Background: Immune checkpoint modulators, such as the programmed death protein-1
(PD-1)/programmed death ligand-1 (PD-L1) inhibitor, cytotoxic T-Lymphocyte-associated antigen 4
(CTLA-4) inhibitor have been investigated with encouraging results for hepatocellular carcinoma
(HCC). However, the safety of this strategy in patients with previous liver transplantation (LT) is not
Objective: To explore the safety and feasibility of immune checkpoints inhibitors in recurrent and
metastatic HCC patients on a background of LT.
Methods: A case of recurrent, refractory, metastatic HCC after LT, where PD-1 inhibitor was initiated,
was described and related literature was reviewed.
Results: There was complete remission in lung metastases and the partial radiological response of
metastatic retroperitoneal lymph node to the drug with no liver graft rejection after 13 cycles of PD-
1 inhibitor injection. PD-1inhibitor, at least in this patient, was verified to play an important role in
controlling tumor progression and prolonging patient survival.
Conclusion: This novel drug might be a useful method to allow doctors to guarantee a better chance
for long-term survival in recurrent, metastatic HCC patients with the previous LT. However, it
should be used with caution in allograft recipients due to the risk of acute graft rejection, further
larger, prospective studies are needed to determine optimal immunomodulatory therapy to achieve
optimal anti-tumor efficacy with transplant liver preservation.