Immune-related AEs and liver transplant rejection risk in patients with HCC treated with ICIs

Results from a multicenter, retrospective, Chinese cohort study, evaluating the association between immune-related adverse events (irAEs) and the risk of allograft rejection in patients with hepatocellular carcinoma (HCC) who received immune checkpoint inhibitor (ICI) therapy before liver transplantation (N = 209), were published in Gut by Fang et al. The study also investigated independent risk factors to develop a predictive model of rejection. The primary endpoints were allograft rejection and survival. 

Key data: Allograft rejection occurred in 17.2% of patients and was more frequent with vs without irAEs (58.3% vs 13.3%; p < 0.001). Any-grade irAEs were the strongest independent risk factor for rejection (odds ratio [OR], 9.170; 95% confidence interval [CI], 4.000–21.020; p < 0.001; receiver operating characteristic [ROC] area under the curve [AUC], 0.725), alongside age (<40 vs ≥40 years; OR, 3.028; 95% CI, 1.003–9.139; p = 0.049; ROC AUC, 0.568) and ICI washout (<30 vs ≥30 days; OR, 3.071; 95% CI, 1.211–7.787; p = 0.018; ROC AUC, 0.592). A predictive model incorporating these three independent risk factors achieved a ROC AUC of 0.788, higher than each individual factor (all p < 0.05). One-year survival was lower in the rejection group (hazard ratio [HR], 3.56; 95% CI, 1.01–12.55; p = 0.048).  

Key learning: Identifying irAEs as biomarkers may improve pretransplant risk stratification and enable individualized washout intervals, perioperative immune monitoring, and immunosuppressive strategies to optimize liver transplant outcomes.