Fatal Hepatic Necrosis After Nivolumab As a Bridge to Liver Transplant for HCC: Are Checkpoint Inhibitors Safe for the Pretransplant Patient?

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2019 Sep 25

PMID 31550417

Citations 61

Authors

Mina F Nordness

Stephanie Hamel

Caroline M Godfrey

Chanjuan Shi

Douglas B Johnson

Laura W Goff

Heather ODell

Roman E Perri

Sophoclis P Alexopoulos

Affiliations

Soon will be listed here.

Abstract

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.

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