{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:16:51Z","timestamp":1773814611129,"version":"3.50.1"},"reference-count":109,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea (NRF) grant funded by the Korea government","award":["RS-2024-00451810"],"award-info":[{"award-number":["RS-2024-00451810"]}]},{"name":"Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea","award":["RS-2025-25459150"],"award-info":[{"award-number":["RS-2025-25459150"]}]},{"name":"Translational R&D Project through Institute for Bio-Medical Convergence, Incheon St. Mary\u2019s Hospital, The Catholic University of Korea"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced hepatocellular carcinoma (HCC), establishing immunotherapy-based combinations as the standard of care. Improved treatment responses have expanded liver transplant eligibility for selected patients with advanced HCC through downstaging or bridging strategies. Such advances have directly influenced transplant candidacy and post-transplant outcomes. However, accumulating evidence indicates that pretransplant exposure to ICIs may disrupt post-transplant immune homeostasis, increasing the risk of acute allograft rejection and graft failure requiring retransplantation. From an immunological perspective, rejection following pretransplant ICI therapy predominantly manifests as T cell-mediated rejection and is characterized by the sustained activation of effector T cells and impairment of regulatory immune pathways. Blockade of immune checkpoint signaling interferes with mechanisms critical for allograft tolerance, including T cell apoptosis and regulatory T cell induction. Recent studies further underscore the importance of the washout period between ICI discontinuation and LT, with longer washout intervals being associated with lower rejection rates. Importantly, timely recognition and appropriate immunosuppressive management can often resolve acute rejection without adversely affecting long-term graft outcomes. This review integrates current immunological insights with emerging clinical evidence to inform optimal transplant timing and management strategies for liver transplant candidates receiving ICIs.<\/jats:p>","DOI":"10.3390\/ijms27062680","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T10:10:43Z","timestamp":1773655843000},"page":"2680","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Liver Transplantation Following Immune Checkpoint Inhibitor Therapy: What Do We Need to Know from Clinical and Immunological Perspective?"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6587-5081","authenticated-orcid":false,"given":"Hee Sun","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1865-8225","authenticated-orcid":false,"given":"Soon Kyu","family":"Lee","sequence":"additional","affiliation":[{"name":"The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Department of Internal Medicine, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.jhep.2023.03.017","article-title":"Global burden of liver disease: 2023 update","volume":"79","author":"Devarbhavi","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.ejca.2021.11.023","article-title":"Global, regional and national burden of primary liver cancer by subtype","volume":"161","author":"Rumgay","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"671","DOI":"10.3350\/cmh.2025.0043","article-title":"Liver disease trends in the Asia-Pacific region for the next 50 years","volume":"31","author":"Shiina","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3350\/cmh.2023.0125","article-title":"Recent advances in the management of hepatocellular carcinoma","volume":"30","author":"Sankar","year":"2024","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1056\/NEJMoa1915745","article-title":"Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma","volume":"382","author":"Finn","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Abou-Alfa, G.K., Lau, G., Kudo, M., Chan, S.L., Kelley, R.K., Furuse, J., Sukeepaisarnjaroen, W., Kang, Y.K., Van Dao, T., and De Toni, E.N. (2022). Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma. NEJM Evid., 1.","DOI":"10.1056\/EVIDoa2100070"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jhep.2021.11.030","article-title":"Updated efficacy and safety data from IMbrave150: Atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma","volume":"76","author":"Cheng","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kulkarni, A.V., Tevethia, H., Kumar, K., Premkumar, M., Muttaiah, M.D., Hiraoka, A., Hatanaka, T., Tada, T., Kumada, T., and Kakizaki, S. (2023). Effectiveness and safety of atezolizumab-bevacizumab in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis. eClinicalMedicine, 63.","DOI":"10.1016\/j.eclinm.2023.102179"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Shimose, S., Saeki, I., Tomonari, T., Ito, T., Tani, J., Takeuchi, Y., Yoshioka, N., Naito, T., Takeuchi, M., and Kakizaki, S. (2024). Initial clinical experience with durvalumab plus tremelimumab in patients with unresectable hepatocellular carcinoma in real-world practice. Oncol. Lett., 28.","DOI":"10.3892\/ol.2024.14530"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/S0140-6736(25)00403-9","article-title":"Nivolumab plus ipilimumab versus lenvatinib or sorafenib as first-line treatment for unresectable hepatocellular carcinoma (CheckMate 9DW): An open-label, randomised, phase 3 trial","volume":"405","author":"Yau","year":"2025","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update","volume":"76","author":"Reig","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3325","DOI":"10.3748\/wjg.v22.i12.3325","article-title":"Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: A review","volume":"22","author":"Xu","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tabrizian, P., Marino, R., and Chow, P.K.H. (2024). Liver resection and transplantation in the era of checkpoint inhibitors. JHEP Rep., 6, Erratum in JHEP Rep. 2025, 7, 101554.","DOI":"10.1016\/j.jhepr.2025.101554"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jhep.2024.06.042","article-title":"Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in HCC: A systematic review and individual patient data meta-analysis","volume":"82","author":"Yeo","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/MOT.0000000000001228","article-title":"Liver transplantation for hepatocellular carcinoma following immunotherapy","volume":"30","author":"Marino","year":"2025","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jhep.2024.11.005","article-title":"The use of immunotherapy pre-liver transplant","volume":"82","author":"Aceituno","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/j.jhep.2024.01.011","article-title":"Immunotherapy and transplantation for hepatocellular carcinoma","volume":"80","author":"Tabrizian","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","article-title":"Hepatocellular carcinoma","volume":"7","author":"Llovet","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Childs, A., Aidoo-Micah, G., Maini, M.K., and Meyer, T. (2024). Immunotherapy for hepatocellular carcinoma. JHEP Rep., 6.","DOI":"10.1016\/j.jhepr.2024.101130"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1038\/s41568-021-00339-z","article-title":"Antigen presentation in cancer: Insights into tumour immunogenicity and immune evasion","volume":"21","author":"Jhunjhunwala","year":"2021","journal-title":"Nat. Rev. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1038\/s41571-021-00573-2","article-title":"Immunotherapies for hepatocellular carcinoma","volume":"19","author":"Llovet","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Li, Y., and Zhu, B. (2015). T-cell exhaustion in the tumor microenvironment. Cell Death Dis., 6.","DOI":"10.1038\/cddis.2015.162"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Myers, J.A., Schirm, D., Bendzick, L., Hopps, R., Selleck, C., Hinderlie, P., Felices, M., and Miller, J.S. (2022). Balanced engagement of activating and inhibitory receptors mitigates human NK cell exhaustion. JCI Insight, 7.","DOI":"10.1172\/jci.insight.150079"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ness, S., Lin, S., and Gordon, J.R. (2021). Regulatory Dendritic Cells, T Cell Tolerance, and Dendritic Cell Therapy for Immunologic Disease. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.633436"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Catalan, D., Mansilla, M.A., Ferrier, A., Soto, L., Oleinika, K., Aguillon, J.C., and Aravena, O. (2021). Immunosuppressive Mechanisms of Regulatory B Cells. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.611795"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Shigeta, K., Matsui, A., Kikuchi, H., Klein, S., Mamessier, E., Chen, I.X., Aoki, S., Kitahara, S., Inoue, K., and Shigeta, A. (2020). Regorafenib combined with PD1 blockade increases CD8 T-cell infiltration by inducing CXCL10 expression in hepatocellular carcinoma. J. Immunother. Cancer, 8.","DOI":"10.1136\/jitc-2020-001435"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1158\/1078-0432.CCR-21-2517","article-title":"Cabozantinib Enhances Anti-PD1 Activity and Elicits a Neutrophil-Based Immune Response in Hepatocellular Carcinoma","volume":"28","author":"Willoughby","year":"2022","journal-title":"Clin. Cancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1159\/000542572","article-title":"First-Line Lenvatinib plus Pembrolizumab for Hepatocellular Carcinoma: Post hoc Analysis of Japanese Patients from the Phase 3 LEAP-002 Trial","volume":"14","author":"Kudo","year":"2025","journal-title":"Liver Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jhep.2025.10.020","article-title":"BCLC strategy for prognosis prediction and treatment recommendations: The 2025 update","volume":"84","author":"Reig","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"516","DOI":"10.3350\/cmh.2023.0051","article-title":"Systemic therapy in advanced hepatocellular carcinoma","volume":"29","author":"Ahn","year":"2023","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1126\/science.285.5425.221","article-title":"The immunological synapse: A molecular machine controlling T cell activation","volume":"285","author":"Grakoui","year":"1999","journal-title":"Science"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1084\/jem.20112741","article-title":"Programmed cell death 1 forms negative costimulatory microclusters that directly inhibit T cell receptor signaling by recruiting phosphatase SHP2","volume":"209","author":"Yokosuka","year":"2012","journal-title":"J. Exp. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4749","DOI":"10.1073\/pnas.1718217115","article-title":"Role of PD-1 during effector CD8 T cell differentiation","volume":"115","author":"Ahn","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lee, S.K., Lim, J., Jhun, J.Y., Moon, J., Kim, H.S., Choi, J.Y., Choi, H.J., You, Y.K., Han, J.W., and Sung, P.S. (2025). Landscape of T-cell exhaustion heterogeneity and HBV integration in virus-related HCC revealed by whole-exome, transcriptome, and single-cell sequencing. JHEP Rep., 7.","DOI":"10.1016\/j.jhepr.2025.101518"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Lim, T.S., Chew, V., Sieow, J.L., Goh, S., Yeong, J.P., Soon, A.L., and Ricciardi-Castagnoli, P. (2016). PD-1 expression on dendritic cells suppresses CD8(+) T cell function and antitumor immunity. Oncoimmunology, 5.","DOI":"10.1080\/2162402X.2015.1085146"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1146\/annurev-med-012017-043208","article-title":"CD8 T Cell Exhaustion in Chronic Infection and Cancer: Opportunities for Interventions","volume":"69","author":"Hashimoto","year":"2018","journal-title":"Annu. Rev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/intimm\/dxs098","article-title":"PD-1 is a novel regulator of human B-cell activation","volume":"25","author":"Thibult","year":"2013","journal-title":"Int. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6143","DOI":"10.1038\/onc.2017.209","article-title":"Increased expression of programmed cell death protein 1 on NK cells inhibits NK-cell-mediated anti-tumor function and indicates poor prognosis in digestive cancers","volume":"36","author":"Liu","year":"2017","journal-title":"Oncogene"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.1084\/jem.20090847","article-title":"PD-L1 regulates the development, maintenance, and function of induced regulatory T cells","volume":"206","author":"Francisco","year":"2009","journal-title":"J. Exp. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1126\/science.2479986","article-title":"Vascular endothelial growth factor is a secreted angiogenic mitogen","volume":"246","author":"Leung","year":"1989","journal-title":"Science"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/(SICI)1097-0215(19990118)80:2<315::AID-IJC23>3.0.CO;2-L","article-title":"Angiogenesis inhibitors overcome tumor induced endothelial cell anergy","volume":"80","author":"Griffioen","year":"1999","journal-title":"Int. J. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1038\/s41571-021-00496-y","article-title":"Anti-angiogenic agents\u2014Overcoming tumour endothelial cell anergy and improving immunotherapy outcomes","volume":"18","author":"Huinen","year":"2021","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_43","first-page":"1833","article-title":"Vascular endothelial growth factor and dendritic cells in human squamous cell carcinoma of the oral cavity","volume":"26","author":"Kikuchi","year":"2006","journal-title":"Anticancer Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1158\/0008-5472.CAN-12-2325","article-title":"VEGFA-VEGFR pathway blockade inhibits tumor-induced regulatory T-cell proliferation in colorectal cancer","volume":"73","author":"Terme","year":"2013","journal-title":"Cancer Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1038\/nri2506","article-title":"Myeloid-derived suppressor cells as regulators of the immune system","volume":"9","author":"Gabrilovich","year":"2009","journal-title":"Nat. Rev. Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000543245","article-title":"Lenvatinib plus Pembrolizumab Combined with Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma","volume":"14","author":"Kudo","year":"2025","journal-title":"Liver Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/S0092-8674(05)80055-8","article-title":"Costimulation of T lymphocytes: The role of CD28, CTLA-4, and B7\/BB1 in interleukin-2 production and immunotherapy","volume":"71","author":"Schwartz","year":"1992","journal-title":"Cell"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"9543","DOI":"10.1128\/MCB.25.21.9543-9553.2005","article-title":"CTLA-4 and PD-1 receptors inhibit T-cell activation by distinct mechanisms","volume":"25","author":"Parry","year":"2005","journal-title":"Mol. Cell Biol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/nrclinonc.2016.58","article-title":"Safety profiles of anti-CTLA-4 and anti-PD-1 antibodies alone and in combination","volume":"13","author":"Boutros","year":"2016","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1126\/science.1202947","article-title":"Trans-endocytosis of CD80 and CD86: A molecular basis for the cell-extrinsic function of CTLA-4","volume":"332","author":"Qureshi","year":"2011","journal-title":"Science"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1146\/annurev.immunol.14.1.233","article-title":"CD28\/B7 system of T cell costimulation","volume":"14","author":"Lenschow","year":"1996","journal-title":"Annu. Rev. Immunol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/nrc3239","article-title":"The blockade of immune checkpoints in cancer immunotherapy","volume":"12","author":"Pardoll","year":"2012","journal-title":"Nat. Rev. Cancer"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1038\/nrc3237","article-title":"Combining immunotherapy and targeted therapies in cancer treatment","volume":"12","author":"Vanneman","year":"2012","journal-title":"Nat. Rev. Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.annonc.2024.02.005","article-title":"Four-year overall survival update from the phase III HIMALAYA study of tremelimumab plus durvalumab in unresectable hepatocellular carcinoma","volume":"35","author":"Sangro","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1111\/liv.12818","article-title":"Global patterns of hepatocellular carcinoma management from diagnosis to death: The BRIDGE Study","volume":"35","author":"Park","year":"2015","journal-title":"Liver Int."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Rezaee-Zavareh, M.S., and Yang, J.D. (2026). Liver transplantation for hepatocellular carcinoma: From patient selection and downstaging to risk stratification and post-transplant surveillance. Gastroenterol. Rep., 14.","DOI":"10.1093\/gastro\/goag018"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Tabrizian, P., Marino, R., Bhoori, S., Zeitlhoefler, M., Mehta, N., Banz, V., Gruttadauria, S., Iavarone, M., Mazzarelli, C., and Simonotti, N. (2025). Neoadjuvant atezolizumab plus bevacizumab prior liver transplantation for hepatocellular carcinoma. JHEP Rep., 7.","DOI":"10.1016\/j.jhepr.2024.101246"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.jhep.2024.09.003","article-title":"Intention-to-treat outcomes of patients with hepatocellular carcinoma receiving immunotherapy before liver transplant: The multicenter VITALITY study","volume":"82","author":"Tabrizian","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"S285","DOI":"10.3350\/cmh.2024.0323","article-title":"Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation","volume":"31","author":"Sha","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/SLA.0000000000002964","article-title":"Is it Time to Abandon the Milan Criteria?: Results of a Bicoastal US Collaboration to Redefine Hepatocellular Carcinoma Liver Transplantation Selection Policies","volume":"268","author":"Halazun","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.livres.2025.03.001","article-title":"Short-term prognosis of recipients with pretransplant exposure to immune checkpoint inhibitors after liver transplantation for hepatocellular carcinoma: A retrospective cohort study","volume":"9","author":"Pang","year":"2025","journal-title":"Liver Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/LVT.0000000000000603","article-title":"Combining radiomics and imaging biomarkers with clinical variables for the prediction of HCC recurrence after liver transplantation","volume":"31","author":"Schindler","year":"2025","journal-title":"Liver Transplant."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1038\/s41575-020-0334-4","article-title":"Understanding, predicting and achieving liver transplant tolerance: From bench to bedside","volume":"17","author":"Thomson","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1002\/hep.27254","article-title":"Immune tolerance in liver disease","volume":"60","author":"Crispe","year":"2014","journal-title":"Hepatology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3979","DOI":"10.1177\/0300060518785543","article-title":"Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure","volume":"46","author":"Dogan","year":"2018","journal-title":"J. Int. Med. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/liv.15419","article-title":"Immune checkpoint inhibitors in malignancies after liver transplantation: A systematic review and pooled analysis","volume":"43","author":"Kayali","year":"2023","journal-title":"Liver Int."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Toti, L., Manzia, T.M., Sensi, B., Blasi, F., Baiocchi, L., Lenci, I., Angelico, R., and Tisone, G. (2021). Towards tolerance in liver transplantation. Best Pract. Res. Clin. Gastroenterol., 54\u201355.","DOI":"10.1016\/j.bpg.2021.101770"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Que, W., Zhu, P., and Li, X.K. (2020). The Role of Diverse Liver Cells in Liver Transplantation Tolerance. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01203"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1097\/00007890-199709150-00024","article-title":"Secreted donor-MHC class I antigen prolongs liver allograft survival and inhibits recipient anti-donor cytotoxic T lymphocyte responses","volume":"64","author":"Geissler","year":"1997","journal-title":"Transplantation"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Cunningham, E.C., Sharland, A.F., and Bishop, G.A. (2013). Liver transplant tolerance and its application to the clinic: Can we exploit the high dose effect?. Clin. Dev. Immunol., 2013.","DOI":"10.1155\/2013\/419692"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1097\/TP.0000000000005220","article-title":"The Critical Role of Regulatory T Cells in Immune Tolerance and Rejection Following Liver Transplantation: Interactions With the Gut Microbiome","volume":"109","author":"Lee","year":"2025","journal-title":"Transplantation"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Lee, S.K., Park, M.J., Jhun, J.Y., Beak, J.A., Choi, J.W., Rye, J.Y., Jang, J.W., Bae, S.H., Yoon, S.K., and Choi, H.J. (2020). Combination Treatment With Metformin and Tacrolimus Improves Systemic Immune Cellular Homeostasis by Modulating Treg and Th17 Imbalance. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.581728"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"5227","DOI":"10.4049\/jimmunol.1103382","article-title":"IL-27 production and STAT3-dependent upregulation of B7-H1 mediate immune regulatory functions of liver plasmacytoid dendritic cells","volume":"188","author":"Matta","year":"2012","journal-title":"J. Immunol."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Zhang, W., Liu, Z., and Xu, X. (2021). Navigating immune cell immunometabolism after liver transplantation. Crit. Rev. Oncol. Hematol., 160.","DOI":"10.1016\/j.critrevonc.2021.103227"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1002\/hep.27793","article-title":"Liver inflammation abrogates immunological tolerance induced by Kupffer cells","volume":"62","author":"Heymann","year":"2015","journal-title":"Hepatology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.4049\/jimmunol.169.5.2407","article-title":"Immunomodulatory effects of the liver: Deletion of activated CD4+ effector cells and suppression of IFN-gamma-producing cells after intravenous protein immunization","volume":"169","author":"Klugewitz","year":"2002","journal-title":"J. Immunol."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Lee, S.K., Jhun, J., Lee, S.Y., Choi, S., Choi, S.S., Park, M.S., Lee, S.Y., Cho, K.H., Lee, A.R., and Ahn, J. (2022). A decrease in functional microbiomes represented as Faecalibacterium affects immune homeostasis in long-term stable liver transplant patients. Gut Microbes, 14.","DOI":"10.1080\/19490976.2022.2102885"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Abenavoli, L., Scarlata, G.G.M., Paravati, M.R., Boccuto, L., Luzza, F., and Scarpellini, E. (2023). Gut Microbiota and Liver Transplantation: Immune Mechanisms behind the Rejection. Biomedicines, 11.","DOI":"10.3390\/biomedicines11071792"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3350\/cmh.2025.0476","article-title":"Harnessing the Microbiome: Unveiling the Influence of the Gut Microbiota on Hepatobiliary Cancer Therapeutic Strategies","volume":"32","author":"Li","year":"2026","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1034\/j.1600-6143.2003.00153.x","article-title":"IFN-gamma is an absolute requirement for spontaneous acceptance of liver allografts","volume":"3","author":"Mele","year":"2003","journal-title":"Am. J. Transplant."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1111\/j.1600-6143.2008.02300.x","article-title":"New insights into mechanisms of spontaneous liver transplant tolerance: The role of Foxp3-expressing CD25+CD4+ regulatory T cells","volume":"8","author":"Li","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1053\/j.gastro.2010.10.059","article-title":"Immunologic basis of graft rejection and tolerance following transplantation of liver or other solid organs","volume":"140","author":"Strom","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/j.1600-6143.2005.00823.x","article-title":"CTLA4 engagement is required for induction of murine liver transplant spontaneous tolerance","volume":"5","author":"Li","year":"2005","journal-title":"Am. J. Transplant."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Ju, F., Wang, D., Huang, L., Jiang, C., Gao, C., Xiong, C., and Zhai, G. (2023). Progress of PD-1\/PD-L1 signaling in immune response to liver transplantation for hepatocellular carcinoma. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1227756"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1097\/TP.0000000000003598","article-title":"Immunological Determinants of Liver Transplant Outcomes Uncovered by the Rat Model","volume":"105","author":"Wang","year":"2021","journal-title":"Transplantation"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1097\/TP.0000000000004572","article-title":"An Immune Atlas of T Cells in Transplant Rejection: Pathways and Therapeutic Opportunities","volume":"107","author":"Short","year":"2023","journal-title":"Transplantation"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.suc.2023.07.009","article-title":"Immunotherapy and Liver Transplantation: The Future or the Failure?","volume":"104","author":"Tabrizian","year":"2024","journal-title":"Surg. Clin. N. Am."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1001\/jamaoncol.2023.2677","article-title":"Critical Appraisal of Guideline Recommendations on Systemic Therapies for Advanced Hepatocellular Carcinoma: A Review","volume":"10","author":"Cappuyns","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Gao, Q., Anwar, I.J., Abraham, N., and Barbas, A.S. (2021). Liver Transplantation for Hepatocellular Carcinoma after Downstaging or Bridging Therapy with Immune Checkpoint Inhibitors. Cancers, 13.","DOI":"10.3390\/cancers13246307"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"3167","DOI":"10.1200\/JCO.2009.26.7609","article-title":"Phase I study of single-agent anti-programmed death-1 (MDX-1106) in refractory solid tumors: Safety, clinical activity, pharmacodynamics, and immunologic correlates","volume":"28","author":"Brahmer","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1056\/NEJMoa1200690","article-title":"Safety, activity, and immune correlates of anti-PD-1 antibody in cancer","volume":"366","author":"Topalian","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1056\/NEJMoa1200694","article-title":"Safety and activity of anti-PD-L1 antibody in patients with advanced cancer","volume":"366","author":"Brahmer","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2424","DOI":"10.1158\/1078-0432.CCR-13-2648","article-title":"CTLA4 blockade broadens the peripheral T-cell receptor repertoire","volume":"20","author":"Robert","year":"2014","journal-title":"Clin. Cancer Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/ajt.15617","article-title":"Fatal hepatic necrosis after nivolumab as a bridge to liver transplant for HCC: Are checkpoint inhibitors safe for the pretransplant patient?","volume":"20","author":"Nordness","year":"2020","journal-title":"Am. J. Transplant."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1002\/hep.31234","article-title":"Immunotherapy as a Downstaging Therapy for Liver Transplantation","volume":"72","author":"Minciuna","year":"2020","journal-title":"Hepatology"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e398","DOI":"10.1097\/TP.0000000000003855","article-title":"Durvalumab as a Successful Downstaging Therapy for Liver Transplantation in Hepatocellular Carcinoma: The Importance of a Washout Period","volume":"105","author":"Sogbe","year":"2021","journal-title":"Transplantation"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.14309\/ajg.0000000000001391","article-title":"Immunotherapy as a Downstaging Tool for Liver Transplantation in Hepatocellular Carcinoma","volume":"116","author":"Mathur","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1111\/ajt.16448","article-title":"PD-1 inhibitor as bridge therapy to liver transplantation?","volume":"21","author":"Tabrizian","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1016\/j.ajt.2024.04.007","article-title":"Pretransplant use of immune checkpoint inhibitors for hepatocellular carcinoma: A multicenter, retrospective cohort study","volume":"24","author":"Guo","year":"2024","journal-title":"Am. J. Transplant."},{"key":"ref_100","unstructured":"Fang, J., Zhong, S., Wang, T., He, K., Mu, A., Ong, M., Lin, Y., Zhu, Z., Wang, N., and Wu, J. Immune-related adverse events are a potent predictor of post-transplant rejection in HCC: A multicentre retrospective cohort study. Gut, Online ahead of print."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.21037\/jgo.2018.07.05","article-title":"Pilot evaluation of PD-1 inhibition in metastatic cancer patients with a history of liver transplantation: The Mayo Clinic experience","volume":"9","author":"DeLeon","year":"2018","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1002\/lt.25887","article-title":"Graft Programmed Death Ligand 1 Expression as a Marker for Transplant Rejection Following Anti-Programmed Death 1 Immunotherapy for Recurrent Liver Tumors","volume":"27","author":"Shi","year":"2021","journal-title":"Liver Transplant."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jhep.2016.02.034","article-title":"Counter-regulation of rejection activity against human liver grafts by donor PD-L1 and recipient PD-1 interaction","volume":"64","author":"Shi","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Chen, G.H., Wang, G.B., Huang, F., Qin, R., Yu, X.J., Wu, R.L., Hou, L.J., Ye, Z.H., Zhang, X.H., and Zhao, H.C. (2021). Pretransplant use of toripalimab for hepatocellular carcinoma resulting in fatal acute hepatic necrosis in the immediate postoperative period. Transpl. Immunol., 66.","DOI":"10.1016\/j.trim.2021.101386"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.jhep.2023.01.030","article-title":"Liver transplantation immunology: Immunosuppression, rejection, and immunomodulation","volume":"78","author":"Pageaux","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/TP.0000000000002147","article-title":"International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients","volume":"102","author":"Charlton","year":"2018","journal-title":"Transplantation"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/lt.500050418","article-title":"Banff schema for grading liver allograft rejection: Utility in clinical practice","volume":"5","author":"Ormonde","year":"1999","journal-title":"Liver Transplant. Surg."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2024). EASL Clinical Practice Guidelines on liver transplantation. J. Hepatol., 81, 1040\u20131086.","DOI":"10.1016\/j.jhep.2024.07.032"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"3224","DOI":"10.1007\/s10620-010-1149-x","article-title":"Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation","volume":"55","author":"Schmitt","year":"2010","journal-title":"Dig. Dis. Sci."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2680\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:23:03Z","timestamp":1773811383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,15]]},"references-count":109,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijms27062680"],"URL":"https:\/\/doi.org\/10.3390\/ijms27062680","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,15]]}}}