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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?

Authors
  • Nordness, Mina F1
  • Hamel, Stephanie2
  • Godfrey, Caroline M1
  • Shi, Chanjuan3
  • Johnson, Douglas B4
  • Goff, Laura W4
  • O'Dell, Heather1
  • Perri, Roman E5
  • Alexopoulos, Sophoclis P1
  • 1 Section of Surgical Sciences, Department of Surgery, Division of Hepatobiliary Surgery & Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 2 Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 3 Department of Pathology, Vanderbilt University Medical Center, Microbiology, Microbiology, Nashville, Tennessee.
  • 4 Department of Medicine, Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 5 Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
Type
Published Article
Journal
American Journal of Transplantation
Publisher
Wiley (Blackwell Publishing)
Publication Date
Sep 24, 2019
Identifiers
DOI: 10.1111/ajt.15617
PMID: 31550417
Source
Medline
Keywords
Language
English
License
Unknown

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. © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.

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