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Fatal hepatic necrosis after nivolumab as a bridge to liver transplant for HCC: Are checkpoint inhibitors safe for the pretransplant patient?
Author(s) -
Nordness Mina F.,
Hamel Stephanie,
Godfrey Caroline M.,
Shi Chanjuan,
Johnson Douglas B.,
Goff Laura W.,
O’Dell Heather,
Perri Roman E.,
Alexopoulos Sophoclis P.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15617
Subject(s) - nivolumab , medicine , hepatocellular carcinoma , liver transplantation , oncology , clinical trial , gastroenterology , immunology , immunotherapy , transplantation , cancer
Nivolumab is an immune checkpoint inhibitor (ICI) currently in phase 3 clinical trials for hepatocellular carcinoma. The safety of ICIs in recipients of organ allotransplant is unclear, and several reports of fatal alloimmune injury after posttransplant ICI use have been published. We present the first published case of nivolumab used in the pretransplant setting for HCC resulting in fatal acute hepatic necrosis in the immediate postoperative period from a profound immune reaction likely propagated by nivolumab. Further investigation and significant caution are needed in the evaluation of patients awaiting transplant who are receiving ICI therapy.