-transplant rejection persist. Methods: We conducted an international retrospective cohort study including 119 HCC patients who received ICIs prior to LT. We analyzed the incidence of allograft rejection, graft loss, and post-transplant recurrence with particular focus on the washout period between the last ICI dose and LT. Results: In this study, 24 of the 119 (20.2%) patients experienced allograft rejection with a median time to rejection of 9 days (IQR 6-10) post-LT. A linear relationship was observed between shorter washout periods and higher rejection risk. Washout periods less than 30 days (OR 21.3, 95% CI: 5.93-103, p<0.001) and between 30 and 50 days (OR 9.48, CI 2.47-46.8, p=0.002) were significantly associated with higher rejection rates in the univariate analysis compared to the washout period above 50 days. Graft loss as a result of rejection occurred in 6 patients (25%) with rejection. No factors related to grafts were associated with rejection. A longer washout period was not associated with a lower recurrence-free survival post-transplantation at 36 months (71 vs. 67%, p=0.71). Conclusions: Our findings suggest that a washout period longer than 50 days for ICIs before liver transplantation appears to be safe with respect to rejection risk. While these results may help guide clinical decision-making, future prospective studies are essential to establish definitive guidelines. Dewey 617 Swiss National Science Foundation Impact of the gut-liver axis on de novo and recurrent hepatocellular carcinoma in the presence non-alcoholic fatty liver disease 182471 CH Projects 57 Département de chirurgie 222 false 562 Transplantation et hépatologie 905 Hepatology 485ad5b8-885c-421d-bb01-162cc16756f7 Article (Accepted version) Public determining_safe_washout_period_for.pdf 1016421 application/pdf CC BY-NC-ND-4.0 a6d0b9e59806b7dbcf552156d6cf238a2feb0d36a80e82eacd45b50605d2d341 Vignette Public 20250220_GraphicalAbstract.jpg 185314 image/png openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Sukumaran, Rohan