Background:

The success of immunotherapy for patients with hepatocellular carcinoma (HCC) suggests that immune dysregulation occurs in HCC patients. This warrants an immuno-oncological risk assessment in the platform of liver transplantation.

Methods:

This retrospective single-center study analyzed risk factors for—particularly cross-matching performed through conventional complement-dependent cytotoxicity cross-match tests—and the outcomes of HCC recurrence following living donor liver transplant.

Results:

A total of 71 patients were included. The median follow-up period was 29.1 months; 17 (23.9%) patients had posttransplant HCC recurrence, and their 1-, 3-, and 5-year-survival rates were 70.6%, 25.7%, and 17.1%, respectively, which were inferior to those of patients without HCC recurrence (87.0%, 80.7%, and 77.2%, respectively; P < .001). In addition to microvascular invasion, positive cross-match results for B cells at 37°C (B- 37°C) or T cells at 4°C (T- 4°C) were associated with inferior overall survival in multivariable analysis after adjustment for tumor status beyond Milan criteria and elevated alpha-fetoprotein levels. Rejection alone cannot be the mechanism underlying the effects of positive cross-match results on patient outcomes. Adjusted survival curves suggested that positive cross-match B- 37°C or T- 4°C was associated with inferior recurrence-free and patient survival, but the robustness of the finding was limited by insufficient power.

Conclusions:

Additional large-scale studies are required to validate positive cross-match as an immuno-oncological factor associated with HCC recurrence and inferior patient survival.

中文翻译：

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交叉匹配作为肝细胞癌复发和活体肝移植后存活率降低的免疫肿瘤学风险因素：呼吁进一步调查

背景：

肝细胞癌 (HCC) 患者免疫治疗的成功表明 HCC 患者存在免疫失调。这需要在肝移植平台上进行免疫肿瘤学风险评估。

方法：

这项回顾性单中心研究分析了风险因素——特别是通过传统的补体依赖性细胞毒性交叉匹配试验进行的交叉匹配——以及活体肝移植后 HCC 复发的结果。

结果：

共纳入 71 名患者。中位随访时间为 29.1 个月；HCC移植后复发17例（23.9%），1年、3年、5年生存率分别为70.6%、25.7%、17.1%，低于无HCC复发的患者。分别为 87.0%、80.7% 和 77.2%；P < .001)。除了微血管侵袭，在调整后的多变量分析中，37°C (B-37°C) 下 B 细胞或 4°C (T-4°C) 下 T 细胞的阳性交叉匹配结果与较差的总体存活率相关超出米兰标准的肿瘤状态和甲胎蛋白水平升高。单独的拒绝不能成为阳性交叉匹配结果对患者结果影响的潜在机制。调整后的生存曲线表明，阳性交叉匹配 B-37°C 或 T-4°C 与较差的无复发和患者生存率相关，但该发现的稳健性因功效不足而受到限制。

结论：

需要更多的大规模研究来验证阳性交叉匹配是与 HCC 复发和较差的患者生存率相关的免疫肿瘤学因素。