Immune Checkpoint Inhibitors and Liver Transplantation: Case Report and Review of the Literature

As immunotherapy is becoming more inevitable in everyday oncology, we are witnessing a higher number of patients who are on immunosuppressive medication but are also candidates for immune checkpoint inhibitors (ICIs) treatment. There have been few case reports and several small retrospective studies investigating the use of ICIs in liver transplant recipients mainly with hepatocellular carcinoma and skin cancer, but there is no report regarding the use of atezolizumab for the treatment of metastatic breast cancer in liver transplant recipients. We are presenting a metastatic breast cancer female patient undergoing both immunosuppressive treatment after liver transplantation due to cryptogenic liver failure and anti-programmed death ligand 1 (PDL1) medication-atezolizumab whose liver enzymes and tacrolimus level we have monitored intensively through 18 months and is still ongoing. Our patient has not presented with any signs of acute graft rejection and has a regression on follow-up imaging despite the treatment combination.