Rescued with T and B lymphocytes depletion therapy for immune checkpoint inhibitor-associated transplant rejection.

The impact of immune checkpoint inhibitors (ICIs) on transplant rejection remains controversial. We report a case of a hepatocellular carcinoma patient who received Atezolizumab plus Bevacizumab regimen prior to liver transplantation and developed steroid-refractory T cell-mediated rejection combined with antibody-mediated rejection post-transplant. Given the short discontinuation and outstanding tumor response, we believe that the use of ICIs prior to transplantation contributed to this complex condition. The rejection was successfully cured with anti-thymocyte globulin (ATG) combined with an anti-CD20 monoclonal antibody (Rituximab). After 9-months follow-up, no tumor recurrence occurs. This case highlights the unique immune activation state affecting both T and B lymphocytes induced by ICIs. It also provides a case reference for the use of intensive immunosuppressive regimens in ICI recipients experiencing adverse reactions.