Fatal orthotopic liver transplant organ rejection induced by a checkpoint inhibitor in two patients with refractory, metastatic hepatocellular carcinoma. Issue 12 (23rd June 2017)

• Record Type: Journal Article
• Authors: Friend, Brian D.; Venick, Robert S.; McDiarmid, Sue V.; Zhou, Xiaoyan; Naini, Bita; Wang, Hanlin; Farmer, Douglas G.; Busuttil, Ronald W.; Federman, Noah
• Is Part Of: Pediatric blood & cancer. Volume 64:Issue 12(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-06-23
• Subjects: checkpoint inhibitor -- fibrolamellar -- hepatocellular carcinoma -- liver transplant -- PD‐1 inhibitor; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.26682
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Although checkpoint inhibitor therapies have demonstrated significant efficacy in many malignancies, they have not been well studied in patients with a history of solid organ transplant. We describe two patients with recurrent, refractory, and progressive advanced fibrolamellar hepatocellular carcinoma (HCC) following orthotopic liver transplantation who received programmed cell death protein 1 (PD‐1) inhibitor, nivolumab, on a patient access, off‐label basis. Both rapidly developed irreversible acute liver rejection shortly after starting therapy, and ultimately died. While checkpoint inhibitors clearly have tremendous potential as a targeted therapy, they should be avoided or used with extreme caution in the context of an organ transplant.