Nivolumab-Induced Autoimmune-Like Cholestatic Hepatitis in a Liver Transplant Recipient

Cancer treatment has taken giant strides in recent years with the advent of immunotherapy, including checkpoint inhibitors. The use of these medications in liver transplant recipients has been debated, and the added effect of previous hepatitis C infection on the immune system in this setting, is poorly understood. We present a case of cholestatic hepatitis after the treatment of recurrent hepatocellular carcinoma with nivolumab in the post-transplant period. Understanding the pathophysiology is relevant to improving the management of this type of liver injury and expanding our knowledge of programmed death-1 inhibitors in liver transplant recipients.