中国肝癌肝移植受者免疫检查点抑制剂应用专家共识(2024版)

Chinese expert consensus on the application of immune checkpoint inhibitors in recipients of liver transplantation for hepatocellular carcinoma(2024 edition)

免疫检查点抑制剂(immune checkpoint inhibitor,ICI)为肝癌的治疗掀开了新的篇章,已成为肝癌转化和辅助治疗的主要选择之一。ICI现已较广泛地应用于肝癌肝移植术前的桥接和降期治疗,并在肝移植术后肝癌复发转移的治疗中,也有了一些探索性应用。实体器官移植受者为预防排斥反应的发生,术后均需长期进行免疫抑制治疗。由于担心ICI引发排斥反应的潜在风险及其他相关副作用,ICI在肝癌肝移植受者的应用方面,还存在诸多疑惑与问题,这限制了ICI在肝癌肝移植术前、术后安全有效的使用。目前国内外尚缺乏关于ICI在肝癌肝移植受者应用的指南或共识,因此,由中华医学会器官移植学分会发起,邀请领域内专家提出临床问题,结合已发表的国内外相关指南、共识和研究进展,经过多轮的讨论、商榷以及专家决定,共同制订了本共识。以期为肝脏移植领域的临床工作者提供合理的指导和参考。

As an emerging therapeutic agent of hepatocellular carcinoma(HCC),immune checkpoint inhibitor(ICI)has been widely applied for transformation,adjuvant,bridging and downstaging treatments of HCC prior to liver transplantation(LT).Also it has demonstrated some promising results for recurrence and metastasis of HCC post-LT.For preventing rejections,solid organ transplant recipients must undergo long-term immunosuppressive therapy.However,current concerns about the potential risks of graft rejections and other side effects associated with ICIs have generated great uncertainties and challenges in their pre-and post-LT applications for HCC,limiting their safe and effective usages.In light of a lack of standardized guideline or consensus on dosing of ICIs in LT for HCC,Branch of Organ Transplantation,Chinese Medical Association had convened domestic LT experts to reflect upon various clinical issues.Through multiple rounds of consultations and voting,this consensus was drafted on the basis of the relevant published guidelines,consensuses and researches.The objective was to provide clinical guidance and reference for LT practitioners.