Immunotherapy and immunosuppression in liver transplantation

Medical research and expert discussions have focused on the role of immune checkpoint inhibitor (ICI)-based therapy for patients with hepatocellular carcinoma (HCC) awaiting liver transplants. A multicentre study in China involving 416 recipients indicated that using ICI-based multimodal treatment before transplantation may improve overall survival and recurrence-free survival for patients who initially exceeded the Milan criteria.

However, the study also noted a higher incidence of acute transplant rejection associated with these benefits. During The Liver Meeting 2026, experts discussed the necessity of balancing oncological success with rejection risks, suggesting a potential washout period of approximately two months before surgery.

Additionally, clinicians are addressing the long-term challenges of immunosuppression as 20-year survival rates for transplant recipients exceed 50 percent. Concerns include metabolic complications, infection, and cancer risks. Experts suggest that while complete withdrawal of immunosuppression should be limited to controlled trials, reducing dosage levels after the first post-transplant year may benefit most patients.