OnCo
ideasIdea

Immunotherapy downstaging to transplant with a safe washout

Use immunotherapy to shrink liver cancer enough for a transplant, and find the safe gap between the last dose and surgery so the new liver is not rejected.

Case series report graft rejection when PD-1 antibodies are given within weeks of transplant; others report successful downstaging. Prospective trials (e.g., nivolumab-ipilimumab before living-donor transplant) are defining washout intervals and rejection monitoring.

Hypothesis
A washout of at least three months after PD-(L)1 blockade, with pre-transplant PD-1 receptor-occupancy or ctDNA-guided timing, allows safe transplantation with recurrence-free survival equal to conventionally downstaged patients.
Rationale
Checkpoint inhibitors persist on T cells for months; the immunologic risk is time-dependent and measurable.
What would test it
Prospective single-arm trial with protocolised washout and biopsy-proven rejection as the primary safety endpoint; compare to historical downstaging cohorts.
Maturity
early clinical

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