Administration of Ipilimumab to a Liver Transplant Recipient With Unresectable Metastatic Melanoma

Abstract

The CTLA-4 immune checkpoint inhibitor ipilimumab improves overall survival in metastatic melanoma. Its use in organ transplant recipients has not been studied and has been reported once in the literature. We report the case of a 59-year-old liver transplant patient who was given ipilimumab after previous treatment for advanced melanoma. She did not experience organ rejection, immune-related adverse events, or evidence of tumor regression.

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

“…While clinical trials of immunotherapy checkpoint inhibitors targeting cytotoxic T‐lymphocyte‐associated protein 4 (CTLA‐4), programmed cell death protein 1 (PD‐1), and programmed death‐ligand 1 (PD‐L1) have demonstrated significant clinical benefits for many patients, these studies have excluded patients with a history of solid organ transplant and/or receiving immunosuppressive medications to control rejection. As a result, there is a paucity of safety data with the use of these immunotherapeutic agents in the context of organ transplantation . We describe two patients with recurrent, refractory, and progressive advanced fibrolamellar HCC after orthotopic liver transplantation who received nivolumab on a patient access, off‐label basis.…”

Renal complications of immune checkpoint blockade

“…The choice of checkpoint inhibitor (anti-CTLA4, anti-PD-1 or combination use) could be a possible contributor; PD-1 blockade with greater deleterious effect on transplant, compared to CTLA4 blockade. Reinforcing this observation, cases of successful treatment with ipilimumab that targets CTLA4 in cardiac 53 and liver transplant patients have been reported 54,55 . In addition, the timing of reduction in immune suppression might also be relevant.…”

New Systemic Treatments in Advanced Hepatocellular Carcinoma

“…Thus, the only available data are derived from single experiences of the off‐label use of checkpoint inhibitors in transplanted patients. In this regard, there is information regarding ipilimumab (a human IgG1 monoclonal antibody blocking CTLA4) administration in 2 patients who developed nonliver metastases from melanoma after LT, and it was safe, whereas 1 patient with metastases in the liver graft from ocular melanoma developed liver graft reaction . Off‐label use of pembrolizumab (a human IgG4 monoclonal antibody blocking PD1) in a metastatic HCC patient was safe without organ graft rejection, whereas nivolumab administration in 2 young patients with refractory and metastatic fibrolamellar HCC resulted in a rapid and fatal acute liver rejection …”