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- W4385188077 abstract "Background and aim: Hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is traditionally considered a contraindication for liver transplantation (LT). Successful downstaging with liver transplantation has been shown to improve survival. Limited data have shown promising results with the use of immune check point inhibitor like nivolumab to downstage these patients for liver transplantation. The novel combination of the immune checkpoint inhibitor atezolizumab with bevacizumab has been shown to induce a complete response. Here we discuss the first case of successful downstaging with the above combination followed by ABO-incompatible LDLT. Methods: A 54-year-old male was diagnosed with Hepatitis B-related compensated cirrhosis and Multifocal HCC of size 12.5 x 11.4 cm in right lobe with main PVTT (Vp4) and had an alfa fetoprotein (AFP) level of 25.2 ng/ml. Treatment with 6 cycles of Atezolizumab and bevacizumab combination therapy and stereotactic body radiation therapy for PVT resulted in complete resolution of FDG uptake, decrease in size with normal AFP (7.9 ng/ml), without any enhancement in tumor and thrombus suggestive of complete response. Results: The patient underwent ABO-incompatible (Recipient O+ & Donor A1+) right lobe liver transplantation without intra or perioperative complications. Desensitization protocol included Intravenous Rituximab and plasma exchange with the decrease of Anti A titer to IgM/IgG <1:8. Immunosuppression included oral tacrolimus, mycophenolate mofetil, and tapering dose of steroids. The patient underwent plasma exchange twice post-operatively because of increased titers (HA titer >1:16) and liver transaminitis. The liver explant showed completely necrotic multifocal HCC involving right lobe with portal vein thrombus without any viable tumor cells suggestive of pathological complete response. At 24 months post LT, the patient is doing well without tumor recurrence and normal graft function. Conclusion: The exceptional objective response rates with atezolizumab & bevacizumab can help to bridge advanced stage HCC patients for curative liver transplantation" @default.
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- W4385188077 date "2023-01-01" @default.
- W4385188077 modified "2023-09-26" @default.
- W4385188077 title "The Successful Downstaging with Atezolizumab/Bevacizumab for Liver Transplantation In Hepatocellular Carcinoma With Portal Vein Thrombosis" @default.
- W4385188077 doi "https://doi.org/10.1016/j.jceh.2023.07.122" @default.
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