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Abstract Details
Liver transplantation for hepatocellular carcinoma following checkpoint inhibitor therapy with nivolumab
Am J Transplant. 2022 Jun;22(6):1699-1704. doi: 10.1111/ajt.16965.Epub 2022 Feb 8.
1Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, San Diego, California.
2Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California.
3Department of Pathology, University of California San Diego, San Diego, California.
4Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, San Diego, California.
Abstract
Limited case series describe conflicting results regarding the safety of checkpoint inhibitors (CPI) prior to liver transplantation (LT). We reviewed single-center data on all consecutive patients who underwent LT for hepatocellular carcinoma treated with CPI between January 1, 2018, and January 30, 2021. Time from CPI to LT, immunosuppression, biopsy-proven acute cellular rejection (BPACR), graft loss and death were evaluated. Five patients with a mean age 65 (range 61-71) years underwent LT after CPI with nivolumab. Time from last CPI to LT ranged from 0.3 to 11 months. Two patients with <3 months from the last dose of CPI to LT developed BPACR and severe hepatic necrosis, one of whom required retransplantation with recurrent BPACR but without recurrent graft loss over 38 months of follow up. None of the patients who underwent LT >3 months from the last dose of CPI had BPACR. In conclusion, pretransplant use of CPIs, particularly within 90 days of LT, was associated with BPACR and immune-mediated hepatic necrosis. Future multicenter studies should consider a sufficient interval from the last dose of CPI to LT to mitigate the risk for adverse immune-mediated outcomes and graft loss.