The Successful Downstaging with Atezolizumab/Bevacizumab for Liver Transplantation In Hepatocellular Carcinoma With Portal Vein Thrombosis

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