# Emerging Trends in Neoadjuvant Immunotherapy for Hepatocellular Carcinoma: A Focus on Liver Transplant Candidates

## TL;DR

Neoadjuvant immunotherapy is being explored as a treatment for liver cancer patients before liver transplants, with potential benefits in tumor reduction and recurrence prevention.

## Contribution

This paper reviews emerging trends in neoadjuvant immunotherapy for liver transplant candidates with hepatocellular carcinoma, emphasizing patient selection and risk management.

## Key findings

- Neoadjuvant immunotherapy may improve tumor downstaging and enable radical resection in HCC patients.
- Clinical trials show efficacy and safety data for pre-transplant immunotherapy in liver transplant candidates.
- Patient-specific factors and immunological risks must be carefully considered to optimize treatment outcomes.

## Abstract

Immunotherapy has emerged as a promising neoadjuvant strategy for hepatocellular carcinoma (HCC), with growing evidence supporting its role in tumor downstaging and enabling radical resection. Liver transplantation remains a curative option for HCC, and the integration of neoadjuvant immunotherapy prior to transplantation holds potential to improve staging outcomes and reduce postoperative recurrence. However, this approach necessitates careful evaluation of transplant‐related immunological risks, particularly the risk of allograft rejection.

Recent clinical trials have provided key data on the efficacy and safety of pre‐transplant immunotherapy. These studies highlight the importance of patient selection and risk management strategies to optimize treatment outcomes. Novel immunotherapeutic approaches are being explored, with a focus on identifying patients most likely to benefit from neoadjuvant therapy prior to liver transplantation.

This review synthesizes emerging trends in the use of neoadjuvant immunotherapy for HCC patients undergoing liver transplantation. While immunotherapy shows promise in enhancing staging success and reducing recurrence, careful consideration of immunological risks and patient‐specific factors is essential. Future research should continue to evaluate the long‐term benefits and safety of this approach, as well as refine strategies for patient selection and risk mitigation. The integration of immunotherapy into pre‐transplant care may represent a transformative advancement in the treatment of HCC, provided these challenges are addressed.