Fatal hepatic necrosis after nivolumab as a bridge to liver transplant for HCC: Are checkpoint inhibitors safe for the pretransplant patient?
Mina F NordnessStephanie HamelCaroline M GodfreyChanjuan ShiDouglas B JohnsonLaura W GoffHeather O'DellRoman E PerriSophoclis P AlexopoulosPublished in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2019)
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.
Keyphrases
- clinical trial
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- liver failure
- patients undergoing
- prognostic factors
- peritoneal dialysis
- emergency department
- case report
- systematic review
- stem cells
- oxidative stress
- patient reported outcomes
- drug induced
- meta analyses
- kidney transplantation
- cell therapy
- bone marrow
- open label