Data_Sheet_1_Fatal acute-on-chronic liver failure following camrelizumab for hepatocellular carcinoma with HBsAg seroclearance: a case report and literature review.PDF

In the last few years, immune checkpoint inhibitors (ICIs) have become major therapeutic agents for the treatment of advanced hepatocellular carcinoma (HCC). However, immunotherapy can activate hepatitis B virus (HBV), and immune clearance may lead to liver failure and even life-threatening conditions. Here we report a case of HCC with HBV-related cirrhosis that caused severe liver injury and rapidly progressed to fatal acute-on-chronic liver failure (ACLF) after only once application of camrelizumab; the patient underwent serological conversion of hepatitis B surface antigen (HBsAg) with liver injury. The patient’s condition progressed rapidly. We added corticosteroids and applied plasma dialysis, along with tenofovir alafenamide (TAF) to control HBV. However, the patient eventually died of liver failure. To our knowledge, there are few reports of HBsAg clearance due to ICIs accompanied by fatal acute-on-chronic liver failure shortly after ICIs initiation. These results suggest that ICIs can cause fatal liver injury in a short term; in patients with chronic HBV infection, ICIs use may promote serological conversion of HBsAg.

近年来，免疫检查点抑制剂（ICIs）已成为治疗晚期肝细胞癌（HCC）的主要治疗药物。然而，免疫治疗可能激活乙型肝炎病毒（HBV），而免疫清除可能导致肝衰竭甚至危及生命的状态。在本研究中，我们报告了一例HBV相关肝硬化所致的HCC病例，患者在接受卡瑞利珠单抗治疗后仅一次便出现了严重的肝损伤，并迅速进展为致命的急性慢性肝衰竭（ACLF）。患者经历了乙型肝炎表面抗原（HBsAg）的血清学转换以及肝脏损伤。患者的病情迅速恶化。我们增加了皮质类固醇，并应用血浆透析，同时给予替诺福韦艾拉酚胺（TAF）以控制HBV。然而，患者最终因肝衰竭而死亡。据我们所知，关于ICIs启动后不久因ICIs导致HBsAg清除并伴有致命的急性慢性肝衰竭的报道甚少。这些结果提示ICIs可能在短期内导致致命的肝损伤；在慢性HBV感染患者中，ICIs的使用可能促进HBsAg的血清学转换。