To evaluate the safety of application of PD-1 inhibitor before liver transplantation (LT) for hepatocellular carcinoma (HCC).

Clinical data of 1 patient with HCC who underwent LT after PD-1 inhibitor combined with TACE and local radiotherapy in the First Affiliated Hospital of Guangzhou Medical University on May 12, 2021 were retrospectively analyzed. The informed consents of the patient were obtained and the local ethical committee approval was received. Preoperative conditions, postoperative changes characteristics of the disease and possible causes were summarized, and literature review was conducted.

The patient had a family history of HCC and alcohol addiction. Preoperative CT scan showed a space-occupying mass in the right lobe with a maximum diameter of 8.8 cm.The possibility of HCC complicated with the right anterior portal vein tumor thrombus was considered. The patient was diagnosed with stage Ⅲa HCC based on China liver cancer (CNLC) staging system. Preoperatively, TACE was performed twice. Tislelizumab (200 mg, Q21d) was given for 5 cycles. LT was performed after successful down-staging, and anti-rejection regimen of tacrolimus + mycophenolate mofetil capsule + glucocorticoids was given after surgery. Irreversible elevation of TB, ALT and AST levels occurred at postoperative 8 d. The possibility of acute rejection after LT was considered. Hormone shock therapy and symptomatic treatment yielded low efficacy. At postoperative 13 d, the patient died from multiple organ failure, such as liver failure, respiratory failure and kidney failure.

Cautions should be taken when using PD-1 inhibitor as a down-staging approach for HCC before LT. For patients who have been given with PD-1 inhibitor, immunosuppressive therapy and immune function monitoring should be strengthened after LT.