Fatal orthotopic liver transplant organ rejection induced by a checkpoint inhibitor in two patients with refractory, metastatic hepatocellular carcinoma

Brian D. Friend, Robert S. Venick, Sue V. McDiarmid, Xiaoyan Zhou, Bita Naini, Hanlin Wang, Douglas G. Farmer, Ronald W. Busuttil, Noah Federman

Research output: Contribution to journalArticlepeer-review

120 Scopus citations

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.

Original languageEnglish (US)
Article numbere26682
JournalPediatric Blood and Cancer
Volume64
Issue number12
DOIs
StatePublished - Dec 2017

Keywords

  • checkpoint inhibitor
  • fibrolamellar
  • hepatocellular carcinoma
  • liver transplant
  • PD-1 inhibitor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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