The global burden of hepatocellular carcinoma (HCC), a primary form of liver cancer, is alarming. According to the World Health Organization, nearly 905,700 new cases were reported in 2020, leading to approximately 830,200 fatalities. In Switzerland alone, this aggressive disease claims around 720 lives annually from 960 new diagnoses. HCC ranks as the third most lethal cancer worldwide and the fifth in Switzerland, underscoring the urgent need for effective treatment strategies.

Breakthroughs in medical science have introduced promising treatments for HCC, with liver transplantation emerging as a definitive solution for selected patients. This procedure offers the potential for long-term remission or even complete recovery. Additionally, immunotherapy using immune checkpoint inhibitors (ICI) has gained traction, demonstrating significant efficacy by stimulating the patient's immune system to combat cancer cells. Remarkably, one-third of patients show positive responses, and some experience complete tumor eradication. Consequently, ICI treatments are increasingly recognized as a first-line therapy for advanced HCC.

However, challenges remain. The discontinuation of ICI treatments can lead to cancer recurrence, prompting researchers to explore the combination of immunotherapy and liver transplantation. This dual approach aims to eliminate both cancer and underlying liver disease. Yet, ICI treatments heighten the risk of rapid graft rejection post-transplant. To mitigate this, an international study led by experts from the University Hospitals of Geneva (HUG) and the University of Geneva (UNIGE) analyzed data from 119 patients across 29 hospitals worldwide. The findings revealed that the optimal interval between ceasing ICI treatments and undergoing a liver transplant is 50 days. Shorter intervals significantly increase rejection risks, while longer periods may allow the disease to progress.

This research marks a pivotal moment in optimizing liver transplantation protocols for HCC patients. By identifying the ideal timing for transitioning from immunotherapy to transplantation, it paves the way for improved patient outcomes and reduced recurrence rates. The work conducted by Christian Toso and his team at HUG has already influenced eligibility criteria for liver transplants, integrating biomarkers and total tumor volume into selection processes. This advancement positions HUG as a global leader in HCC treatment, offering hope and better prospects for countless patients.