Immune Checkpoint Inhibitor Therapy before Liver Transplantation - Case and Literature Review

Immune checkpoint inhibitors (ICI) have transformed cancer management. Nivolumab, a monoclonal antibody that blocks the programmed cell death protein 1 pathway (PD-1/PD-L1) has been shown to produce meaningful improvements in survival when compared with sorafenib for patients with advanced hepatocellular carcinoma (HCC). Despite the promising benefits associated with ICI use, the safety and efficacy of their use in the pretransplant setting is unknown. There is trepidation surrounding concomitant use of ICI and posttransplant immunosuppression because of their opposing effects on the immune system and fear of rejection, liver failure, and graft loss. Herein, we describe the case of a 64-y-old male with cirrhosis and advanced HCC who was treated with nivolumab and successfully went on to receive a liver transplant (LT) with early T cell-mediated rejection (TCMR), which was successfully treated. This case highlights the potential feasibility and safety of LT after pretransplant immunotherapy for malignancy.